Search

The surgical treatment of geriatric acetabular fractures is becoming increasingly important due to a demographic change in age. While acetabular fractures used to occur more frequently in younger patients, they are currently more prevalent in geriatric patients. This change has also led to an increase in the frequency of anterior and combined anterior acetabular fractures. Surgery for geriatric acetabular fractures is very challenging, and surgeons need years of experience to be able to deal with the advantages and disadvantages of pelvic surgery. This is why a high level of surgical expertise is required. The aim of this article is to provide an insight into the topic of geriatric acetabular fractures with a critical narrative review of the current literature and a focus on minimally invasive surgical treatment using the modified Stoppa approach without patients' own assessment. The modified Stoppa approach offers excellent visibility of the anterior structures of the acetabulum and can address the quadrilateral surface effectively. Pelvic surgery, in particular acetabular surgery, offers patients many advantages, such as rapid mobilization and the quick relief of pain symptoms. Total hip arthroplasty is currently being discussed as an alternative with good results for certain types of acetabular fractures in older patients, though it requires clarification of studies and recommendations. [ABSTRACT FROM AUTHOR]

Background: In acetabular fracture surgery, understanding the biomechanical behaviour of fractures and implants is beneficial for clinical decision-making about implant selection and postoperative (early) weightbearing protocols. This study outlines a novel approach for creating finite element models (FEA) from actual clinical cases. Our objectives were to (1) create a detailed semi-automatic three-dimensional FEA of a patient with a transverse posterior wall acetabular fracture and (2) biomechanically compare patient-specific implants with manually bent off-the-shelf implants. Methods: A computational study was performed in which we developed three finite element models. The models were derived from clinical imaging data of a 20-year-old male with a transverse posterior wall acetabular fracture treated with a patient-specific implant. This implant was designed to fit the patient's anatomy and fracture configuration, allowing for optimal placement and predetermined screw trajectories. The three FEA models included an intact hemipelvis for baseline comparison, one with a fracture fixated with a patient-specific implant, and another with a conventional implant. Two loading conditions were investigated: standing up and peak walking forces. Von Mises stress and displacement patterns in bone, implants and screws were analysed to assess the biomechanical behaviour of fracture fixation with either a patient-specific versus a conventional implant. Results: The finite element models demonstrated that for a transverse posterior wall type fracture, a patient-specific implant resulted in lower peak stresses in the bone (30 MPa and 56 MPa) in standing-up and peak walking scenario, respectively, compared to the conventional implant model (46 MPa and 90 MPa). The results suggested that patient-specific implant could safely withstand standing-up and walking after surgery, with maximum von Mises stresses in the implant of 156 MPa and 371 MPa, respectively. The results from the conventional implant indicate a likelihood of implant failure, with von Mises stresses in the implant (499 MPa and 1000 MPa) exceeding the yield stress of stainless steel. Conclusion: This study presents a workflow for conducting finite element analysis of real clinical cases in acetabular fracture surgery. This concept of personalized biomechanical fracture and implant assessment can eventually be applied in clinical settings to guide implant selection, compare conventional implants with innovative patient-specific ones, optimizing implant designs (including shape, size, materials, screw positions), and determine whether immediate full weight-bearing can be safely permitted. [ABSTRACT FROM AUTHOR]

Background: Distal forearm fractures were defined as distal radius fractures with concomitant distal ulna fractures, except ulna styloid fractures. Distal forearm fractures are common among geriatric populations, particularly those with osteoporosis. Conventionally, distal forearm fractures are reduced by a double incision approach; however, malreduction and instability of the distal radioulnar joint were not uncommon. We introduced a modified volar dual window approach to treat the distal forearm fracture and evaluate the functional outcomes and complications. Methods: From January 2020 to June 2023, 13 patients with distal forearm fractures underwent open reduction by the modified dual window approach with locking plate fixation. After surgery, splints were applied for two weeks, and the patients underwent postoperative hand therapy for three months. The mean Quick Disabilities of the Arm, Shoulder, and Hand scores, range of motions, grip strength, postoperative radiographic parameters, and complications data were collected. Results: The mean follow-up period was 12.1 months, and the mean age was 52.3 years. Average wrist flexion was 67°, extension 69°, pronation 81°, and supination 79°. Grip strength was 28.3 ± 11.5 kg, which was 88% of the uninjured opposite side. The Visual Analog Scale score during activities was recorded as 0.5 ± 0.9. The mean Quick Disabilities of the Arm, Shoulder, and Hand score was 14 ± 11.5. The postoperative radiographic parameters were as follows: radial height: 10.8 ± 1.7 mm, radial inclination: 22.6 ± 3.7°, volar tilting: 4.0 ± 3.9°, and ulnar variance: −0.4 ± 1.4 mm. All the patients achieved bone union at the final follow-up. Two patients underwent ulnar implant removal due to irritation symptoms. Neither infection, nor neurovascular injury, nor malreduction developed in these patients. Conclusions: The modified volar dual window approach can achieve good wrist function and distal forearm fracture reduction without increasing neurovascular or wound healing complications. This method is an alternative approach for distal forearm fracture, especially in comminuted distal ulna fracture or distal radioulnar joint incongruity. [ABSTRACT FROM AUTHOR]

When performing osteosynthesis for spinal instability after traumatic injury, diagnostic difficulties arise due to the migration of metal structure components to distant “atypical” anatomical areas, which is associated with the risk of neurological deficit and life-threatening conditions. This article presents a casuistic case of migration of a metal structure component through an iatrogenic opening in the occipital bone into the posterior cranial fossa in a patient who had previously undergone instrumental correction for comminuted fractures of the cervical vertebrae. It should be noted that there are no data on “spontaneous” perforation of the occipital bone by metal osteosynthesis elements in the domestic literature.

RELEVANCE. Despite the development of modern diagnostic methods, osteosynthesis instruments and rehabilitation, surgical management of distal tibia fractures remains a great problem due to the high complication rate leading to permanent disability, such as problems with soft tissue healing, infectious complications, post-traumatic arthrosis of the ankle joint. These complications are associated with the high incidence of high-energy injuries, soft-tissue envelope features, and the wide range of movements in the ankle joint. At the same time, in the treatment for comminuted intra-articular pilon fractures, there is no clearly defined operation algorithm: choice of access, reduction and fixation techniques. Recently, when planning osteosynthesis, additive technologies have become increasingly widespread, in particular, 3D printing of full-size fracture prototypes. AIM OF STUDY. To analyze preoperative planning methods of osteosynthesis in pilon fractures and evaluate 3D-printing for the improvement of surgical treatment of pilon fractures. MATERIAL AND METHODS. The literature search was carried out in the databases of medical publications: PubMed, eLibrary, Cyberleninka. The search was performed using the following terms: pilon fractures, osteosynthesis, preoperative planning, 3D-printing, 3D-model, and the corresponding terms in Russian. RESULTS. According to various authors, the use of 3D printing in preoperative planning improves the parameters of operative duration, reduction quality, functional outcome, intraoperative blood loss, and reduces the number of complications. CONCLUSIONS. Evaluation of the long-term results of using 3D printing in preoperative planning for osteosynthesis in pilon fractures is ongoing. But even now we can draw conclusions about the prospects of the method and recommend it for widespread use in the routine practice of the orthopedic traumatologist.

Abstract Background In acetabular fracture surgery, understanding the biomechanical behaviour of fractures and implants is beneficial for clinical decision-making about implant selection and postoperative (early) weightbearing protocols. This study outlines a novel approach for creating finite element models (FEA) from actual clinical cases. Our objectives were to (1) create a detailed semi-automatic three-dimensional FEA of a patient with a transverse posterior wall acetabular fracture and (2) biomechanically compare patient-specific implants with manually bent off-the-shelf implants. Methods A computational study was performed in which we developed three finite element models. The models were derived from clinical imaging data of a 20-year-old male with a transverse posterior wall acetabular fracture treated with a patient-specific implant. This implant was designed to fit the patient's anatomy and fracture configuration, allowing for optimal placement and predetermined screw trajectories. The three FEA models included an intact hemipelvis for baseline comparison, one with a fracture fixated with a patient-specific implant, and another with a conventional implant. Two loading conditions were investigated: standing up and peak walking forces. Von Mises stress and displacement patterns in bone, implants and screws were analysed to assess the biomechanical behaviour of fracture fixation with either a patient-specific versus a conventional implant. Results The finite element models demonstrated that for a transverse posterior wall type fracture, a patient-specific implant resulted in lower peak stresses in the bone (30 MPa and 56 MPa) in standing-up and peak walking scenario, respectively, compared to the conventional implant model (46 MPa and 90 MPa). The results suggested that patient-specific implant could safely withstand standing-up and walking after surgery, with maximum von Mises stresses in the implant of 156 MPa and 371 MPa, respectively. The results from the conventional implant indicate a likelihood of implant failure, with von Mises stresses in the implant (499 MPa and 1000 MPa) exceeding the yield stress of stainless steel. Conclusion This study presents a workflow for conducting finite element analysis of real clinical cases in acetabular fracture surgery. This concept of personalized biomechanical fracture and implant assessment can eventually be applied in clinical settings to guide implant selection, compare conventional implants with innovative patient-specific ones, optimizing implant designs (including shape, size, materials, screw positions), and determine whether immediate full weight-bearing can be safely permitted.

