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Background: Intra-articular fractures of the proximal interphalangeal joint (PIPJ) can result in poor outcomes if inadequately treated. Dynamic external fixation and internal fixation with plates and/or screws are two treatment options. The role of combining these two methods is unclear. The aim of this study is to determine the outcomes of patients with intra-articular fractures of the PIPJ treated with a combination of dynamic external fixation with a plate and/or screws. Methods: A retrospective review was conducted on 18 consecutive cases of intra-articular fractures of the PIPJ treated with pins and rubber band traction system (PRTS) combined with dorsal internal fixation with plates and/or screws. The patients' average age was 51 years (range: 20–81 years). The fracture patterns were volar-type (n = 2), dorsal-type (n = 4) and pilon-type (n = 12). Data with regard to time to surgery, interphalangeal joint range of motion, grip strength, VAS for pain, Quick DASH score, complications, duration of follow-up and return to work were collected. Results: The levels of articular involvement were stable (n = 1), tenuous (n = 5) and unstable (n = 12). The average time to surgery was 9 days, and the average follow-up period was 15 months. The fracture was fixed with a dorsal plate and screws in 10 patients and with only screws in eight patients. All patients had PRTS. All patients returned to their original occupation and the fractures united in good alignment. The average grip strength was 86% of that of the unaffected side. The average active PIPJ motion was 85° (range: 50°–106°), and the average active distal interphalangeal joint (DIPJ) motion was 48° (range: 10°–90°). Conclusions: Our results show that a combination of PRTS and open reduction and fixation with plate and/or screws achieved a good range of motion and articular reduction. Level of Evidence: Level IV (Therapeutic) [ABSTRACT FROM AUTHOR]

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Purpose: Headless compression screws (HCS) have a variable thread pitch and headless design enabling them to embed below the articular surface and generate compression force for fracture healing without restricting movement. Locking screws have greater variety of dimensions and a threaded pitch mirroring the design of the HCS. The objective of this study is to determine whether locking screws can generate compression force and compare the compressive forces generated by HCS versus locking screws. Method: A comparison between 3.5-mm HCS versus 3.5-mm locking screws and 2.8-mm HCS versus 2.7-mm locking screws was performed using a synthetic foam bone model (Synbone) and FlexiForce sensors to record the compression forces (N). The mean peak compression force was calculated from a sample of 3 screws for each screw type. Statistical analysis was performed using the one-way ANOVA test and statistical significance was determined to be p = < 0.05. Results: The 3.5-mm Synthes and Smith and Nephew locking screws generated similar peak compression forces to the 3.5-mm Acutrak 2 headless compression screws with no statistically significant difference between them. The smaller 2.7-mm Synthes and Smith and Nephew locking screws initially generated similar compressive forces up to 1.5 and 2 revolutions, respectively, but their peak compression force was less compared to the 2.8-mm Micro Acutrak 2 HCS. Conclusion: Locking screws are able to generate compressive forces and may be a viable alternative to headless compressive screws supporting their use for intra-articular fractures. [ABSTRACT FROM AUTHOR]

Introduction. Calcaneus fractures are rare but potentially debilitating injuries. Most of them are displaced intraarticular fractures, whose management is among controversial issues. There is no consensus on whether to operate or not. The most often chosen surgical treatment is open reduction and internal fixation as the primary method. Failure of this surgery often needs secondary subtalar arthrodesis as definitive management, so primary subtalar arthrodesis in cases with severe comminution represents definitive treatment in one stage with good functional results. Case outline. We present a case of a 54-year-old male patient with a severely comminuted (Sanders type IV) bilateral calcaneus fracture. After the withdrawal of local swelling and disappearance of fracture blisters, the patient was operated on using one-stage bilateral subtalar arthrodesis with percutaneous screw fixation and bone grafting performed through a mini-open sinus tarsi approach. The early postoperative period was uneventful. The patient did not walk for the first seven postoperative weeks, after which rehabilitation was continued with partial weight bearing with a gradual increase of weight-bearing to full over the next five weeks, after which walking aids were completely phased out. Three years after surgery, the patient has no symptoms and has a close-to-normal gait. Conclusion. Although this type of injury has traditionally been treated with open reduction and internal fixation, we believe that primary subtalar arthrodesis with bone grafting through a mini-open sinus tarsi approach can benefit patients with severe comminution of calcaneus, allowing good functional results and patient satisfaction, with fewer postoperative complications and faster definitive recovery.

