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Posterior and anterior fusion procedures with instrumentation are well-known surgical treatments for scoliosis. Rod migration has been described as unusual complication in anterior spinal instrumentations; migration beyond pelvis is a rare complication. A 32-year-old female presented to the consultant with right thigh pain, rod migration was diagnosed, rod extraction by minimal approach was performed, and spinal instrumentation after nonunion diagnosis was underwent. A rod migration case to the right thigh is presented; this uncommon complication of spinal instrumentation should be ruled out as unusual cause of sudden pain without any other suspicions, and long-term follow-up is important to prevent and diagnose this problem.

Introduction: Bisphosphonates are commonly prescribed to mitigate the effects of osteoporosis, a condition associated with an increased risk of fracture. However, despite their success, there has been growing concern regarding the long-term use of bisphosphonates because of the increased risk of atypical subtrochanteric fractures of the femur (AFFs). The objective of this study was to describe a cohort of patients with AFFs and evaluate the risk of evolving to non-union, the time of consolidation associated with the location of the fracture, the time of use of the drug, and the implant involved in its treatment., Methods: This retrospective study recruited patients between June 2008 and May 2018. We identified patients with AFFs according to the task force criteria and a history of bisphosphonate use. We included all patients older than 65 years, with long-term use of bisphosphonates, AFF criteria according to the task force, and a follow-up of 12 months or longer. We studied the following variables: the time of use of bisphosphonates, localization of the fracture according to Hyodo et al., implant use, and fracture healing time, considering the presence of bone callus observed in two radiologic projections, which were measured in weeks., Results: Between June 2008 and May 2018, 72 patients met the task force criteria for AFFs. A total of 67 patients were included in this study. From this total, 37 were in the proximal region of the femur and 31 corresponded to the diaphyseal region. Univariate and multivariate analyses showed statistical significance in the time of bone healing compared with the different locations of the fracture along the femur., Conclusion: According to our study, the localization of AFFs in patients with a history of bisphosphonate use influences the duration of bone healing., Competing Interests: Declaration of Competing Interest The authors have no conflict of interest to declare., (Copyright © 2023. Published by Elsevier Ltd.)

Introduction: The most universal method for classifying pertrochanteric fractures is the AO/OTA classification. These fractures are classified into different categories according to the features found in the anteroposterior radiograph of the hip. Anteroposterior radiograph of the hip with internal rotation traction can improve the characterization of the fracture. Inter- and intra-observer reliability in any classification is essential to achieve a homogeneous agreement for decision making. Our objective is assessing the overall reliability and by level of experience of the new AO/OTA classification of pertrochanteric fractures., Materials and Methods: A hospital registry was used to collect patients with pertrochanteric hip fracture who had anteroposterior radiograph of the hip with and without internal rotation traction. We selected six evaluators stratified by levels of expertise in orthopedic trauma, leaving three groups: advanced, intermediate and beginner. Radiographs were sent through electronic forms and inter- and intra-observer reliability was calculated using the kappa (K) statistic., Results: 115 (one hundred fifteen) patients were included, each with their corresponding anteroposterior radiograph of the hip with and without internal rotation traction. Overall inter- and intra-observer reliability was moderate on both anteroposterior radiographs of the hip with and without internal rotation traction. Regarding the different levels of experience, the advanced level group reached a substantial inter- and intra-observer reliability in both anteroposterior radiographs with and without traction, while the rest of the groups with lower level of experience obtained a lesser reliability., Conclusion: Our study found that the internal rotation traction x-ray did not improve the reliability of the new AO/OTA classification for pertrochanteric fractures, as assessed by inter- and intra-observer agreement, in either the overall group or in groups divided by experience level., Competing Interests: Declaration of Competing Interest None., (Copyright © 2023. Published by Elsevier Ltd.)