Abstract Background The objective of this study was to compare the clinical outcomes of two internal fixation methods for high tibial osteotomy (HTO): double-triangle locking compression plate (DT-LCP) and T-shaped locking compression plate (T-LCP). Methods 202 adult patients in our hospital between January 2018 and December 2021 were included and followed up for at least one year: group 1(DT-LCP, 98 patients) and group 2 (T-LCP, 104 patients). Detailed information on demographics, preoperative and postoperative follow-up, surgical procedures, and complications were collected. The information of the International Knee Documentation Committee Knee Evaluation Form (IKDC), Knee Injury and Osteoarthritis Outcome Score (KOOS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were collected before surgery and at the last follow-up. Results A total of 202 patients were included in the per-protocol analysis. No significant difference was found in terms of demographic data between groups, except for age and BMI. Clinically relevant improvements in knee pain were reached up to last follow-up after the operation in both groups. The mean pain scores (KOOS, WOMAC) at the final follow-up were significantly higher among group 1 compared to group 2 (P = 0.040 and P = 0.023). Furthermore, the DT-LCP internal fixation exerted more excellent effects on other symptoms, function and quality of life than T-LCP internal fixation. Conclusions Our study demonstrated that DT-LCP provided better clinical performance due to its implant irritant pain, compared with T-LCP. Thus, DT-LCP is a feasible alternative for the fixation of OW-HTO.

Introduction. Deep infection after open osteosynthesis of tibial plateau fractures occurs in 9.9%. This rate is significantly higher than in surgical treatment of closed injuries of other localizations. Many authors consider it necessary to improve management protocols for patients with complex plateau fractures in order to minimize or prevent the development of infectious complications. Aims of the study: 1) to discuss the treatment tactics of a patient with an intraarticular fracture of the tibial plateau after osteosynthesis complicated by the development of early deep surgical site infection (SSI), using clinical case as an example; 2) to carry out the analysis of medical care defects. Case description. A 71-year-old patient with compromised somatic status underwent osteosynthesis with a buttress plate and allogeneic bone grafting of the metaphyseal defect on the 12th day after injury. In 7 days after the occurrence of signs of infection, a revision surgery was performed. Later, a number of consecutive revisions were performed due to recurrences of the infectious process. The complex of measures against SSI included the use of vacuum drainage systems and antibacterial spacers. As a result, the wounds had healed. Two years after the injury, the patient had a good functional result. Conclusion. The presented clinical case has shown that even if the treatment tactic for early peri-implant infection is chosen correctly, there are several defects in our routine practice. First of all, inaccurate sampling of material for bacteriological study and inadequate duration of antibacterial therapy are to be mentioned. To successfully treat infectious complications of osteosynthesis, a team of like-minded specialists including traumatologists as well as physicians, microbiologists and clinical pharmacologists is needed. Undoubtedly, surgical treatment of fractures might develop into infectious complications. Their diagnosis and treatment are often accompanied by a number of various mistakes. The most important points are early radical revision of the postoperative wound, etiotropic antibacterial therapy, maintaining stability of fixation after primary osteosynthesis. If these standards are complied with, the outcome of surgical treatment might be satisfying even with such a severe complication as peri-implant infection. At the same time, we are planning further researches aimed at improving algorithms and tactics for surgical treatment of infectious complications, reducing surgery trauma level and upgrading quality of primary osteosynthesis.

Aim: This study aims to assess the merits, drawbacks, and postoperative outcomes associated with conservative treatment and osteosynthesis methods employed in managing metacarpal (MC) and/or metatarsal (MT) bone fractures resulting from trauma in cats. Materials and Methods: The research encompassed a sample of fifty-two cats of varying breeds, genders, and ages, all presenting with metacarpal and/or metatarsal bone fractures between 2022 and 2023. Conservative treatment was administered in 46 cases, while osteosynthesis was applied in the remaining 6 cases. Results: In the group treated conservatively, 29 cases (63.04%) exhibited no signs of lameness at the 6-week examination, indicating a successful recovery with unimpeded mobility. In contrast, mild lameness was observed in the remaining cases (36.96%) at the 6-week check-up. Upon reassessment at the 12-month examination, 43 cases (93.47%) demonstrated unimpeded walking, with only 3 cases (6.53%) experiencing occasional mild lameness. Conversely, 2 cases (33.3%) showed a complication-free recovery among the cats undergoing osteosynthesis, while postoperative issues emerged in 4 cases (66.6%). In one complication-free case (50%), mild lameness was noted at the 6-week examination, and in the other case (50%), occasional mild lameness was observed. Importantly, all cases exhibited uneventful walking during the 12-month assessment. Conclusion: Conservative treatment proves to yield favorable outcomes in cats, both independently and when osteosynthesis applications fall short. However, the limited number of surgical cases examined in the study constrains the findings' generalizability.

Purpose: Distal radius fractures (DRFs) represent up to 18% of all fractures in the elderly population, yet studies on the rate of complications following surgery are lacking in the literature. This systematic review aimed to quantify the rate of complications and reinterventions in patients treated with volar plate for distal radius fractures, and analyze if there was any predisposing factor. Methods: A comprehensive literature search was performed on three databases up to January 2023, following PRISMA guidelines. Studies describing volar plate complications and hardware removal were included. A systematic review was performed on complications and rate of reintervention. Assessment of risk of bias and quality of evidence was performed with the ‘Down and Black’s Checklist for measuring quality’. Results: About 112 studies including 17 288 patients were included. The number of complications was 2434 in 2335 patients; the most frequent was carpal tunnel syndrome (CTS), representing 14.3% of all complications. About 104 studies reported the number of reinterventions, being 1880 with a reintervention rate of 8.5%. About 84 studies reported the reason of reintervention; the most common were patient’s will (3.0%), pain (1.1%), CTS (1.2%), and device failure (1.1%). Conclusion: The complication rate after DRFs is 13.5%, with the main complication being CTS (14.3%), followed by pain and tendinopathy. The reintervention rate is 8.5%, mainly due to the patient’s willingness, and all these patients had plate removal. Correct positioning of the plate and correct information to the patient before surgery can reduce the number of hardware removal, thereby reducing costs and the risk of complications associated with VLP for distal radius fractures.

Shewanella is an emerging human pathogen. It mostly causes skin and soft tissue infections. Osteosynthesis-associated infection involving Shewanella are rare and in most cases are secondary to direct contamination following open fractures in aquatic environments. Here, we present a rare case of hematogenous osteosynthesis-associated infection involving Shewanella algae affecting an 18-year-old patient who was operated on for 12 th thoracic vertebrae and 4th lumbar vertebrae fractures occurring in an aquatic environment. We performed surgical debridement with subsequent double course parenteral antibiotherapy that was then adapted to bacteria sensitivities for three weeks. After a follow-up of six months, the patient had no signs of recurrent infection. The presence of infected dermabrasions and the concordance between germs isolated in operative samples and in blood cultures presumes that the contamination was hematogenous.

Background: The objective of this study was to compare the clinical outcomes of two internal fixation methods for high tibial osteotomy (HTO): double-triangle locking compression plate (DT-LCP) and T-shaped locking compression plate (T-LCP). Methods: 202 adult patients in our hospital between January 2018 and December 2021 were included and followed up for at least one year: group 1(DT-LCP, 98 patients) and group 2 (T-LCP, 104 patients). Detailed information on demographics, preoperative and postoperative follow-up, surgical procedures, and complications were collected. The information of the International Knee Documentation Committee Knee Evaluation Form (IKDC), Knee Injury and Osteoarthritis Outcome Score (KOOS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were collected before surgery and at the last follow-up. Results: A total of 202 patients were included in the per-protocol analysis. No significant difference was found in terms of demographic data between groups, except for age and BMI. Clinically relevant improvements in knee pain were reached up to last follow-up after the operation in both groups. The mean pain scores (KOOS, WOMAC) at the final follow-up were significantly higher among group 1 compared to group 2 (P = 0.040 and P = 0.023). Furthermore, the DT-LCP internal fixation exerted more excellent effects on other symptoms, function and quality of life than T-LCP internal fixation. Conclusions: Our study demonstrated that DT-LCP provided better clinical performance due to its implant irritant pain, compared with T-LCP. Thus, DT-LCP is a feasible alternative for the fixation of OW-HTO. [ABSTRACT FROM AUTHOR]