Objectives: Lipohemarthrosis is a key finding in acute trauma patients and indicates an intra-articular fracture. The horizontal beam lateral radiography with supine position is known to be the best technique to demonstrate knee lipohemarthrosis. Our main purpose was to compare the sensitivity of supine and standing lateral knee radiographs to detect lipohemarthrosis. Methods: In our retrospective study, consecutive patients with lipohemarthrosis on computed tomography of the knee between October 2019 and September 2021 were included. Fractured bone, the presence of lipohemarthrosis, and image quality in both standing and supine anteroposterior and lateral knee radiographs were evaluated. Interobserver reliability of the three observers was calculated. Fisher exact chi-square and z-proportion tests were used to compare lateral and anteroposterior knee radiographs. Krippendorff's Alpha and Kappa coefficients were used for inter-observer agreement. Results: A total of 61 patients (38 men [62.3%], 23 women [37.7%]; mean age, 43 years ± 17 [standard deviation]) were included. The most common type of fracture was isolated tibial fractures (n = 32; 52.5%). The sensitivity of showing lipohemarthrosis of standing lateral knee radiographs (95.5%) was higher than supine lateral radiographs (38.5%) (p < 0.001). While non-optimal image quality did not affect lipohemarthrosis detection on lateral radiographs (p > 0.99), it caused a significant decrease in the diagnosis of lipohemarthrosis on anteroposterior radiographs (p = 0.036). We found a good–excellent interobserver agreement in lipohemarthrosis detection. Conclusions: Standing lateral radiographs have higher sensitivity than supine lateral radiographs in detecting lipohemarthrosis and are beneficial for detecting lipohemarthrosis which indicates the presence of occult-evident intraarticular fracture in patients with knee trauma. Clinical relevance statement: Standing lateral knee radiographs offer a useful method for reducing the misdiagnosis of the occult intra-articular fractures by showing the fat-fluid leveling more clearly. Its advantages may be more prominent when the advanced imaging modalities are limited. Key Points: • Fat-fluid level (lipohemarthrosis) is an important radiographic sign to assess patients with acute trauma. It almost always indicates an intra-articular fracture. • Our retrospective study results support that lipohemarthrosis sign could be observed more frequently in standing lateral knee radiographs than in supine lateral radiographs. • Knee trauma patients, when available, should be evaluated with standing lateral radiographs for the diagnosis of lipohemarthrosis. [ABSTRACT FROM AUTHOR]

Background and Objectives: While many of the distal radius fractures fractures are relatively uncomplicated and can be effectively treated with closed reduction and casting, unstable intraarticular fractures can compromise joint integrity and lead to complications. This has led to a shift towards surgical management to address these issues. The aim of this study was to compare the functional outcomes of distal end radius fractures treated with closed reduction and cast application versus volar plating. Material and Methods: This study involved a randomized prospective interventional approach in which all patients with distal radius fractures were included based on specific inclusion and exclusion criteria. A total of 70 patients were enrolled and followed for six months. They were evenly divided into two groups, with 35 patients receiving surgical treatment and the other 35 managed conservatively. Patients were scheduled for follow-up at 6 days, 6 weeks, 3 months, and 6 months, during which routine X-rays were taken, and the DASH scoring system was used to assess functional recovery. Results: Patients who received operative management showed a significantly better "Good" DASH score for the affected hand at the 3-month mark. Fair scores were significantly higher among patients managed conservatively, and Excellent scores at 6 months were significantly higher in the operative management group. Conclusion: This study suggests that surgical intervention for distal end radius fractures can reduce the risk of wrist joint stiffness and loss of reduction, resulting in good functional outcomes compared to conservative management. [ABSTRACT FROM AUTHOR]

Simultaneous ipsilateral fractures of the proximal and distal humerus, known as 'floating arm', are rarely seen in adolescents and are considered challenging to manage. Most of the published cases have involved proximal humerus and distal supracondylar fractures. This paper presents a special case of floating arm injury in a 14-year-old boy following a motor vehicle accident that was managed in a well-established trauma center. The injury consisted of displaced proximal humerus and open distal T-condylar intraarticular fractures. The patient was discharged in good condition and regained functionality with no reported complications. [ABSTRACT FROM AUTHOR]

ObjectiveTo identify preoperative imaging-based indicators of knee degeneration that correlate with graft failure risk and postoperative clinical outcome scores after osteochondral graft treatment for chondral defects of the knee.DesignProspectively collected data from 113 patients (mean age, 34 years; 65% male) treated with mosaicplasty or osteochondral allograft transplantation (OCA) was reviewed. Four different aspects of knee degeneration were examined based on preoperative radiographs or magnetic resonance imaging: (1) Osteoarthritis using the Kellgren-Lawrence (KL) grading system, (2) meniscus volume, (3) meniscus quality, and (4) synovitis. Primary outcomes included graft failure, defined by removal/revision of the graft or conversion to arthroplasty, and patient responses to clinical outcome scores.ResultsForty-one knees (36%) underwent mosaicplasty, and 72 knees (64%) underwent OCA. Mean duration of follow-up was 4.5 years (range, 2-14 years). A preoperative KL grade of ≥3 was correlated with increased failure rates (P = 0.01), lower postoperative International Knee Documentation Committee form (IKDC), Activities of Daily Living of the Knee Outcome Survey (KOS-ADL), and Overall Condition scores (P < 0.01), and decreased improvement in Overall Condition scores (P = 0.01). Within an individual tibiofemoral compartment, a preoperative meniscus volume grade of ≥3 (indicating

