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Objectives: The current standard of care for an amputee is a socket-based prostheses. An osseointegrated implant (OI) is an alternative for prosthetic attachment. Osseointegration addresses reported problems related to wearing a socket interface, such as skin issues, discomfort, diminished function, quality of life, prosthetic use, and abandonment. The purpose of this report is to systematically review current literature regarding OI to identify and categorize the reported clinically relevant outcome measures, rate the quality of available evidence, and synthesize the findings., Data Sources: A multidisciplinary team used PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methods. Search methodology was based on identifying clinically relevant articles. Three databases were searched: PubMed, CINAHL, and Web of Science., Study Selection: Clinical studies with aggregated data reporting at least 1 clinically relevant outcome measure were included., Data Extraction: The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criterion was used for critical appraisal and recommendations., Conclusions: This review identified 21 clinically relevant observational studies. Outcome measures were categorized into the following 9 categories: vibratory stimulation, complications, biomechanics, economics, patient-reported outcome measures, electromyography, x-ray, physical functional performance, and energy consumption. This systematic review consisted of Level III and IV observational studies. Homogeneous outcome measures with strong psychometric properties across prospective studies do not exist to date. Higher-level, prospective, randomized, long-term, clinically relevant trials are needed to prove efficacy of OI compared with socket prosthetic attachment. Osseointegration was at least equivalent to sockets in most studies. In some cases, it was superior. Osseointegration represents a promising alternative to socket prosthetic attachments for extremity amputees., Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Background: This literature review was undertaken to determine if commonly held views about the benefits of a bone bridge technique are supported by the literature., Methods: Four databases were searched for articles pertaining to surgical strategies specific to a bone bridge technique of the transtibial amputee. A total of 35 articles were identified as potential articles. Authors included methodology that was applied to separate topics. Following identification, articles were excluded if they were determined to be low quality evidence or not pertinent., Results: Nine articles were identified to be pertinent to one of the topics: Perioperative Care, Acute Care, Subjective Analysis and Function. Two articles sorted into multiple topics. Two articles were sorted into the Perioperative Care topic, 4 articles sorted into the Acute Care topic, 2 articles into the Subjective Analysis topic and 5 articles into the Function topic., Discussion: There are no high quality (level one or two) clinical trials reporting comparisons of the bone bridge technique to traditional methods. There is limited evidence supporting the clinical outcomes of the bone bridge technique. There is no agreement supporting or discouraging the perioperative and acute care aspects of the bone bridge technique. There is no evidence defining an interventional comparison of the bone bridge technique., Conclusion: Current level III evidence supports a bone bridge technique as an equivalent option to the non-bone bridge transtibial amputation technique. Formal level I and II clinical trials will need to be considered in the future to guide clinical practice. Clinical relevance Clinical Practice Guidelines are evidence based. This systematic literature review identifies the highest quality evidence to date which reports a consensus of outcomes agreeing bone bridge is as safe and effective as alternatives. The clinical relevance is understanding bone bridge could additionally provide a mechanistic advantage for the transtibial amputee.

Osseointegration (OI) is a bone-anchoring procedure that allows the direct skeletal attachment of a prosthesis through the use of an implant. Transcutaneous OI implants are similar to subcutaneous intramedullary joint implants with some exceptions. Particularly, OI implants are inserted at the distal aspect of the femur, while intramedullary implants are inserted at the proximal aspect of the femur. In this report, an additional adaptation of the radiographic zonal analysis used for intramedullary implants, known as Gruen zones, is introduced to include OI implants of extremity prosthetics. Radiographic zonal analyses and interpretations are proposed. Gruen zones are used for intramedullary implants, which are generally inserted from the proximal aspect of the bone. OI extremity implants are inserted from the distal end of the bone. Therefore, the zonal analysis is inverted. A radiographic zonal analysis has been introduced by the Osseointegration Group of Australia (OGA). This analysis is needed specifically for the clinical evaluation of extremity OI, as significant changes to the bone and OI implant have been reported and need to be clinically described. A classification technique is necessary for establishing treatment guidelines for the extremity osseointegrated implant. The OGA Zonal analysis addresses this need by adapting a common reference standard to osseointegration of the extremity amputee., Competing Interests: Authors declare no conflicts of interest.

Fractures of the body of the trapezium are uncommon. Ten such cases are reported. They may be associated with other carpal or metacarpal fractures and may require special radiographic views for diagnosis. There does not appear to be a consistent mechanism of injury. A classification system is proposed based on the five fracture configurations identified. Open reduction with internal fixation of the displaced articular surface is preferred.

Methods of treating fibrosarcoma are difficult to assess because of the slow growth and relative infrequency of the tumor and individual variability. Longitudinal amputation, a method of complete origin to insertion compartmental excision of a soft tissue fibrosarcoma, is presented along with a discussion of indications, contraindications, and surgical technique.

Arthrodesis of selected small joints of the hand is often indicated; however, in previously reported series nonunion is not uncommon. There were 171 consecutive arthrodeses of small joints performed on 134 patients. The operative method employed was essentially the method described by Littler. Emphasis was placed on the accurate coaptation of bone surfaces, the use of cancellous bone graft when needed, maintenance of the coaptation with Kirschner wires, and the need for postoperative immobilization. This technique resulted in union of 170 out of 171 arthrodeses (a nonunion rate of 0.6%). There were no infections. There were four delayed unions.

Thirty-eight children (39 hips) with septic arthritis have been reviewed in an effort to determine the factors most important to prognosis of the hip joint. The younger patients, 3 or more years later, had poorer results by roentgenographic classification. This was particularly true of patients under one year of age. Longer duration of disease from clinical onset to initiation of therapy also resulted in a poorer result. The outcome could not be clearly correlated with the causative organism or with open as opposed to closed treatment although the policy of management was strongly biased to open drainage. Sixty per cent of the infections were caused by Staphylococcus aureaus and the majority of the other cases by Streptococcus pyogenes and Hemophilus influenzae. The nonstaphylococcal organisms may be less destructive to the femoral head in infants.

The costo-clavicular ligament is always ruptured in dislocation at the sterno-clavicular joint. Anterior, superior or posterior displacement of the medial end of the clavicle may occur. Acute dislocation usually responds to conservative treatment and operation is seldom required. Chronic, or recurrent, dislocation may cause pain and disability on strenuous activity and necessitate surgical treatment. The operation of tenodesis of the subclavius tendon with capsulorrhaphy described by Burrows (1951) has been adopted. The intraarticular meniscus is often damaged and displaced, and may block reduction; its removal is then necessary. In addition, a threaded Stinmann pin transfixing the joint has been found useful to maintain the stability of reduction. The operation has been performed on five patients, four of whom had excellent results. The fifth patient disrupted the repair in a drinking bout shortly after the operation.