Background/Objectives: The use of miniplates for stabilizing bones post orthognathic surgery has surged in popularity due to their efficacy in ensuring stability and hastening recovery. However, controversy exists regarding what should be done with these miniplates after surgery. Some surgeons advocate for their removal, while others suggest leaving them in place. This study sought to assess the frequency, causes, and potential risk factors linked with miniplate removal in orthognathic procedures. Methods: A thorough meta-analysis was conducted by scrutinizing studies from various databases including PubMed, Google Scholar, Embase, and Scopus, focusing on publications spanning from 1989 to 2023. Results: Ten studies meeting the inclusion criteria, encompassing 1603 patients, were chosen for inclusion in the meta-analysis. The male-to-female ratio varied from 0.7:1 to 4:1. Overall, 5595 miniplates were inserted, with 294 (5.3%) being subsequently removed. Primary reasons for miniplate removal included infection (161 cases, 2.9%), exposure of miniplates (34 cases, 0.6%), and palpable plates (23 cases, 0.4%). Other indications comprised pain, patient preference, and temperature sensitivity. Less frequent causes for miniplate removal included sinusitis, secondary surgery, and dental pathology. The mean duration of miniplate removal was 5.5 months, with the majority (56.1%) being removed from the mandible rather than the maxilla. In conclusion, this meta-analysis underscores the importance of miniplate removal when hardware causes complications and physical discomfort. The primary reasons for removing miniplates were infection and plate exposure, with the mandible being the most common removal site. Conclusions: These findings emphasize the need for continued monitoring to assess the fate of miniplates in orthognathic surgery and provide valuable information for future clinical decision-making. [ABSTRACT FROM AUTHOR]

Copyright of Eurasian Journal of Veterinary Sciences is the property of Eurasian Journal of Veterinary Sciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background and purpose: Fracture-related infections (FRIs) after osteosynthesis for hip fractures have not been thoroughly investigated. Our primary aim was to assess the association between FRIs and mortality after osteosynthesis for hip fracture. Secondary aims were to investigate the incidence, microbiology, and general epidemiological aspects of these FRIs. Methods: This retrospective single-center study included 1,455 patients > 18 years old with non-pathological hip fractures treated with osteosynthesis between 2015 and 2019. Medical records were reviewed and FRIs were diagnosed based on current consensus criteria. The follow-up period was 2 years. Mortality was estimated using Kaplan–Meier survival analysis. Cox regression analyses were performed to investigate the potential association between FRIs, as a time-dependent variable, and increased mortality. Results: The median age for the entire cohort was 83 (interquartile range 75–89) years and 69% were females. At the 2-year follow-up mark, the crude mortality rate was 33% in the non-FRI group and 69% (11 of 16 patients) in the FRI group. Cox regression analysis assessing mortality risk revealed a hazard ratio of 3.5 (95% confidence interval [CI] 1.9–6.4) when adjusted for confounders. The incidence of FRI was 1.1% (16 of 1,455 patients). Staphylococcus aureus was the most common pathogen. Most FRI patients (94%) required at least 1 revision and 56% underwent ≥ 2 revision. Conclusion: We found an association between FRIs after hip fracture osteosynthesis and increased mortality, underscoring the critical need for FRI prevention measures in this frail patient group. The incidence and microbiological findings were consistent with previous studies.

The frontal plane fractures of the distal humerus are rare. The small intraarticular fragments, the commonly encountered osteoporosis and the specific anatomy make the successful osteosynthesis a challenge. For a period of 15 years in First Clinic of Orthopaedic Traumatology 27 patients with capitulotrochlear fractures were treated. Of them, 12 women and 3 men were followed. The fractures were classified after Dubberley as follows: Type 1А - 1, type 2А - 2, type 2В - 3, type 3А - 5, type 3В – 1, and type 4В - 3. A plethora of surgical exposures were used - extended lateral, paratricipital, a combination of medial and lateral, dorsal with olecranon osteotomy. Primary TEA was performed in 3 patients: Type 3A - 1, type 3В – 1, and type 4В - 1. The patients were followed for a period of 12 months to 8 years. The results were evaluated by the MEPS, DASH and McGowan scores. The final ROM, compared to the contralateral side, was recorded. The average scores are comparable with the ones in a number of publications in the referent literature. As evaluated by MEPS, excellent results were found in 53% of patients, good – in 27%, fair in 7%, and poor –in 13%. The most serious problem was the elbow stiffness. Early deep infection was found in 1 patient with type 4B fracture. Ectopic ossification Hastings type I was found in 1 patient. The modern surgical treatment is based on anatomical reduction through fracture type-specific surgical exposure and rigid osteosynthesis. The treatment of choice for irreparable fractures is total elbow arthroplasty (TEA). We discuss the fixation devises, the surgical exposures and the osteosynthesis construct. Our own osteosynthesis preferences are centered around the fixation in the frontal plane and the additional augmentation with sagittal plane implants.

Shewanella is an emerging human pathogen. It mostly causes skin and soft tissue infections. Osteosynthesis-associated infection involving Shewanella are rare and in most cases are secondary to direct contamination following open fractures in aquatic environments. Here, we present a rare case of hematogenous osteosynthesis-associated infection involving Shewanella algae affecting an 18-year-old patient who was operated on for 12th thoracic vertebrae and 4th lumbar vertebrae fractures occurring in an aquatic environment. We performed surgical debridement with subsequent double course parenteral antibiotherapy that was then adapted to bacteria sensitivities for three weeks. After a follow-up of six months, the patient had no signs of recurrent infection. The presence of infected dermabrasions and the concordance between germs isolated in operative samples and in blood cultures presumes that the contamination was hematogenous.

Aims: Patients with proximal femoral fractures (PFFs) are often multimorbid, thus unplanned readmissions following surgery are common. We therefore aimed to analyze 30-day and one-year readmission rates, reasons for, and factors associated with, readmission risk in a cohort of patients with surgically treated PFFs across Austria. Methods: Data from 11,270 patients with PFFs, treated surgically (osteosyntheses, n = 6,435; endoprostheses, n = 4,835) at Austrian hospitals within a one-year period (January to December 2021) was retrieved from the Leistungsorientierte Krankenanstaltenfinanzierung (Achievement-Oriented Hospital Financing). The 30-day and one-year readmission rates were reported. Readmission risk for any complication, as well as general medicine-, internal medicine-, and surgery/injury-associated complications, and factors associated with readmissions, were investigated. Results: The 30-day and one-year readmission rates due to any complication were 15% and 47%, respectively. The 30-day readmission rate (p = 0.001) was higher in endoprosthesis than osteosynthesis patients; this was not the case for the one-year readmission rate (p = 0.138). Internal medicine- (n = 2,273 (20%)) and surgery/injury-associated complications (n = 1,612 (14%)) were the most common reason for one-year readmission. Regardless of the surgical procedure, male sex was significantly associated with higher readmission risk due to any, as well as internal medicine-associated, complication. Advanced age was significantly associated with higher readmission risk after osteosynthesis. In both cohorts, treatment at mid-sized hospitals was significantly associated with lower readmission risk due to any complication, while prolonged length of stay was associated with higher one-year readmission risks due to any complication, as well as internal-medicine associated complications. Conclusion: Future health policy decisions in Austria should focus on optimization of perioperative and post-discharge management of this vulnerable patient population. Cite this article: Bone Jt Open 2024;5(4):294–303.

Introduction Limb length discrepancy (LLD) can be debilitating and may cause other medical and social problems. LLD is a serious physical condition and have a significant impact on the patient's quality of life changing the gait, forming pathological adaptive mechanisms and causing long-term musculoskeletal disturbances in children. The objective was to analyze the evolution of tactical approaches to the rehabilitation of patients with lower limb length inequality. Material and methods The original literature search was conducted on key resources including Scientific Electronic Library (www.elibrary.ru) and the National Library of Medicine (www.pubmed.org). Literature searches included both Russian and English studies. The search strategy was comprised of keywords: lower limbs, limb length inequality, approaches and means of limb length correction, osteosynthesis. Clinical guidelines, clinical recommendations, systematic reviews, randomized controlled trials and multicenter cohort studies were selected for analysis. Results and discussion Normal individuals can often experience a difference in the length of the lower limbs from several mm to 1.5 cm and have no effect on the gait, condition of adjacent joints and joints of the opposite limb. Some authors report inequality of 5 mm leading to orthopaedic pathology. A variety of conservative and surgical treatments are offered for limb length equalization. Elimination of LLD is a common and unresolved medical problem. Conservative treatment of LLD can be considered as one of the stages of rehabilitation. Some patients can benefit from conservative treatments. Alternatively, surgical equalization is a treatment option for patients with LLD. Conclusion Surgical methods offered earlier to address LLD had disadvantages, which ultimately minimized their use, and orthopaedic surgeons abandoned some of them due to the high risk of severe complications. The device and the technique developed by Dr. Ilizarov in the 50s of the last century was an epoch-making event in the elimination of LLD and are constantly being improved.