Aim: This study was aimed to evaluate the effect of radial inclination (RI) angle, assessed with radiological measurement, on the clinical outcomes of intra-articular fractures of the distal radius (IFDR) treated with closed reduction and penning type dynamic wrist fixator. Material and Methods: A total of 120 patients who underwent closed reduction and dynamic wrist fixation due to IFDR between 2012 and 2020 were retrospectively reviewed. The effects of the changes in RI on clinical outcomes according to Mayo wrist scoring (MWS) criteria were investigated by measuring the RI angles in anteroposterior wrist radiographs of the patients at postoperative 2nd, 6th, and 10th weeks. Results: According to the AO fracture classification, 77 (64.2%) of the patients had type C1 and 43 (35.8%) of the patients had type C2 fracture. The patients comprised 69 (57.7%) females and 51 (42.3%) males, and the mean age was 50.08±15.36 years. Fixators were removed at six weeks. RI angles measured at post-op week 10 were 20°-30° in 83 (69.1%) patients, 10°-19° in 32 (26.6%) patients, and 0°-9° in 5 (4.3%) patients. According to MWS, 39 (32.5%) patients were evaluated as excellent, 76 (63.3%) patients as good, and 5 (4.2%) patients as moderate. A statistically significant positive correlation was observed between RI values and MWS (r=0.369, p

Intra-articular fractures (IAF) result in significant and prolonged inflammation, increasing the chances of developing post-traumatic osteoarthritis (PTOA). Interleukin-one beta (IL-1β) and Tumor Necrosis Factor-alpha (TNF-α) are key inflammatory factors shown to be involved in osteochondral degradation following IAF. As such, use of targeted biologics such as Infliximab (INX), a TNF-α inhibitor, and Anakinra (ANR), an interleukin-one (IL-1) receptor antagonist (IL1RA), may protect against PTOA by damping the inflammatory response to IAF and reducing osteochondral degradation. To test this hypothesis, IAFs were induced in the hindlimb knee joints of rats treated with INX at 10 mg/kg/day, ANR at 100 g/kg/day, or saline (vehicle control) by subcutaneous infusion for a period of two weeks and healing was evaluated at 8-weeks post injury. Serum and synovial fluid (SF) were analyzed for soluble factors. In-vivo microcomputed tomography (µCT) scans assessed bone mineral density and bone morphometry measurements. Cationic CA4+ agent assessed articular cartilage composition via ex vivo µCT. Scoring according to the Osteoarthritis Research Society International (OARSI) guidelines was performed on stained histologic tibia sections at the 56-day endpoint on a 0–6 scale. Systemically, ANR reduced many pro-inflammatory cytokines and reduced osteochondral degradation markers Cross Linked C-Telopeptide Of Type II (CTXII, p < 0.05) and tartrate-resistant acid phosphatase (TRAP, p < 0.05). ANR treatment resulted in increased chemokines; macrophage-chemotractant protein-1 (MCP-1), MPC-3, macrophage inhibitory protein 2 (MIP2) with a concomitant decrease in proinflammatory interleukin-17A (IL17A) at 14 days post-injury within the SF. Microcomputed tomography (µCT) at 56 days post-injury revealed ANR Treatment decreased epiphyseal degree of anisotropy (DA) (p < 0.05) relative to saline. No differences were found with OARSI scoring but contrast-enhanced µCT revealed a reduction in glycosaminoglycan content with ANR treatment. These findings suggest targeted cytokine inhibition, specifically IL-1 signaling, as a monotherapy has minimal utility for improving IAF healing outcomes but may have utility for promoting a more permissive inflammatory environment that would allow more potent disease modifying osteoarthritis drugs to mitigate the progression of PTOA after IAF. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to compare the mid-term results of patients who underwent open reduction and internal fixation with closed reduction and external fixation in the surgical treatment of distal radius intra-articular fractures. Methods: The data were retrospectively analyzed of 95 patients who underwent internal fixation with volar plate after open reduction or application of external fixator after closed reduction due to distal radius intra-articular fracture between April 2019 and October 2022 in our clinic. All patients who agreed to participate in the study were clinically evaluated using the MAYO wrist score at the final follow-up examination. Palmar angulation loss, radial length loss, and radial tilt loss were investigated by comparing the radiographs taken at the final follow-up visit with the healthy side. Results: Evaluation was made of a total of 47 patients, as group 1 comprising 24 patients applied with volar plate and group 2 comprising 23 patients applied with external fixator. A statistically significant difference was determined between the groups in terms of operation time (P = .002), duration of follow-up (P = .031), wrist extension range of motion (P = .001), and volar angulation (P = .010). Conclusion: Some clinical and radiological differences were detected between volar plate fixation and external fixator fixation in the surgical treatment of intra-articular radius distal fractures. However, the MAYO wrist score showed no significant difference between the groups. It is most important that the patient returns to normal life as soon as possible and is able to maintain that. Therefore, these methods can be used interchangeably when necessary. [ABSTRACT FROM AUTHOR]