Purpose: Functional outcome in patients after trochanteric fracture fixation with pre-existing radiographic osteoarthritis (OA) is unclear. Analyzing their function and independence, before and after fracture, could optimize their treatment and decrease the socioeconomic burden in this particular group., Methods: The influence of pre-existing radiographic hip OA on functional outcome was retrospectively analyzed with a cohort of patients undergoing proximal femoral nailing for trochanteric fracture. OA was graded according to the Tonnis classification. Functional outcome was assessed preoperatively and 12 months after surgery by the Parker Mobility Score (PMS). We consider a meaningful reduction a difference between preoperatively PMS and 12 months after surgery ≥ 2. In order to evaluate if OA is related to PMS reduction ≥ 2, we calculate the SubHazard ratio (SHR) performing a competing risk regression model considering death as a competing risk event, adjusting by confounders. Death, reoperations, readmissions, surgical time, and fracture reduction quality in patients with and without osteoarthritis were recorded., Results: 375 trochanteric hip fractures treated with cephalomedullary nails were included, from which 80 (21% CI95% 17%-21%) were classified as Tonnis 2 or 3. This group of patients with pre-existing OA was significantly older (mean age of 88.6 [SD 5.65] vs 85.5 years [SD 6.95]) than the group without OA. The preoperatively PMS score was 6.28 (2.71) in non-OA patients and 5.69 (2.67) in OA patients. The mean PMS reduction 12 months after surgery was 1.3 (SD 2.05) in OA patients and 1.07 (SD 2.2) in non-OA patients (p = 0.43). Competing risks analysis, adjusted by confounders had an SHR of 1.15 (IC95% 0.77 - 1.69). Death, readmission, reoperations, surgical time, and fracture reduction quality did not differ in both groups., Conclusions: Patients with pre-existing radiographic OA treated with femoral nailing have a similar reduction in functional outcomes compared to the non-OA group at one-year follow-up. Further studies will be needed to compare the results of the functional outcome in arthroplasty with those of femoral nailing for the treatment of trochanteric femur fractures in patients with OA., Competing Interests: Declaration of Competing Interest The authors have no conflict of interest to declare., (Copyright © 2023. Published by Elsevier Ltd.)

Background: Ankle fractures are commonly treated with non-surgical or surgical (preferably ORIF) approaches based on fracture characteristics. The postoperative care regimens vary widely, and the impact of very early mobilization on complications and reoperation rates in ankle fractures treated with ORIF remains unclear., Methods: A retrospective analysis was conducted on ankle fractures treated between January 2014 and November 2020. Demographic and fracture characteristic data were collected. Very early prescription of range of motion exercises was defined as initiation within the first week after surgery, typically between the second and seventh postoperative day. Complications, reoperations, and time to these events were analyzed. Kaplan Meier survival analysis was performed to assess the risk of complications with very early mobilization., Results: A total of 299 patients met the inclusion criteria. The cohort included 83 unimalleolar, 77 bimalleolar, and 138 trimalleolar fractures. Of the patients, 116 (38.8%) underwent very early range of motion. Complications occurred in 45 events among 39 patients (13%), with 16 events (41%) in the very early range of motion group. Reoperations were required for 23 patients (3.67% of the cohort). No statistically significant differences were found in the analysis of complications, with a hazard ratio (HR) of 1.17, and in the adjusted analysis with an HR of 1.12. Similarly, the reoperation analysis showed no significant differences, with an HR of 0.85 and 0.68 in the adjusted analysis., Conclusion: Very early prescription of range of motion exercises in ankle fractures treated with ORIF is a safe approach, as it does not increase the rates of complications or reoperations compared to early or late mobilization. This study supports the use of very early mobilization as a rehabilitation method for ankle fractures., Competing Interests: Declaration of Competing Interest The authors have no conflict of interest to declare., (Copyright © 2023. Published by Elsevier Ltd.)

Introduction: Acetabular fractures are devastating injuries that can affect patients of different ages, as well as being associated with high or low energy trauma. Conversion to total hip arthroplasty (THA) results in increased complication rates, resource use and costs compared to primary THA due to osteoarthritis. The aim of this paper is to describe a retrospective cohort of patients over 65 years of age who presented with an acetabular fracture and were treated with open reduction and internal fixation (ORIF)., Methods: A retrospective cohort study was conducted from January 2002 to December 2017. The study identified all patients over 65 years of age who suffered an acetabular fracture and were treated primarily with ORIF. The quality of reduction, fracture pattern and associated poor prognostic factors for fracture were analyzed., Results: A total of 50 cases of acetabular fractures in patients over 65 years of age were included. Six of them required conversion to THA (12%). In 3 of these cases conversion surgery was performed because of pre-existing osteoarthritis, pain, and postoperative progression of osteoarthritis. The main factors involved in the conversion cases were intra-articular fragments, femoral head protrusion and posterior wall comminution. Postoperative intra-articular gap had a p = 0.01 in linear regression analysis for conversion to arthroplasty., Conclusion: The conversion rate reported in our cohort of elderly patients is similar to that reported in the literature in patients of all age ranges. The quality of reduction was a significant factor in predicting progression to conversion to THA., Competing Interests: Declaration of Competing Interest The authors have no conflict of interest to declare., (Copyright © 2023. Published by Elsevier Ltd.)