Abstract Background This study investigated the biomechanical properties of a new plate used for the treatment of posterolateral tibial plateau fractures using finite element analysis. Methods The study groups were as follows: group PM, model of the new plate with posteromedial tibial plateau fracture; group PL, model of the new plate with posterolateral tibial plateau fracture; and group PC, model of the new plate with posterior tibial plateau fracture. We used two loading modes: uniform loading on the entire plateau, and loading on the posterior plateau. Data such as the displacement of the fracture and distribution of stress on the new plate and screws were recorded and analyzed. Results When the whole plateau was loaded, the displacement of fractures in groups PM, PL, and PC were 0.273, 0.114, and 0.265 mm, respectively. The maximum stresses on the plates in groups PM, PL, and PC were 118.131 MPa, 44.191 MPa, and 115.433 MPa. The maximum stresses on the screws in Groups PM, PL, and PC were 166.731, 80.330, and 164.439 MPa, respectively. When the posterior tibial plateau was loaded, the displacement of the fractures in groups PM, PL, and PC was 0.410, 0.213, and 0.390 mm, respectively. The maximum stresses on the plates in groups PM, PL, and PC were 194.012 MPa, 72.806 MPa, and 185.535 MPa. The maximum stresses on the screws in Groups PM, PL, and PC were 278.265, 114.839, and 266.396 MPa, respectively. Conclusion The results of this study revealed that titanium plates have good fixation effects in all groups; therefore, the use of the new plate for posterolateral tibial plateau fractures appears to be safe and valid.

Abstract Purpose The treatment of unstable atlas fractures remains a controversial topic. The study aims at assessing the prognosis and efficacy of osteosynthesis for unstable atlas fractures through a review of the current literature and additionally aims to compare outcomes between the transoral and posterior approaches. Methods A systematic review of databases including PubMed, EMBASE, Cochrane, Web of Science, CNKI, and Wanfang was conducted. Titles and abstracts were screened by two reviewers to identify studies meeting pre-defined inclusion criteria for comprehensive analysis. Results The systematic review included 28 articles, 19 employing the posterior approach and 9 utilizing the transoral approach. It covered osteosynthesis in 297 patients with unstable atlas fractures, comprising 169 treated via the posterior approach and 128 via the transoral approach. Analysis revealed high healing rates and clinical improvement in both approaches, evidenced by improvements in the visual analog scale, range of motion, atlantodens interval, and lateral displacement distance post-surgery. Conclusion Osteosynthesis offers effective treatment for unstable atlas fractures. Both transoral and posterior approaches can achieve good clinical outcomes for fracture, and biomechanical studies have confirmed that osteosynthesis can maintain the stability of the occipitocervical region, preserve the motor function of the atlantoaxial and occipito-atlantoaxial joints, and greatly improve the quality of life of patients. However, variations exist in the indications and surgical risks associated with each method, necessitating their selection based on a thorough clinical evaluation of the patient's condition.

Introduction More than 80% of injuries to the acetabulum involve its posterior parts or injuries associated with their destruction. Most poor outcomes of surgical treatment of acetabular fractures manifest themselves in the first 24 months. Surgeons consider accurate anatomical reduction of fragments to be the main predictor of good results. A number of researchers showed good results of its surgical treatment, including those with inaccurate reduction. Poor results also occur in patients with no risk factors and ideal reduction. Thus, inaccurate reduction does not always lead to poor results; the reasons for positive results have not been discussed. Purpose To evaluate the effect of maintaining hip joint isometry in surgical approach on the outcome of reconstructive operations in the treatment of traumatic destruction of the posterior parts of the acetabulum. Materials and methods From 2005 to 2021, surgeons from the Moscow Regional Research and Clinical Institute performed 120 reconstructive operations on 120 patients with fractures of the posterior structures of the acetabulum. Of these, 84 patients followed the recommended monitoring regimen, completed the Harris Questionnaire, and had radiographs taken within the specified time frame. From the 84 patients, two groups of 42 patients each were formed that differed in the method of treating the external rotators. Results During two years of follow-up after reconstructive surgery on the acetabulum, clinical indications for hip replacement were identified or hip replacement was performed in 5 patients in the first group and in 25 patients in the second (11.9 and 59.5%, respectively). Discussion Accurate reduction of fragments is considered to be the main condition for good results after reconstructive operations for fractures of the posterior part of the acetabulum. Maintaining the isometry in the joint, namely, cutting off and then reinserting external rotators while preserving the attachment sites and length of the muscles, can have a significant impact on the outcome of reconstructive operations for traumatic injuries of the posterior parts of the acetabulum due to maintaining isometry of the hip joint. It seems that the preservation of force vectors centering the femoral head in the acetabulum causes the growth of ossification that forms secondary congruence. Conclusions Maintaining hip joint isometry in surgical treatment of fractures of the posterior acetabulum by changing the method of treating the external rotators provides significantly better clinical outcomes.

A separate direction in osteosynthesis is the study on the possibilities of bone union after tumor resection. In this regard, the issue of using implants made of metals, polymers, and carbon, which have a high bone binding affinity, is on the agenda for modern oncological orthopedics. Studying carbon composite materials has shown practical effectiveness of their medical use, in particular in orthopedics and traumatology, that can be applied to replace bone defects in oncological traumatology. Aim. To determine the possibility of using carbon composite materials in the femur defect replacement after tumor resection. Clinical case. A case of using an implant made of the carbon composite material for a patient with right femur osteosarcoma and a pathological femoral middle-third fracture is presented. The study was carried out in accordance with the principles of the Declaration of Helsinki. The patient signed the written informed consent form for the study. Conclusions. The results of using the implant made of the carbon composite material have shown its permeability to X-rays and potential use for bone defect replacement in oncological traumatology.

Background: Open reduction and internal fixation with plate is one of the most widely used treatments for distal third humeral shaft fractures. The purpose of this study was to report the outcomes of the treatment of distal third humeral shaft fractures with posterior minimally invasive plate osteosynthesis (MIPO) with segmental isolation of the radial nerve. Methods: We performed an observational, retrospective, consecutive, monocentric, continuous multioperator study. We reviewed 22 distal third humeral shaft fractures treated with posterior MIPO in our institution with an extra-articular distal humerus plate from 2018 to 2021. Inclusion was limited to functionally independent patients with displaced fractures involving the junction of the middle and distal thirds of the humerus and minimum 12-month follow-up for implant removal. We assessed clinical outcomes including range of motion; QuickDASH score; Mayo Elbow Performance Score; and Constant-Murley score. Results: The average follow-up period of the sample was 31.7 ± 11.6 months (range, 15.7-51.3 months). The average elbow flexion and extension were 146.4° ± 7.3° (range, 120°-150°) and −0.7° ± 3.3° (range, −15° to 0°), respectively. The average shoulder anterior flexion, elevation, and abduction were 178.6° ± 3.6° (range, 170°-180°), 179.1° ± 2.9° (range, 170°-180°), and 140.9° ± 14.8° (range, 110°-160°), respectively. The average external rotation was 88.6° ± 6.4 (range, 65°-90°). The mean visual analog scale score for pain was 1.0 ± 1.6 (range, 0-5) and the mean Mayo Elbow Performance Score was 90.5 ± 9.9 (range, 70-100). The mean QuickDASH and Constant–Murley scores were 4.7 ± 6.8 (range, 0-20.5) and 95.5 ± 5.1 (range, 81-100), respectively. Two patients presented with relevant compromise of radial nerve motor function postoperatively (M3 and M2; the more compromised was preoperative injury). All patients recovered radial nerve neuropraxia within six weeks postoperatively. All fractures achieved union. The average anteroposterior and lateral axis were 175.0 ± 3.6 (168.0°-180.0°) and 177.5 ± 2.0 (173.0°-180.0°), respectively. No superficial or deep infection was reported. No cases of re-displacement of fracture, implant failure, or any other implant-related complication in follow-up were reported. No patient required plate withdrawal. Conclusion: The results of this study demonstrate that the posterior MIPO technique is a reliable option for treating distal third shaft humeral fractures. The radial nerve must be identified and protected in all cases to prevent palsy.