Background: The distal ends of radius fractures continue to pose a therapeutic challenge. With the advent of locking plates, the fixation of these fractures has been made better. This study evaluates the functional outcome of surgical management of intra-articular fractures of distal radius by open reduction and internal fixation with volar plate using the demerit point system of Gartland and Werley. Subjects and Methods: Thirty-four patients with intra-articular fractures of the distal end of radius, who were operated by open reduction and internal fixation with volar plate, were included in the study during the period of July 2017–June 2018. With a minimum follow-up of 6 months, radiological outcome was analyzed and functional outcome was recorded. Results: Seventeen patients had excellent results accounting for 50.00%, 13 patients had good results accounting for 38.23%, and 3 patients had fair results accounting for 8.82%. Thirty (88.22%) patients did not have any complications. Highly significant difference (P < 0.001) was found in radial shortening, radial inclination, and volar tilt of patients preoperatively and postoperatively and also between preoperative and at final follow-up (P < 0.001). Nine (52.95%) patients having 3 days of duration from injury to surgery had excellent outcome and 8 (61.54%) had good outcome. Conclusion: Open reduction and internal fixation by volar plate provides better functional outcome in treating the intra-articular fracture of distal end radius. Hence, this procedure can be used as an alternative to other procedures in treating intra-articular fractures of distal end radius with less complications.

Displaced intra-articular calcaneal fractures are difficult to treat because of complex anatomy and high soft tissue complications. Various surgical approaches have been introduced to solve these problems, but the treatment remains complex. Recently, clinically and radio-graphically superior results were reported using a subtalar arthroscopy in reducing the posterior facet in both percutaneous and open approaches. In the percutaneous approach, the arthroscopically assistant percutaneous approach must be selected carefully for mild-to- moderately displaced fractures because of the limited view. In the open approach, there is little evidence of the utility of subtalar arthroscopy. Therefore, intraoperative arthroscopy should always be used in conjunction with fluoroscopy to achieve reduction and assess the internal fixation placement. [ABSTRACT FROM AUTHOR]

Aim: This study was aimed to evaluate the effect of radial inclination (RI) angle, assessed with radiological measurement, on the clinical outcomes of intra-articular fractures of the distal radius (IFDR) treated with closed reduction and penning type dynamic wrist fixator. Material and Methods: A total of 120 patients who underwent closed reduction and dynamic wrist fixation due to IFDR between 2012 and 2020 were retrospectively reviewed. The effects of the changes in RI on clinical outcomes according to Mayo wrist scoring (MWS) criteria were investigated by measuring the RI angles in anteroposterior wrist radiographs of the patients at postoperative 2nd, 6th, and 10th weeks. Results: According to the AO fracture classification, 77 (64.2%) of the patients had type C1 and 43 (35.8%) of the patients had type C2 fracture. The patients comprised 69 (57.7%) females and 51 (42.3%) males, and the mean age was 50.08±15.36 years. Fixators were removed at six weeks. RI angles measured at post-op week 10 were 20°-30° in 83 (69.1%) patients, 10°-19° in 32 (26.6%) patients, and 0°-9° in 5 (4.3%) patients. According to MWS, 39 (32.5%) patients were evaluated as excellent, 76 (63.3%) patients as good, and 5 (4.2%) patients as moderate. A statistically significant positive correlation was observed between RI values and MWS (r=0.369, p<0.001). Conclusion: Dynamic wrist fixation with closed reduction is a simple and minimally invasive method, and provides successful clinical and functional results in the treatment of IFDR. We consider that optimal RI angles are effective in clinical and functional outcomes. [ABSTRACT FROM AUTHOR]

Abstract Background The aim of this retrospective monocentric study was to investigate the clinical efficacy of percutaneous reduction and screw fixation without bone grafting in Sanders Type-II and Type-III displaced intra-articular calcaneal fractures (DIACFs). Methods The medical records of calcaneal fractures patients who were admitted to our department from January 2018 to January 2020 were retrospectively reviewed, and those meeting the inclusion criteria were fnally included for analysis. All patients were treated with percutaneous reduction and screw fixation, and no patients received bone grafting. The radiologic parameters evaluated included the BÖhler angle and the calcaneal height. In addition, the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot scores, Maryland Foot Score (MFS), and visual analog scale (VAS) score were determined. Results Thirty-eight patients with Sanders Type-II and Type-III DIACFs were finally included, including 30 males and 8 females aged 21 to 61 years [(42.6 ± 9.6) years]. According to the Essex-Lopresti classification, 27 of the fractures were the tongue type, and 11 were the joint compression type. According to the Sanders classification, 27 of the fractures were type II, and 11 were type III. Immediately postoperatively, the calcaneal height had recovered to 39.8 ± 2.1 mm, the BÖhler angle had recovered from 4.2° ± 13.6° preoperatively to 27.2° ± 3.4° (P = 0.000). All patients were followed up for 18–42 months [(25.2 ± 9.5) months]. All fractures healed. No differences were found in the outcome measures six-months postoperatively (BÖhler angle, p = 0.24; calcaneal height, p = 0.82) or at final follow-up (BÖhler angle, p = 0.33; calcaneal height, p = 0.28) compared to the immediately postoperative values. At the final follow-up, the AOFAS score was 91.7 ± 7.4 points, with an excellent and good rate of 92.1%; the MFS was 90.3 ± 7.8 points, with an excellent and good rate of 92.1%; and the VAS score was 2.2 ± 1.5 points. None of the patients had incision complications, and one patient developed traumatic arthritis. Conclusion Percutaneous reduction and screw fixation without bone grafting in Sanders Type-II and Type-III DIACFs can achieve good recovery and maintenance of the BÖhler angle and calcaneal height. Moreover, it has the advantage of a low complication rate.