Introduction: Intramedullary nailing is the most frequent procedure used for the treatment of tibial fractures that do not involve the articular surfaces. The goal of this study is to analyse the clinical outcomes, time of surgery and use of fluoroscopy in patients with midshaft and distal tibial fractures treated with suprapatellar and infrapatellar nailing and compare the results between these different groups., Methods: A retrospective study was conducted, and patients were selected between the period of March 2018 and October 2019. The following variables were studied: age, gender, AO classification, time of surgery (minutes), time of fluoroscopy (seconds), quality of reduction in postoperative controls and 1 year follow-up (using the angles MPTA, LDTA, PPTA, ADTA). Functional outcomes were studied at 1 month and 1 year follow-up. The visual analogue scale was used to study and compare the postoperative pain of the patients. The Lysholm Knee Score was used to evaluate the functional outcomes of the patients., Results: A total of 80 patients meeting the inclusion criteria were included in this study. The suprapatellar approach was used in 44 patients and the infrapatellar in 36 patients. The time of surgery (p=0.008) and the mean time of use of fluoroscopy (p <0.001) difference were significant in favour of the suprapatellar approach. In the quality of reduction analysis, we have statistically significant results in the LDTA and ADTA angles. Also, in the evaluation of postoperative pain, significant difference was found in favour of the suprapatellar approach., Conclusion: In conclusion, our study compared the suprapatellar approach and the infrapatellar approach for the treatment of midshaft and distal tibia fractures with intramedullary nailing. The results showed lesser time of surgery and use of fluoroscopy, lower knee pain, and lower rate of malalignment with the suprapatellar approach than with the infrapatellar approach., (© 2022. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)

Introduction: Ankle syndesmosis injuries can be associated with a spiral mechanism on tibial shaft fractures. We are not aware if there is evidence of the incidence of ipsilateral syndesmotic lesson associated to high-energy tibial shaft fracture mechanisms. The aim of this study was to analyze the incidence of syndesmotic injuries associated with high-energy tibial shaft fractures., Methods: 233 diaphyseal tibial fractures operated between January 2007 and January 2017, the fracture patterns were analyzed, they were classified according to AO, the talocrural angle was measured, they analyzed failures and reoperations and described a novel failure method., Results: From a total of 234 fractures that met the inclusion criteria, 159 (64.96%) suffered closed fractures and 75 (32.05%) where open fractures. According to the AO classification system: 152 (64.10%) were simple patterns 42.A; 49 (20.94%) wedge type patterns 42.B and 33 (14.10%) complex patterns 42.C. Ten patients, a 4.27% of the sample, shown an increased talocrural angle in the postoperative radiographs, evidencing shortening of the fibula. Nine patients underwent surgery, the remaining patient was lost to follow-up. All the treated patients presented restoration of the normal talocrural angle., Conclusion: The incidence of syndesmotic injuries associated with high-energy tibial shaft fractures reaches 4.27%. We think that is necessary to evaluate the ankle and syndesmosis in all tibial shaft fractures, even with high-energy patterns, not only in spiral patterns., (Copyright © 2021 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.)

Calcaneal fractures are the most frequent of the tarsus (3.5% of all fractures). Young adults are mainly affected, being more frequent in men (5.9:1). On the other hand, ligament injuries associated with fracture of the calcaneus are very infrequent. We describe a case of a 39 year old patient who suffered ankle trauma. He presented instability in plantar flexion and inversion. A fracture of the calcaneus was diagnosed. During surgery, a complete lesion of the lateral ligament complex was found. The reduction and osteosynthesis associated with ligament reconstruction was performed. We consider important to confirm the stability of the ankle after a calcaneus fracture. Lack of diagnosis in this type of injuries can evolve into chronic instability.