Background: Bioresorbable patient-specific additive-manufactured bone grafts, meshes, and plates are emerging as a promising alternative that can overcome the challenges associated with conventional off-the-shelf implants. The fabrication of patient-specific implants (PSIs) directly at the point-of-care (POC), such as hospitals, clinics, and surgical centers, allows for more flexible, faster, and more efficient processes, reducing the need for outsourcing to external manufacturers. We want to emphasize the potential advantages of producing bioresorbable polymer implants for cranio-maxillofacial surgery at the POC by highlighting its surgical applications, benefits, and limitations. Methods: This study describes the workflow of designing and fabricating degradable polymeric PSIs using three-dimensional (3D) printing technology. The cortical bone was segmented from the patient's computed tomography data using Materialise Mimics software, and the PSIs were designed created using Geomagic Freeform and nTopology software. The implants were finally printed via Arburg Plastic Freeforming (APF) of medical-grade poly (L-lactide-co-D, L-lactide) with 30% β-tricalcium phosphate and evaluated for fit. Results: 3D printed implants using APF technology showed surfaces with highly uniform and well-connected droplets with minimal gap formation between the printed paths. For the plates and meshes, a wall thickness down to 0.8 mm could be achieved. In this study, we successfully printed plates for osteosynthesis, implants for orbital floor fractures, meshes for alveolar bone regeneration, and bone scaffolds with interconnected channels. Conclusions: This study shows the feasibility of using 3D printing to create degradable polymeric PSIs seamlessly integrated into virtual surgical planning workflows. Implementing POC 3D printing of biodegradable PSI can potentially improve therapeutic outcomes, but regulatory compliance must be addressed. [ABSTRACT FROM AUTHOR]

Background: This study investigated the biomechanical properties of a new plate used for the treatment of posterolateral tibial plateau fractures using finite element analysis. Methods: The study groups were as follows: group PM, model of the new plate with posteromedial tibial plateau fracture; group PL, model of the new plate with posterolateral tibial plateau fracture; and group PC, model of the new plate with posterior tibial plateau fracture. We used two loading modes: uniform loading on the entire plateau, and loading on the posterior plateau. Data such as the displacement of the fracture and distribution of stress on the new plate and screws were recorded and analyzed. Results: When the whole plateau was loaded, the displacement of fractures in groups PM, PL, and PC were 0.273, 0.114, and 0.265 mm, respectively. The maximum stresses on the plates in groups PM, PL, and PC were 118.131 MPa, 44.191 MPa, and 115.433 MPa. The maximum stresses on the screws in Groups PM, PL, and PC were 166.731, 80.330, and 164.439 MPa, respectively. When the posterior tibial plateau was loaded, the displacement of the fractures in groups PM, PL, and PC was 0.410, 0.213, and 0.390 mm, respectively. The maximum stresses on the plates in groups PM, PL, and PC were 194.012 MPa, 72.806 MPa, and 185.535 MPa. The maximum stresses on the screws in Groups PM, PL, and PC were 278.265, 114.839, and 266.396 MPa, respectively. Conclusion: The results of this study revealed that titanium plates have good fixation effects in all groups; therefore, the use of the new plate for posterolateral tibial plateau fractures appears to be safe and valid. [ABSTRACT FROM AUTHOR]

Bone morphogenic protein 2 (BMP2) is known to induce osteogenesis and is applied clinically to enhance spinal fusion despite adverse effects. BMP2 needs to be used in high doses to be effective due to the presence of BMP2 inhibitors. L51P is a BMP2 analogue that acts by inhibition of BMP2 inhibitors. Here, we hypothesized that mixtures of BMP2 and L51P could achieve better spinal fusion outcomes regarding ossification. To test whether mixtures of both cytokines are sufficient to improve ossification, 45 elderly Wistar rats (of which 21 were males) were assigned to seven experimental groups, all which received spinal fusion surgery, including discectomy at the caudal 4–5 level using an external fixator and a porous β-tricalcium phosphate (βTCP) carrier. These βTCP carriers were coated with varying concentrations of BMP2 and L51P. X-rays were taken immediately after surgery and again six and twelve weeks post-operatively. Histological sections and µCT were analyzed after twelve weeks. Spinal fusion was assessed using X-ray, µCT and histology according to the Bridwell scale by voxel-based quantification and a semi-quantitative histological score, respectively. The results were congruent across modalities and revealed high ossification for high-dose BMP2 (10 µg), while PBS induced no ossification. Low-dose BMP2 (1 µg) or 10 µg L51P alone did not induce relevant bone formation. However, all combinations of low-dose BMP2 with L51P (1 µg + 1/5/10 µg) were able to induce similar ossificationas high-dose BMP2. These results are of high clinical relevance, as they indicate L51P is sufficient to increase the efficacy of BMP2 and thus lower the required dose for spinal fusion. Spinal fusion surgery is frequently applied to treat spinal pathologies. Bone Morphogenic Protein-2 (BMP2) has been approved by the U.S. Food and Drug Administration (FDA-) and by the "Conformité Européenne" (CE)-label. However, its application is expensive and high concentrations cause side-effects. This research targets the improvement of the efficacy of BMP2 in spinal fusion surgery. [Display omitted] [ABSTRACT FROM AUTHOR]

Featured Application: Interfragmentary movement is crucial in promoting callus formation during secondary fracture healing. Fixation stiffness is a critical factor, with excessive flexibility and rigidity hindering optimal healing. The concepts of flexible fixation, techniques for regulating implant stiffness, and material selection, favoring a lower Young's modulus like titanium alloys, are emphasized. A novel TiNbSn alloy with a low Young's modulus has been introduced as a potential solution that has shown efficacy in promoting osteosynthesis and superior mechanical properties. The bone healing process is influenced by various physiological factors. Fracture fixation traditionally relied on rigid metallic implants. However, excessively rigid constructs can lead to complications, necessitating revision surgery. This review focuses on approaches to improve bone healing by introducing adequate interfragmentary movement (IFM) at the fracture site. IFM promotes secondary fracture healing and callus formation. Studies suggest that rigid fixation may impair fracture healing by inhibiting callus formation and causing stress shielding. Titanium alloy locking plates have been shown to be biomechanically superior to stainless steel. Flexible fixation and techniques to regulate implant stiffness are crucial for managing fractures with bridge plating. Materials with a lower Young's modulus balance biomechanical properties. A novel TiNbSn alloy with a low Young's modulus has been developed to address stress shielding issues. It is effective in promoting osteosynthesis, bone healing, and superior mechanical properties compared with materials with higher Young's moduli. The enhanced formation of bone and callus associated with TiNbSn alloy suggests its promise for use in fracture treatment plates. Understanding the biomechanics of fracture healing, optimizing fixation stiffness, and exploring innovative materials like TiNbSn alloys, are crucial for advancing approaches to accelerate and enhance bone healing. [ABSTRACT FROM AUTHOR]

Proximal humerus fractures are common in clinical practice, and there are relatively a few studies on postoperative incision infections of such fractures. The purpose of this study was to explore the risk factors for surgical site infection (SSI) after internal fixation in patients with closed proximal humerus fractures. Patients with closed proximal humerus fractures who underwent surgery from January 2016 to January 2022 were retrospectively analysed. Cases with superficial or deep infections within 3 months after surgery were in the infection group and the remaining cases were in the non‐infection group. The types of pathogenic bacteria in the infection group were analysed. The potential risk factors for SSI in all patients were recorded: (1) patient‐related factors: gender, age, body mass index (BMI), smoking, comorbidities; (2) trauma‐related factors: mechanism of injury, Injury Severity Score, visual analogue scale, fracture type, soft tissue condition and combined dislocation; (3) laboratory‐related indexes: haemoglobin, albumin; (4) surgery‐related factors: time from injury to surgery, American Society of Anesthesiologists anaesthesia classification, surgical time, fixation mode, intraoperative blood loss, suture method, bone graft and postoperative drainage. The risk factors for the occurrence of SSI were analysed using univariate analysis and multivariate logistic regression. The incidence of SSI was 15.7%. The most common bacterium in the infection group was Staphylococcus aureus. High BMI (p = 0.033), smoking (p = 0.030), an increase in mean time from injury to definitive surgery (p = 0.013), and prolonged surgical time (p = 0.044) were independent risk factors for the development of SSI after closed proximal humeral fractures. In patients with closed proximal humerus fractures, weight loss, perioperative smoking cessation, avoidance of delayed surgery, and shorter surgical time may be beneficial in reducing the incidence of SSI. [ABSTRACT FROM AUTHOR]