Intra-articular fractures (IAF) result in significant and prolonged inflammation, increasing the chances of developing post-traumatic osteoarthritis (PTOA). Interleukin-one beta (IL-1β) and Tumor Necrosis Factor-alpha (TNF-α) are key inflammatory factors shown to be involved in osteochondral degradation following IAF. As such, use of targeted biologics such as Infliximab (INX), a TNF-α inhibitor, and Anakinra (ANR), an interleukin-one (IL-1) receptor antagonist (IL1RA), may protect against PTOA by damping the inflammatory response to IAF and reducing osteochondral degradation. To test this hypothesis, IAFs were induced in the hindlimb knee joints of rats treated with INX at 10 mg/kg/day, ANR at 100 g/kg/day, or saline (vehicle control) by subcutaneous infusion for a period of two weeks and healing was evaluated at 8-weeks post injury. Serum and synovial fluid (SF) were analyzed for soluble factors. In-vivo microcomputed tomography (µCT) scans assessed bone mineral density and bone morphometry measurements. Cationic CA4+ agent assessed articular cartilage composition via ex vivo µCT. Scoring according to the Osteoarthritis Research Society International (OARSI) guidelines was performed on stained histologic tibia sections at the 56-day endpoint on a 0–6 scale. Systemically, ANR reduced many pro-inflammatory cytokines and reduced osteochondral degradation markers Cross Linked C-Telopeptide Of Type II (CTXII, p < 0.05) and tartrate-resistant acid phosphatase (TRAP, p < 0.05). ANR treatment resulted in increased chemokines; macrophage-chemotractant protein-1 (MCP-1), MPC-3, macrophage inhibitory protein 2 (MIP2) with a concomitant decrease in proinflammatory interleukin-17A (IL17A) at 14 days post-injury within the SF. Microcomputed tomography (µCT) at 56 days post-injury revealed ANR Treatment decreased epiphyseal degree of anisotropy (DA) (p < 0.05) relative to saline. No differences were found with OARSI scoring but contrast-enhanced µCT revealed a reduction in glycosaminoglycan content with ANR treatment. These findings suggest targeted cytokine inhibition, specifically IL-1 signaling, as a monotherapy has minimal utility for improving IAF healing outcomes but may have utility for promoting a more permissive inflammatory environment that would allow more potent disease modifying osteoarthritis drugs to mitigate the progression of PTOA after IAF.

Objective To compare the clinical efficacy of percutaneous minimally invasive reduction combined with external fixation and a tarsal sinus approach to treat Sanders type II and III intra‐articular calcaneal fractures. Methods The clinical data of 64 patients with Sanders type II and III calcaneal fractures admitted to our hospital from January 2010 to January 2016 were retrospectively analyzed; data includedage, sex, body mass index. According to the surgical method, they were divided into the percutaneous minimally invasive reduction with internal and external fixation group (30 cases) and the tarsal sinus approach group (34 cases).The two groups of patients were compared in terms of the time tosurgery, length of hospital stay, intraoperative blood loss, operative duration, complications, radiographic features, including the heel bone length, width, height, Bohlerangle, Gissane angle, and calcaneal varus angle, and clinical efficacy indicators, including the American Orthopedic Foot and Ankle Society (AOFAS) score, the visual analog scale (VAS) pain score, health survey profile (SF‐36) score and Maryland ankle function score. Results Patients in both groups were followed up for 12 to 50 months, with an average of 24.8 months.Bony union was achieved in all cases. The time to surgery, length of hospitalstay, intraoperative blood loss and incidence of incision‐related complications were significantly lower in the percutaneous minimally invasive medial external fixation group than in the tarsal sinus group (P 0.05). As measures of clinical efficacy, the AOFAS, VAS, SF‐36 and Maryland scores were 85.28 ± 8.21, 0.84 ± 1.21, 82.95 ± 3.25 and 83.56 ± 3.32, respectively, at the last follow‐up in the percutaneous minimally invasive medial external fixation group and 83.32 ± 7.69, 1.85 ± 1.32, 80.71 ± 5.42, and 81.85 ± 2.41 in the tarsal sinus group, respectively, with no significant differences between the two groups (P > 0.05). Conclusion Under the condition of a good command of surgical indications and surgical skills, the use of plastic calcaneal forceps for percutaneous minimally invasive reduction combined with medial external fixation for the treatment of Sanders type II and III intra‐articular calcaneal fractures can achieve similar clinical effects as the tarsal sinus approach. However, the use of plastic calcaneal forceps for percutaneous minimally invasive reduction combined with internal and external fixation has advantages, such as fewer complications, less bloodloss, and a shorter operation, and thus has good safety and is worthy of clinical promotion.