Background: Common failure modes of dynamic hip screw are cut-out and lift-off. To minimize the latter, distal screws can be inserted in different orientations. However, the effectiveness remains controversial. The aim of this study was to biomechanically investigate the influence of distal screw orientation on construct stability., Methods: Thirty artificial generic long bones were assigned to three groups (n = 10) and fixed with two-hole dynamic hip screw-plates, inserting distal cortical screws with neutral parallel screw orientation (A), divergent screw orientation (B) or convergent screw orientation (C). Starting at 60 N, cyclic loading was applied to the implant tip perpendicular to the lag screw axis with progressive peak load increase at a rate of 0.002 N/cycle until failure. Parameters of interest were construct stiffness and machine actuator displacement after 250, 1000 and 5000 cycles, as well as cycles to failure., Results: Displacement after 250, 1000 and 5000 cycles was significantly higher in Group C than in Groups A and B, p  < 0.01, whereas no significant differences were observed between Groups A and B, p  = 0.20. Specimens in Group C failed after 11,584 [standard deviation (SD), 5924] cycles, significantly earlier than those in Groups A and B [A: 27,351 (SD, 12,509); B: 28,793 (SD, 14,764)], p  ≤ 0.02. Cycles to failure were not significantly different between Groups A and B, p  > 0.99., The Translational Potential of This Article: Parallel or divergent distal screw insertion provides similar construct stability in terms of resistance to plate lift-off. In contrast, converging screw insertion leads to inferior stability and is not advisable from a biomechanical point of view.

Background: A clinical registry encompasses a selective set of rigorously collected and stored clinical data focused on a specific condition. Hip fracture is a common complication of osteoporosis in elderly patients. Hip fracture substantially increases the risk of death and major morbidity in the elderly patients. Limited data regarding hip fracture are available from Latin America and Argentina. The purpose of this project is to create an institutional registry of elderly patients with hip fracture in order to obtain data that reveal the impact of this disease in our environment, allowing us to evaluate different strategies of patient's care and clinical outcomes., Objective: To describe the implementation of an institutional registry of elderly patients with hip fracture in Argentina., Methods: In this article, we described the creation, implementation, and data management of a prospective registry of elderly patients with hip fracture. The registry contains information on baseline demographics, comorbidities, laboratory, and radiological data. Follow-up at 3 and 12 months postfracture is done by phone interview to assess physical function, readmissions, and morbi-mortality. Clinical Trials registry number NCT02279550., Conclusion: In this project, we have created a hip fracture registry. We hope that this registry will provide valuable data that can lead us to new lines of research, addressed to answer questions raised in clinical practice.

Introduction: Treatment of posterior pelvic ring injuries is frequently associated with pain or/and high mortality rates. Percutaneous sacro-iliac (SI) screw fixation has proved to be one of the methods of choice, providing minimal operative time, blood loss and wound-related morbidity. However, fixation failures due to secondary fracture dislocation or screw backing out have been reported. There is a little knowledge regarding the impact of varying screw orientation and quality of reduction on the fixation strength., Purpose: The purpose of the present study was biomechanical investigation of joint stability after SI screw fixation and its dependence on quality of reduction and screw orientation., Methods: Thirty-two artificial hemi-pelvices were assigned to four study groups and simulated SI dislocations were fixed with two SI screws in oblique or transverse screw orientation and anatomical or non-anatomical reduction in group A (oblique/anatomical), B (transverse/anatomical), C (oblique/non-anatomical) and D (transverse/non-anatomical). Mechanical testing was performed under progressively increasing cyclic axial loading until fixation failure. SI joint movements were captured via optical motion tracking. Fixation performance was statistically evaluated at a level of significance p = 0.05., Results: The highest cycles to failure were observed in group A (14038 ± 1057), followed by B (13909 ± 1217), D (6936 ± 1654) and C (6706 ± 1295). Groups A and B revealed significantly longer endurance than C and D (p ≤ 0.01)., Conclusions: Different screw orientations in the presented model do not influence substantially SI joint stability. However, anatomical reduction is not only mandatory to restore a malalignment, but also to increase the SI screw fixation strength and prevent fixation failures.

Compartment syndrome of the thigh is an uncommon pathology, and its acute presentation after spinal surgery is rare. Because a large muscle mass is involved and systemic manifestations of crush syndrome and altered mental status are present, such abnormalities may lead to a delay in appropriate diagnosis and subsequent treatment. A 56-year-old man who was suspected of having a posterior compartment syndrome in the thigh after spinal decompression in the knee-chest position was evaluated clinically and with the use of a catheter for intracompartmental pressure measurement as a tool to help establish the diagnosis and monitor the evolution. Because of sciatic involvement and a demonstrated increase in the pressure in the posterior compartment with myoglobinuria and acute renal failure, prompt longitudinal fasciotomy was performed with excellent neurologic recovery and improvement of both clinical parameters and mental status.