Background: Multi-comminuted, intra-articular fractures of the distal humerus still pose a challenge to modern orthopedics due to unsatisfactory treatment results and a high percentage (over 50%) of postoperative complications. When surgical treatment is chosen, such fractures are fixed using two plates with locking screws, which can be used in three spatial configurations: either parallel or one of two perpendicular variants (posterolateral and posteromedial). The evaluation of the fracture healing conditions for these plate configurations is unambiguous. The contradictions between the conclusions of biomechanical studies and clinical observations were the motivation to undertake a more in-depth biomechanical analysis aiming to indicate the weak points of two-plate fracture stabilization. Methods: Research was conducted using the finite element method based on an experimentally validated model. Three variants of distal humerus fracture (Y, λ, and H) were fixed using three different plate configurations (parallel, posterolateral, and posteromedial), and they were analyzed under six loading conditions, covering the whole range of flexion in the elbow joint (0–145°). A joint reaction force equal to 150 N was assumed, which corresponds with holding a weight of 1 kg in the hand. The biomechanical conditions of bone union were assessed based on the interfragmentary movement (IFM) and using criteria formulated by Steiner et al. Results: The IFMs were established for particular regions of all of the analyzed types of fracture, with distinction to the normal and tangential components. In general, the tangential component of IFM was greater than normal. A strong influence of the elbow joint's angular position on the IFM was observed, with excessive values occurring for flexion angles greater than 90°. In most cases, the smallest IFM values were obtained for the parallel plaiting, while the greatest values were obtained for the posteromedial plating. Based on IFM values, fracture healing conditions in particular cases (fracture type, plate configuration, loading condition, and fracture gap localization) were classified into one of four groups: optimal bone union (OPT), probable union (PU), probable non-union (PNU), and non-union (NU). Conclusions: No plating configuration is able to ensure distal humerus fracture union when the full elbow flexion is allowed while holding a weight of 1 kg in the hand. However, flexion in the range of 0–90° with such loadings is acceptable when using parallel plating, which is a positive finding in the context of the early rehabilitation process. In general, parallel plating ensures better conditions for fracture healing than perpendicular plate configurations, especially the posteromedial version. [ABSTRACT FROM AUTHOR]

Purpose: The treatment of unstable atlas fractures remains a controversial topic. The study aims at assessing the prognosis and efficacy of osteosynthesis for unstable atlas fractures through a review of the current literature and additionally aims to compare outcomes between the transoral and posterior approaches. Methods: A systematic review of databases including PubMed, EMBASE, Cochrane, Web of Science, CNKI, and Wanfang was conducted. Titles and abstracts were screened by two reviewers to identify studies meeting pre-defined inclusion criteria for comprehensive analysis. Results: The systematic review included 28 articles, 19 employing the posterior approach and 9 utilizing the transoral approach. It covered osteosynthesis in 297 patients with unstable atlas fractures, comprising 169 treated via the posterior approach and 128 via the transoral approach. Analysis revealed high healing rates and clinical improvement in both approaches, evidenced by improvements in the visual analog scale, range of motion, atlantodens interval, and lateral displacement distance post-surgery. Conclusion: Osteosynthesis offers effective treatment for unstable atlas fractures. Both transoral and posterior approaches can achieve good clinical outcomes for fracture, and biomechanical studies have confirmed that osteosynthesis can maintain the stability of the occipitocervical region, preserve the motor function of the atlantoaxial and occipito-atlantoaxial joints, and greatly improve the quality of life of patients. However, variations exist in the indications and surgical risks associated with each method, necessitating their selection based on a thorough clinical evaluation of the patient's condition. [ABSTRACT FROM AUTHOR]

This study aimed to share our experience of a self-developed plate for acetabular fracture fixation through the presentation of clinical cases. Eight patients with complex acetabular fractures (Letournel classification) underwent surgery using a modified Stoppa approach and the novel plate design between 2021 and 2023 at the National Scientific Center for Traumatology and Orthopedics. Criteria such as the mechanism of injury, type of fracture, surgical approach, intraoperative and postoperative complications, quality of reduction, and functional and radiological results were evaluated. All patients included in the study presented complex types of acetabular fractures according to the Letournel classification. In all cases, surgical interventions were performed using a modified Stoppa approach. The assessment of reduction quality was conducted based on the radiological standards established by Matta. The reduction in quality was excellent in two patients, good in four, and satisfactory in two. One patient developed a post-traumatic false joint requiring additional surgery. The remaining patients achieved fracture healing with satisfactory Harris Hip Score (HHS) scores, indicating good overall function. The results of the self-developed plate for acetabular fracture fixation in our series were satisfactory. [ABSTRACT FROM AUTHOR]

Osteosynthesis in fracture treatment typically uses hardware that remains in the patient's body, which brings a permanent risk of negative side effects such as foreign body reactions or chronic inflammation. Bioabsorbable materials, however, can degrade and slowly be replaced by autologous bone tissue. A suitable material is requested to offer great biocompatibility alongside excellent mechanical properties and a reasonable corrosion rate. Zinc–silver alloys provide these characteristics, which makes them a promising candidate for research. This study investigated the aptitude as a bioabsorbable implant of a novel zinc–silver alloy containing 3.3 wt% silver (ZnAg3). Here, the tensile strength as well as the corrosion rate in PBS solution (phosphate buffered solution) of ZnAg3 were assessed. Furthermore, shear tests, including fatigue and quasi-static testing, were conducted with ZnAg3 and magnesium pins (MAGNEZIX®, Syntellix AG, Hannover, Germany), which are already in clinical use. The detected corrosion rate of 0.10 mm/year for ZnAg3 was within the proposed range for bioabsorbable implants. With a tensile strength of 237.5 ± 2.12 MPa and a shear strength of 144.8 ± 13.2 N, ZnAg3 satisfied the mechanical requirements for bioabsorbable implants. The fatigue testing did not show any significant difference between ZnAg3 and magnesium pins, whereas both materials withstood the cyclic loading. Thus, the results support the assumption that ZnAg3 is qualified for further investigation. [ABSTRACT FROM AUTHOR]

The shear fractures of the capitellum are rare fractures in the pediatric population. Their diagnosis is challenging because of the high cartilaginous component of the growing elbow, requiring a high level of clinical suspicion especially in the case of small osteochondral or chondral fragments. The literature on capitellar shear fractures is mainly represented by case reports, which provides a patchy view of the topic. For this reason, we aimed to draw a narrative review presenting the available management strategies and their outcomes, and present two cases treated in our institution.

IntroductionAcetabular fractures are among the most challenging injuries in traumatology. The complex anatomy usually requires extensive surgical approaches baring the risk for iatrogenic damage to surrounding neurovascular structures. As a viable alternative, minimally invasive endoscopic techniques have emerged during the recent years. This paper reports on the feasibility of different coupling mechanisms for a novel suprapectineal plate especially designed for minimally invasive acetabular surgery.MethodsA total number of 34 participants contributed to the present study, who differed in their arthroscopic and surgical experience. A laparoscopic model was used to compare four different coupling mechanisms by the number of failed attempts, the time required for plate fixation, the influence of surgical experience as well as the learning success for each individual coupling mechanism. Moreover, the feasibility of each mechanism was evaluated by a questionnaire.ResultsThe results demonstrate that plates employing grooved and pressure-sliding coupling mechanisms exhibit fewer failed attempts and reduce trial times, especially in contrast to sole sliding mechanisms. Furthermore, our study revealed that proficiency in endoscopic procedures significantly influenced the outcome. Notably, the subjective evaluation of the participants show that the pressure base and pressure-slide base plate designs are the most supportive and feasible designs.ConclusionsIn summary, the present study evaluates for the first-time different plate and coupling designs for minimal-invasive surgery, indicating a superior feasibility for plates with a grooved and pressure-sliding mechanism.

Introducción En los últimos años, la cirugía ha ganado relevancia en el tratamiento de las fracturas del extremo distal del radio (FEDR). Dentro de las técnicas quirúrgicas, la osteosíntesis con placa mínimamente invasiva (minimally-invasive plate osteosynthesis, MIPO, en inglés) está en auge, y se han incrementado sus indicaciones respecto a la técnica convencional.

Aims: Post-traumatic periprosthetic acetabular fractures are rare but serious. Few studies carried out on small cohorts have reported them in the literature. The aim of this work is to describe the specific characteristics of post-traumatic periprosthetic acetabular fractures, and the outcome of their surgical treatment in terms of function and complications. Methods: Patients with this type of fracture were identified retrospectively over a period of six years (January 2016 to December 2021). The following data were collected: demographic characteristics, date of insertion of the prosthesis, details of the intervention, date of the trauma, characteristics of the fracture, and type of treatment. Functional results were assessed with the Harris Hip Score (HHS). Data concerning complications of treatment were collected. Results: Our series included 20 patients, with a mean age of 77 years (46 to 90). All the patients had at least one comorbid condition. Radiographs showed that 75% of the fractures were pure transverse fractures, and a transverse component was present in 90% of patients. All our patients underwent surgical treatment: open reduction and internal fixation, revision of the acetabular component, or both. Mean follow-up was 24 months, and HHS at last follow-up was 75.5 (42 to 95). The principal complications observed were dislocations of the prosthesis (30%) and infections (20%). A need for revision surgery was noted in 30% of patients. No dislocation occurred in patients undergoing osteosynthesis with acetabular reconstruction. We did not note either mechanical loosening of the acetabular component nor thromboembolic complications. In all, 30% of patients presented acute anemia requiring transfusion, and one death was reported. Conclusion: Post-traumatic periprosthetic acetabular fractures frequently have a transverse component that can destabilize the acetabular implant. The frequency of complications, principally dislocations, led to a high rate of revision surgery. Improvements in preoperative planning should make it possible to codify management to reduce this high rate of complications. The best results were obtained when the surgical strategy combined osteosynthesis with acetabular reconstruction. Cite this article: Bone Jt Open 2024;5(1):28–36.