Purpose: This study compared screw and Kirschner-wire (K-wire) fixation for intra-articular fractures of the proximal phalanx head regarding the success of union and functional outcomes. Methods: In this retrospective study, we enrolled patients with closed intra-articular fractures of the proximal phalangeal head treated between January 2011 and December 2021. Patients with open wounds, tendon or neurovascular injuries, comminuted fractures, or middle phalangeal fractures were excluded. Patients' demographics, bone union, proximal interphalangeal (PIP) joint range of motion (ROM), grip power, and complications were collected and analyzed. The percentage of intra-articular surface involvement and the number of bone fragments were also analyzed in relation to the functional results. Results: Among 41 patients, 21 were managed with screw fixation, and the remaining 20 with K-wire fixation. The mean union rate was 100% in the screw fixation group and 95.0% in the K-wire fixation group, with no statistically significant difference (p=0.488). Other functional parameters (PIP joint ROM, time to bone union, and grip power) were not significantly different between the two groups. Regardless of the treatment modality, the PIP joint ROM showed significant negative associations with the involvement of more intra-articular surfaces (p<0.001) and the presence of a greater number of bone fragments (p=0.040). Conclusion: In intra-articular fractures of the proximal phalanx head, the treatment modality (screw or K-wire) did not affect the treatment outcome. Instead, the percentage of intra-articular surface involvement and the number of bone fragments showed significant negative associations with the PIP joint ROM after treatment. [ABSTRACT FROM AUTHOR]

Purpose: Minimally invasive plate osteosynthesis (MIPO) is used for the treatment of distal tibial fractures, especially in cases of intra-articular fractures. There are many advantages of MIPO, including preservation of blood supply to the fracture site and enhanced bone healing, however, it is not without complication. The study aimed to elaborate the benefits of MIPO technique in managing distal tibia fractures and to describe the necessities for good union and functional outcome. Methods: A total of 38 patients with distal tibia comminuted and spiral fractures, having closed distal tibia AO/OTA 43-A, B or C fractures with or without fibular fractures, were included. All the cases were assessed for union time, complications and functional outcomes. Binomial regression using R v3.6.0 was used to assess the success of MIPO based on four-cortex alignment. P value < 0. 0 5 was considered statistically significant. Results: The mean operative time was 70 min. All 38 tibial fractures united and the mean union time was found to be 18 weeks. Five cases were noted to have complications (four superficial infections and one implant failure). Out of 38 patients, 28 (majority) showed excellent functional outcomes as assessed by the American Orthopaedic Foot and Ankle Society score, i.e. a score of ≥ 90. Conclusion: MIPO is a good method for the management of tibial fractures with extra-articular and intra-articular involvement, with good union even when absolute four cortical contact is not achieved. [ABSTRACT FROM AUTHOR]

A twenty-four-year-old patient presented with elbow ankylosis with a range of motion of 5° secondary to failed osteosynthesis 11 months after the internal fixation of an intra-articular distal humerus fracture. The computed tomography scan showed the impaction of the coronoid process into a comminuted fracture of the trochlea, as well as the presence of heterotopic ossification. Intra-articular osteotomy was performed and the range of motion was improved to 90° (20° to 110° flexion). Ten years postoperatively, the range of motion, and the distance in the ulnohumeral joint space, was preserved. In the case of elbow ankylosis secondary to the failed osteosynthesis of the intraarticular distal humerus fracture and malunions with cartilage injury, intra-articular corrective osteotomy may help achieve congruency even when the articular cartilage is damaged. [ABSTRACT FROM AUTHOR]