Abstract Background Displaced lateral malleolus fractures are typically stabilised through open reduction and internal fixation. The biomechanically and clinically efficacy of locking plates and lag screws, particularly in Weber A and B distal fibular fractures remains a subject of contention. This study examines two locking plate designs for lateral malleolus fractures, evaluating their performance with and without interfragmentary screws using finite element models. Methods Utilising CT images of a healthy adult male volunteer, a three-dimensional finite element model was constructed. The Fibula-specific Flank Multiaxial Locking Anatomic Plate (FMLP) and the Conventional Locking Plate (CLP) were subjected to stabilisation, both with and without an interfragmentary screw, mimicking the Danis-Weber A and B lateral malleolus oblique fracture fixation. Loads of 140 N and 70 N, equivalent to 20% of the body weight, were applied to simulate the single-leg and two-leg standing conditions in the axial direction. The von Mises stress (VMS) distributions and element displacements were subsequently analyzed. Results In the Danis-Weber A fracture model group, the FMLP with an interfragmentary screw fixation exhibited the lowest peak VMS values: 51.9 MPa in the fibula, 89.0 MPa in the plate, and 61.3 MPa in the screws for simulating single-leg conditions. Under two-leg standing conditions, these peak VMS values decreased to 25.9 MPa in the fibula, 44.5 MPa in the plate, and 30.6 MPa in the screws, respectively. Furthermore, the overall structural peak displacements during single-leg standing for both Weber-A and B fractures with different implants ranged from 1.61 to 2.54 mm. While standing on two feet, the ranged was from 0.80 to 1.27 mm. An interfragmentary screw at the oblique fracture site resulted in reduced the peak value of VMS in the fibula, plate, screws, consequently decreased the overall structural displacement for FMLP and CLP fixation in lateral malleolus fractures. Conclusions The current finite element analysis (FEA) demonstrates that FMLP exhibits superior mechanical characteristics in Danis-Weber A and B lateral malleolus fractures compared to CLP. The inclusion of an interfragmentary screw, combined with locking plate design, enhances stability for simple oblique distal fibular fractures. The FMLP presents itself as potential as an alternative for lateral malleolus fractures from a biomechanical perspective. Nevertheless, further verification of these results is imperative through subsequent clinical studies.

Abstract Background Patellar fractures have a comparatively low incidence compared to all fracture frequencies of the musculoskeletal system. However, surgical management is crucial to prevent postoperative complications that affect the knee joint. The purpose of the present study was to evaluate the incidence of postoperative complications and onset of postoperative osteoarthritis related to the chosen technique of patellar fracture management. Methods In a retrospective cohort study consecutive managed, isolated patella fractures were reviewed for demographic data, trauma mechanism, patella fracture type, fixation technique and postoperative complications. The results were documented radiographically and clinically and analysed statistically. The reporting followed the STROBE guidelines. Results A total of 112 patients were eligible for data evaluation. Surgical management of comminuted patellar fractures with small fragment screws showed significant fewer postoperative complications compared to other fixation techniques (8%, p

Abstract Osteoporosis is a common disease that leads to a reduction in bone density and increases the risk of fractures. Stable surgical treatment is particularly important for these fractures. The aim of this study was to examine the influence of bone density in the area of ​​the proximal ulna on the failure of the fixation technique of K-wires in tension band wiring (TBW). We provided 10 ulna specimens with TBW and biomechanically examined the pull-out strength of bi- and tricortical K-wires. Bone density measurement was performed using qCT. In the paired t-test, the tricortical group showed a significantly higher pull-out strength in relation to bone density than the bicortical group (p = 0.001). Furthermore, the Pearson correlation showed a high influence of bone density on pull-out strength in the tricortical group (r = 0.544), but without significance (p = 0.100). Our work shows that bone density has a direct effect on the pull-out strength of K-wires in TBW. TBW should therefore be used as osteosynthesis technique, especially in young patients with non-osteoporotic bones. In the case of osteoporotic fractures, alternative procedures should be preferred.

Background: Distal forearm fractures were defined as distal radius fractures with concomitant distal ulna fractures, except ulna styloid fractures. Distal forearm fractures are common among geriatric populations, particularly those with osteoporosis. Conventionally, distal forearm fractures are reduced by a double incision approach; however, malreduction and instability of the distal radioulnar joint were not uncommon. We introduced a modified volar dual window approach to treat the distal forearm fracture and evaluate the functional outcomes and complications. Methods: From January 2020 to June 2023, 13 patients with distal forearm fractures underwent open reduction by the modified dual window approach with locking plate fixation. After surgery, splints were applied for two weeks, and the patients underwent postoperative hand therapy for three months. The mean Quick Disabilities of the Arm, Shoulder, and Hand scores, range of motions, grip strength, postoperative radiographic parameters, and complications data were collected. Results: The mean follow-up period was 12.1 months, and the mean age was 52.3 years. Average wrist flexion was 67°, extension 69°, pronation 81°, and supination 79°. Grip strength was 28.3 ± 11.5 kg, which was 88% of the uninjured opposite side. The Visual Analog Scale score during activities was recorded as 0.5 ± 0.9. The mean Quick Disabilities of the Arm, Shoulder, and Hand score was 14 ± 11.5. The postoperative radiographic parameters were as follows: radial height: 10.8 ± 1.7 mm, radial inclination: 22.6 ± 3.7°, volar tilting: 4.0 ± 3.9°, and ulnar variance: −0.4 ± 1.4 mm. All the patients achieved bone union at the final follow-up. Two patients underwent ulnar implant removal due to irritation symptoms. Neither infection, nor neurovascular injury, nor malreduction developed in these patients. Conclusions: The modified volar dual window approach can achieve good wrist function and distal forearm fracture reduction without increasing neurovascular or wound healing complications. This method is an alternative approach for distal forearm fracture, especially in comminuted distal ulna fracture or distal radioulnar joint incongruity.

The incidence of articular injury, particularly osteochondral fractures (OCFs), has seen a cinnotable increase in recent years. Regardless of their location, fragments can be overlooked by plain radiographs, which might lead to osteoarthritis in the long run. Diagnostic imaging has a pivotal role in the assessment and classification of the fracture severity, as well as the presence of any associated dislocations. These fractures require surgical intervention for the restoration of joint function and the reduction of long-term complications. This paper aims to present the surgical correction and post-operative treatment of osteochondral fractures with absorbable implants in four children. The following affected areas are discussed: lateral condyle of the femur, patella and radial head. Utilising absorbable implants for the management of OCFs provides numerous advantages, including the elimination of the need for re-anaesthesia and reoperation, reduction of complications and facilitation of early rehabilitation. This approach also minimises the period of hospitalisation and proves effective in pediatric OCF treatment. [ABSTRACT FROM AUTHOR]

Background: Longitudinal patellar fractures are uncommon in veterinary orthopedics routine. These fractures directly affect pelvic limb movements and can result in joint incongruity and potentially degenerative joint disease. Surgical repair is necessary to preserve the quadriceps extensor mechanism and reduce possible complications. This paper describes the clinical status of a cat suffering from a longitudinal patellar fracture, the surgical procedure used to repair and stabilize the bone, and the postoperative outcomes during the animal's different healing phases. Case: One cat with a longitudinal patellar fracture of the left pelvic limb was treated at the Veterinary Hospital of the Federal University of Santa Maria (UFSM), in the state of Rio Grande do Sul, Brazil. The patient was diagnosed based on physical and radiographic examinations of the affected pelvic limb. Under anesthesia, the patella was subjected to osteosynthesis using cerclage wire and to trochlear sulcoplasty to prevent luxation. The veterinarian recommended postoperative rest and basic care involving hygiene of the surgical wound. After 60 days, the cat was brought back to the hospital for radiographic reassessment to verify the osseous consolidation of the patella. The X-ray exam revealed non-consolidation of the bone fragments, despite the cemented implant and the proper joining of the fragments. However, although the fracture did not consolidate, the animal exhibited clinical improvement of its lameness. Discussion: Longitudinal fractures are rare and the literature contains few reports about them. It is believed that cats are more likely to present longitudinal fractures after direct blows that cause compression of the patella over the trochlear groove, since the patella in this species is relatively wider and smoother than that of dogs. The literature still lacks a clear description of the causal mechanism of longitudinal fractures; however, but the main causes may vary according to the clinical presentation. The choice of the best method to treat patellar fractures still poses a challenge, since several methods have been described, depending on how the fracture presents. Regardless of the choice of treatment, the techniques for surgical repair of patellar fractures must involve the following steps: the fracture must be reduced, the fragments kept in apposition until the fracture closes, the soft tissues are healed, and the knee function restored. The cat's patellar fracture was repaired with cerclage wire to restore its anatomical normality, reducing the fracture and stabilizing the bone fragments in order to immobilize them and ensure proper better bone healing. Maintenance and approximation of the lateral fragment of the longitudinal fracture, in conjunction with sulcoplasty, were proposed to ensure greater contact between the patella and the trochlear groove, thereby reducing the possibility of luxation. Despite the non-consolidation of the fracture, the fragment remained intact and immobile, and no post-surgical complications were reported. This confirmed the success of the technique employed to bring together the patellar fragments of the lateral longitudinal fracture, even in the absence of bone callus formation. Moreover, the technique proved to be simple and resulted in complete joint stability after 60 days. This is therefore an important tool for patellar fractures, whose lateral longitudinal fragment was retained, allowing for correct approximation and fragment immobilization, without the need for excision by partial patellectomy. [ABSTRACT FROM AUTHOR]