Background: The aim of this retrospective monocentric study was to investigate the clinical efficacy of percutaneous reduction and screw fixation without bone grafting in Sanders Type-II and Type-III displaced intra-articular calcaneal fractures (DIACFs).Methods: The medical records of calcaneal fractures patients who were admitted to our department from January 2018 to January 2020 were retrospectively reviewed, and those meeting the inclusion criteria were fnally included for analysis. All patients were treated with percutaneous reduction and screw fixation, and no patients received bone grafting. The radiologic parameters evaluated included the BÖhler angle and the calcaneal height. In addition, the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot scores, Maryland Foot Score (MFS), and visual analog scale (VAS) score were determined.Results: Thirty-eight patients with Sanders Type-II and Type-III DIACFs were finally included, including 30 males and 8 females aged 21 to 61 years [(42.6 ± 9.6) years]. According to the Essex-Lopresti classification, 27 of the fractures were the tongue type, and 11 were the joint compression type. According to the Sanders classification, 27 of the fractures were type II, and 11 were type III. Immediately postoperatively, the calcaneal height had recovered to 39.8 ± 2.1 mm, the BÖhler angle had recovered from 4.2° ± 13.6° preoperatively to 27.2° ± 3.4° (P = 0.000). All patients were followed up for 18-42 months [(25.2 ± 9.5) months]. All fractures healed. No differences were found in the outcome measures six-months postoperatively (BÖhler angle, p = 0.24; calcaneal height, p = 0.82) or at final follow-up (BÖhler angle, p = 0.33; calcaneal height, p = 0.28) compared to the immediately postoperative values. At the final follow-up, the AOFAS score was 91.7 ± 7.4 points, with an excellent and good rate of 92.1%; the MFS was 90.3 ± 7.8 points, with an excellent and good rate of 92.1%; and the VAS score was 2.2 ± 1.5 points. None of the patients had incision complications, and one patient developed traumatic arthritis.Conclusion: Percutaneous reduction and screw fixation without bone grafting in Sanders Type-II and Type-III DIACFs can achieve good recovery and maintenance of the BÖhler angle and calcaneal height. Moreover, it has the advantage of a low complication rate. [ABSTRACT FROM AUTHOR]

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We report two patients with reconstruction of osteochondral defects of the proximal interphalangeal joint (PIPJ) using a costal osteochondral graft (COG). A box-cut osteotomy was done at the end of the phalanx preserving the lateral cortices and the insertion of the collateral ligaments. A COG was harvested from the rib, moulded and press fit into the groove formed by the box-cut osteotomy. The COG was fixed with mini screws in the coronal plane (dorsal to palmar) and the fixation off-loaded with an external fixator. This technique maintained the collateral ligament in-situ and is useful in reconstruction of chondral defects of the PIPJ. Level of Evidence: Level V (Therapeutic) [ABSTRACT FROM AUTHOR]

Objective To develop a post‐traumatic osteoarthritic model of hip following fracture of acetabulum in rabbit for revealing biochemical mechanism of post‐traumatic osteoarthritis. Methods A total of 36 mature male New Zealand white rabbits were equally divided into sham group (n = 12), non‐ORIF group (n = 12), and open reduction and internal fixation (ORIF) group (n = 12). Except for the sham group, rabbits had survival surgeries to create acetabular fractures of dorsal wall for simulating dashboard impaction mechanism. The ORIF group received open reduction and internal fixation, while fractures in the non‐ORIF group were left as displaced but transverse fracture and dislocation was reduced. Besides intraoperative appearance and postoperative recovery, macroscopic and radiographic characteristics of the hips were recorded and assessed by a radiographic scoring scale at 3 weeks, 6 weeks, and 6 months, respectively. Results Out of 24 modeled acetabula, 21 (87.5%) were pure dorsal wall fractures as proposed and the remaining three were associated fractures (dorsal wall plus transverse fracture) accompanied by dorsal dislocation or not. All hips were stable, and no sciatic nerve injury was observed. One rabbit in the ORIF group died of deep infection 4 days after surgery. Rabbits in the sham and ORIF groups returned to normal gait in 2 weeks, but animals in the non‐ORIF group suffered from limping and restricted movement. As the time progressed, the hips in the non‐ORIF group experienced progressive and severe degeneration which exhibited dramatically malformed and hypertrophic joints at 6 months, but the ORIF group maintained much better morphological structure. Corresponding to morphological changes, the average radiographic scores of the non‐ORIF group increased from 1.25 at 3 weeks to 2.75 at 6 months and showed statistically significant difference when compared to the sham group at all three time points (P = 0.011, 0.011, 0.015, respectively,

Backgrounds: Proximal interphalangeal (PIP) joint injuries can cause scar contractures by different mechanisms, leading to significant functional loss, the most important thing in the treatment process is to maintain joint mobility, in this way, scar formation will be reduced. Dynamic external fixators have been used for this purpose. Although it is an old method, it has many unknown aspects. Materials and Methods: Nineteen patients participated in our study. The patients were divided into two groups as those who were treated immediately after the injury and those who applied in the late period. All patients were treated with pin and rubber traction systems (PRTS). After 6 weeks of traction, the fixator was removed. Patients were assessed with X-rays for the amount of distraction, Visual Analog Scale score for pain and quick DASH scores for satisfaction. The patients were also examined for passive and active range of motion (AROM) in all controls. Results: We compared the preoperative and postoperative data of the patients and also we compared the amount of distraction with functional gain. There was no relationship between the increase in PIP joint space distance and posttreatment PIP joint AROM values. Hence, the amount of distraction on the joint space distance has no direct effect on the functional results. Another important result of the study is that the loss of extension in the PIP joint, which can be unregarded in the early period, negatively affects the late results. The other important result of our study is that successful results can be obtained when applied in combination with surgery in delayed cases. Conclusion: The use of PRTS has an important role in the treatment of PIP joint injuries. In our study, we have shown that satisfactory results can be obtained in both acute and delayed cases when combined with additional surgery or applied alone. The change in joint space distance during the patient follow-up is not an important issue in terms of range of motion. Another important result we obtained from the study is the demonstration that PRTS can be successfully used in untreated joint dislocations in a single stage.

Isolated unicondylar fractures of the distal femur are rare injuries, accounting for 3–6 % of adult femur fractures. The association with a femoral shaft fracture is very rare and, to our knowledge, has, never been described in the literature. In this article, we report the case of a 19-year-old motorcyclist involved in an accident, that resulted in both a midshaft transverse femoral fracture and an ipsilateral sagittal fracture of the medial femoral condyle (Trélat fracture). The surgical intervention involved open reduction and internal fixation for both fractures, utilizing a dynamic compression plate for the femoral shaft fracture and screws for the medial condyle fracture. Postoperative results showed excellent fracture reduction, and the patient progressed well with rehabilitation. The choice of fixation method for the sagittal medial femoral condyle fracture considered the unique anatomical challenges posed by this rare combination, the emergency (fat embolism), and the fact we didn't have a retrograde nail in our structure. A dynamic compression plate was used for femoral shaft fracture and screw fixation for condyle fracture treatment. The traction table in anterograde femoral nailing, led to the recurvatum of the condylar fracture and difficulty accessing it with the medial subvastus approach. This case report adds a description of a rare combination and valuable insight into the management of complex femoral fractures, emphasizing the importance of individualized treatment approaches. • This is a case of the association of sagial medial femoral fracture associated with an ipsilateral femoral shaft fracture, an extremely rare combination. • Operation was performed with a dynamique compressuin plate for femoral shaft and screw fixation for the medial femoral condyle for the no availibility of an retrograde nail in our structure. • The implants fitted well and the patient had a good fonctional income at 14 moths of followup. • This implants could be a option for this fracture assocaiation. [ABSTRACT FROM AUTHOR]

ABSTRACT Introduction We evaluated the clinical and radiological outcomes of capitellar fractures treated with modified screw insertion (inserting the first fixation screw anteroposteriorly and the second screw posteroanteriorly), a technique that can be applied with a minimally invasive lateral elbow approach. Materials and Methods Twenty-one isolated capitellum fractures that were surgically treated were included in the study. Fixation was achieved with two headless cannulated compression screws placed in anteroposterior and posteroanterior order using the modified lateral elbow approach. The Broberg-Morrey rating system was used to assess the post-operative functional status of the patients. Results According to the Broberg-Morrey criteria, the mean score was 92.7 (77-100) and 13 cases had excellent, 7 had good, and 1 had fair results. None of the patients developed avascular necrosis or heterotopic ossification. According to the Broberg-Morrey arthrosis score, two cases had Grade 1 and one had Grade 2 arthrosis. One patient had a superficial wound site infection that was treated with antibiotics, and in one case a 60° extension loss was observed in the elbow. Conclusion Treatment of isolated capitellar fractures with 2 headless screws placed anteroposteriorly and posteroanteriorly can provide stable fixation and is less traumatic for the elbow joint. Level of Evidence IV; Therapeutic Studies - Investigating the results of treatment.

Animal models of osteoarthritis (OA) are essential tools for investigating the development of the disease on a more rapid timeline than human OA. Mice are particularly useful due to the plethora of genetically modified or inbred mouse strains available. The majority of available mouse models of OA use a joint injury or other acute insult to initiate joint degeneration, representing post-traumatic osteoarthritis (PTOA). However, no consensus exists on which injury methods are most translatable to human OA. Currently, surgical injury methods are most commonly used for studies of OA in mice; however, these methods may have confounding effects due to the surgical/invasive injury procedure itself, rather than the targeted joint injury. Non-invasive injury methods avoid this complication by mechanically inducing a joint injury externally, without breaking the skin or disrupting the joint. In this regard, non-invasive injury models may be crucial for investigating early adaptive processes initiated at the time of injury, and may be more representative of human OA in which injury is induced mechanically. A small number of non-invasive mouse models of PTOA have been described within the last few years, including intra-articular fracture of tibial subchondral bone, cyclic tibial compression loading of articular cartilage, and anterior cruciate ligament (ACL) rupture via tibial compression overload. This review describes the methods used to induce joint injury in each of these non-invasive models, and presents the findings of studies utilizing these models. Altogether, these non-invasive mouse models represent a unique and important spectrum of animal models for studying different aspects of PTOA.