Background and objective. Most of the activities of daily life are carried out with our hands; hand fractures represent 10% of all skeletal injuries and are caused by high energy trauma. The main complication is the stiffness of the hand, and an ideal treatment must produce an adequate reduction, limit pain, minimize scarring and start mobility as soon as possible. Methods. A retrospective review of 10 patients operated on for a distal phalanx fracture between January and June 2023 was carried out through the application of 2.4 and 1.7 mm cannulated screws for transverse and oblique strokes, respectively. Results. Patients presented an adequate reduction, minimal pain and began rehabilitation between 10 and 14 days after surgery; did not present complications and had adequate mobility at the end of rehabilitation. Conclusion. In our experience, management with cannulated screws of the distal phalanx fractures has shown an adequate reduction, requires little surgical time, is placed percutaneously, and favors early mobility, preventing the appearance of rigidity. [ABSTRACT FROM AUTHOR]

Joint replacement is a common surgery and is predominantly utilized for treatment of osteoarthritis in the aging population. The longevity of many of these implants depends on bony ingrowth. Here, we provide an overview of current techniques in osteogenesis (inducing bone growth onto an implant), which is affected by aging and inflammation. In this review we cover the biologic underpinnings of these processes as well as the clinical applications. Overall, aging has a significant effect at the cellular and macroscopic level that impacts osteosynthesis at bone-metal interfaces after joint arthroplasty; potential solutions include targeting prolonged inflammation, preventing microbial adhesion, and enhancing osteoinductive and osteoconductive properties. [ABSTRACT FROM AUTHOR]

Due to the military aggression of the Russian Federation against Ukraine, a large number of soldiers and civilians were wounded and injured. Along with fractures of the long bones of the limbs, skull injuries, limb amputations, the number of injuries in the pelvic area with fractures of the pelvic bones as a result of being hit by high-velocity projectiles (shrapnel, bullets) has increased. This work is devoted to the preparation and research of the characteristics of stiffness and reliability of fixation of complex fractures of the pelvic bones in the area of the sacroiliac joint and the upper and lower branches of the pubic bone, which may occur as a result of injury by high-velocity projectiles that injure. The sacroiliac area was fixed with two cancellous screws with a parallel arrangement at the intersection of the horizontal and vertical planes (a typical technique for stabilizing the posterior parts of the pelvis). The anterior parts of the pelvic bones were stabilized with rod devices of external fixation with a typical location of the rods in the upper anterior iliac spine. The upper branch of the pubic bone was synthesized with a bony reconstructive plate with a typical location. [ABSTRACT FROM AUTHOR]

A separate direction in osteosynthesis is the study on the possibilities of bone union after tumor resection. In this regard, the issue of using implants made of metals, polymers, and carbon, which have a high bone binding affinity, is on the agenda for modern oncological orthopedics. Studying carbon composite materials has shown practical effectiveness of their medical use, in particular in orthopedics and traumatology, that can be applied to replace bone defects in oncological traumatology. Aim. To determine the possibility of using carbon composite materials in the femur defect replacement after tumor resection. Clinical case. A case of using an implant made of the carbon composite material for a patient with right femur osteosarcoma and a pathological femoral middle-third fracture is presented. The study was carried out in accordance with the principles of the Declaration of Helsinki. The patient signed the written informed consent form for the study. Conclusions. The results of using the implant made of the carbon composite material have shown its permeability to X-rays and potential use for bone defect replacement in oncological traumatology. [ABSTRACT FROM AUTHOR]

Background: Displaced lateral malleolus fractures are typically stabilised through open reduction and internal fixation. The biomechanically and clinically efficacy of locking plates and lag screws, particularly in Weber A and B distal fibular fractures remains a subject of contention. This study examines two locking plate designs for lateral malleolus fractures, evaluating their performance with and without interfragmentary screws using finite element models. Methods: Utilising CT images of a healthy adult male volunteer, a three-dimensional finite element model was constructed. The Fibula-specific Flank Multiaxial Locking Anatomic Plate (FMLP) and the Conventional Locking Plate (CLP) were subjected to stabilisation, both with and without an interfragmentary screw, mimicking the Danis-Weber A and B lateral malleolus oblique fracture fixation. Loads of 140 N and 70 N, equivalent to 20% of the body weight, were applied to simulate the single-leg and two-leg standing conditions in the axial direction. The von Mises stress (VMS) distributions and element displacements were subsequently analyzed. Results: In the Danis-Weber A fracture model group, the FMLP with an interfragmentary screw fixation exhibited the lowest peak VMS values: 51.9 MPa in the fibula, 89.0 MPa in the plate, and 61.3 MPa in the screws for simulating single-leg conditions. Under two-leg standing conditions, these peak VMS values decreased to 25.9 MPa in the fibula, 44.5 MPa in the plate, and 30.6 MPa in the screws, respectively. Furthermore, the overall structural peak displacements during single-leg standing for both Weber-A and B fractures with different implants ranged from 1.61 to 2.54 mm. While standing on two feet, the ranged was from 0.80 to 1.27 mm. An interfragmentary screw at the oblique fracture site resulted in reduced the peak value of VMS in the fibula, plate, screws, consequently decreased the overall structural displacement for FMLP and CLP fixation in lateral malleolus fractures. Conclusions: The current finite element analysis (FEA) demonstrates that FMLP exhibits superior mechanical characteristics in Danis-Weber A and B lateral malleolus fractures compared to CLP. The inclusion of an interfragmentary screw, combined with locking plate design, enhances stability for simple oblique distal fibular fractures. The FMLP presents itself as potential as an alternative for lateral malleolus fractures from a biomechanical perspective. Nevertheless, further verification of these results is imperative through subsequent clinical studies. [ABSTRACT FROM AUTHOR]

The middle third of the face can be seriously compromised functionally and aesthetically, through the more complex traumas of Le Fort I, II and III. We can find associated and isolated fractures, such as zygoma, orbit, maxilla and nasal bones. Fractures are treated through surgical reconstruction of the deepest bones to the most external ones using titanium plates and screws, reconstructing the middle third of the face, as well as restoring the patient's functionality and aesthetics. This case report article aims to describe the importance of treating fractures and facial reconstruction in a patient with associated Le Fort I and II, in addition to its diagnosis and prognosis. [ABSTRACT FROM AUTHOR]

Purpose of the Study: Femoral neck fracture osteosynthesis is usually performed by using dynamic hip screw (DHS) or multiple parallel cannulated screws (MCS). In orthopedic surgery training, certain hip fractures are one of the most common operations performed by residents. It has been questioned, whether residents can provide as safe treatment and patient outcomes as those of more experienced surgeons. The aim of this study was to evaluate the effect of surgical experience on risk of complications by comparing the surgical performance and clinical outcomes in femoral neck osteosyntheses between surgical residents and orthopaedic surgeons. Methods: All patients with femoral neck fracture admitted to Helsinki and Uusimaa Hospital District (HUS) Hyvinkää Hospital from 2011 to 2016 were collected as research material. 88 hip fractures (87 patients) treated with DHS or MCS osteosyntheses were included in this study. The patients were divided into 2 groups, based on the surgeon's experience: an orthopedic surgeon group (n = 68) and a surgical resident group (n = 20). All data from complications, reoperations, and the duration of operations were collected. Results: There was no significant difference in characteristics of operated patients between orthopaedics and residents group. There was no significant difference in complications or re-operations between groups (p = 0.4, p = 0.2). Surgical residents had statistically longer surgical time (mean 76 min, 95% CI 62.92 min, mean 46 min, 95% Cl 42.51 min; p-value < 0.001). Still surgical time was not a risk factor for complication (p-value 0.5). Conclusion: Our results show that surgical residents´ outcomes in femoral neck fracture osteosynthesis seem to be as favorable as those of orthopedic surgeons; the operations just last slightly longer. [ABSTRACT FROM AUTHOR]