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Nie S, Li J, Liu X, Liu J, Wu X, Tang P, Zhao Y, Li M, Zhang L. The clinical efficacy of Medial Sustain Nail(MSN) and Proximal femoral nail anti-rotation(PFNA) for fixation of medial comminuted trochanteric fractures: a prospective randomized controlled trial. INTERNATIONAL ORTHOPAEDICS 2024; 48:2189-2200. [PMID: 38772935 DOI: 10.1007/s00264-024-06220-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 04/30/2024] [Indexed: 05/23/2024]
Abstract
PURPOS To evaluate the clinical efficacy of the Medial Sustain Nail (MSN) for medial comminuted trochanteric fractures fixation in comparison to Proximal Femoral Nail Antirotation (PFNA) through a clinical study. METHODS A non-inferiority randomized controlled trial was conducted at a single centre between July 2019 and July 2020. Fifty patients diagnosed comminuted trochanteric fractures were randomly assigned to either the MSN group (n = 25) or the PFNA group (n = 25). A total of forty-three patients were included in the final study analysis. The primary outcome measure was Short Form 36 health surgery physical component summary (SF-36 PCS) score. Secondary outcomes included the Oxford Hip Scores (OHS), weight bearing, complication relate to implant and so on. This study was not blined to surgeons, but to patients and data analysts. RESULTS The MSN demonstrated significantly better functional outcomes as measured by SF-36 PCS and OHS at six months postoperative compared to PFNA (p < 0.05). Union of fractures in the MSN group reached 90.9% at three months after surgery, whereas the PFNA group achieved a union rate of 57.1% (p < 0.05). Furthermore, weight-bearing time of MSN group was earlier than PFNA group (p < 0.05). Additionally, complications related to implant usage were more prevalent in the PFNA group (33.3%) compared to the MSN group (4.5%) (p < 0.05). CONCLUSION MSN exhibited superior quality of life outcomes compared to PFNA at six months postoperative. This indicates that MSN effectively reconstructs medial femoral support in patients with comminuted trochanteric fractures, which facilitates early weight-bearing and accelerates the recovery process. TRIAL REGISTRATION Trial registration number: NCT01437176, Date of the trial registration:2011-9-1, Date of commencement of the study:2011-9, Date of enrolment/recruitment of the study subjects:2019-7.
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Affiliation(s)
- Shaobo Nie
- Department of Orthopaedics, The First Medical Centre of Chinese PLA General Hospital, Beijing, 100853, China
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, 100853, China
| | - Jiantao Li
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, 100853, China
- Senior Department of Orthopaedics, The Fourth Medical Center of Chinese, PLA General Hospital, Beijing, 100853, China
| | - Xiao Liu
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, 100853, China
- Senior Department of Orthopaedics, The Fourth Medical Center of Chinese, PLA General Hospital, Beijing, 100853, China
| | - Jianheng Liu
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, 100853, China
- Senior Department of Orthopaedics, The Fourth Medical Center of Chinese, PLA General Hospital, Beijing, 100853, China
| | - Xiaoyong Wu
- Department of Orthopaedics, The First Medical Centre of Chinese PLA General Hospital, Beijing, 100853, China
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, 100853, China
| | - Peifu Tang
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, 100853, China
- Senior Department of Orthopaedics, The Fourth Medical Center of Chinese, PLA General Hospital, Beijing, 100853, China
| | - Yanpeng Zhao
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, 100853, China.
- Senior Department of Orthopaedics, The Fourth Medical Center of Chinese, PLA General Hospital, Beijing, 100853, China.
| | - Ming Li
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, 100853, China.
- Senior Department of Orthopaedics, The Fourth Medical Center of Chinese, PLA General Hospital, Beijing, 100853, China.
| | - Licheng Zhang
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, 100853, China.
- Senior Department of Orthopaedics, The Fourth Medical Center of Chinese, PLA General Hospital, Beijing, 100853, China.
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Zakusylo A, Escobar JA, Toci GR, Nakashian MN, Fletcher D, Katt BM. Capitate Fracture Subsequent to Capitolunate Staple Fusion: A Case Report. J Hand Microsurg 2024; 16:100021. [PMID: 38854383 PMCID: PMC11127519 DOI: 10.1055/s-0043-1761224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023] Open
Abstract
We report a case of a 71-year-old man who underwent capitolunate fusion for scapholunate advanced collapse. At the patient's 4-month follow-up, there was evidence of a fracture at the distal staple tine. He subsequently underwent removal of staple hardware with revision open reduction internal fixation using headless compression screw fixation and bone grafting. The literature review aimed to identify possible mechanisms and analyze similar cases of this complication. We presume that the fracture resulted from increased stress on the bone from both drill holes and the orientation of the staples. Placing the tines in different planes may decrease the risk of this complication.
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Affiliation(s)
- Anna Zakusylo
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States
| | - Jared A. Escobar
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States
| | - Gregory R. Toci
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, United States
| | | | - Daniel Fletcher
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, United States
| | - Brian M. Katt
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States
- Orthopaedic Institute Brielle Orthopaedics, Brielle, New Jersey, United States
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Su AW, Johns WL, Bansal S. Martial Arts: Orthopaedic Injuries and Related Biomechanics. J Am Acad Orthop Surg 2024; 32:e1-e12. [PMID: 37531453 DOI: 10.5435/jaaos-d-23-00261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 06/05/2023] [Indexed: 08/04/2023] Open
Abstract
Martial arts are various systems of combat skills encompassing striking and grappling. Many styles have evolved into modern sports, and some have been included in the Olympics. The physicality of these can predispose practitioners to musculoskeletal injuries, such as anterior cruciate ligament ruptures; patellar, shoulder, or elbow instabilities; extremity fractures; and hand and spine injuries, which have been studied both clinically and biomechanically. The most common injury related to longer time loss from participation is an anterior cruciate ligament rupture. Higher injury incidence is associated with a higher level of experience and competition. Orthopaedic management of martial arts injuries should reflect the specific needs of each martial artist and the biomechanics of motions common to each style. Full-contact practitioners may benefit from broader surgical indications and special attention to the choice and positioning of implants; nonsurgical treatment may be appropriate for certain pediatric or noncontact practitioners. Approximately 60% of martial artists can return to the preinjury level of participation after a major injury. Injury prevention and rehabilitation programs should optimize neuromotor control and core engagement to ensure proper body mechanics. Gradual incorporation of martial arts movement into the postoperative physical therapy curriculum can benefit physical progress and help gain confidence toward full participation.
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Affiliation(s)
- Alvin W Su
- From the Department of Orthopedics, Nemours (duPont) Children's Hospital, Delaware Valley (Su), the Rothman Orthopedics, Thomas Jefferson University Hospital, Philadelphia, PA (Johns), and the Department of Biomedical Engineering, University of Delaware, Newark, DE (Su, and Bansal)
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Bowers KM, Terrones LD, Sun X, Rifkin R, Croy E, Adair HS, Mulon PY, Hecht S, Anderson DE. Changes in tibial cortical dimensions and density associated with long-term locking plate fixation in goats. J Exp Orthop 2023; 10:111. [PMID: 37934300 PMCID: PMC10634227 DOI: 10.1186/s40634-023-00669-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 10/09/2023] [Indexed: 11/08/2023] Open
Abstract
PURPOSE Cortical porosis, secondary to either vascular injury or stress-shielding, is a comorbidity of fracture fixation using compression bone plating. Locking plate constructs have unique mechanics of load transmission and lack of reliance on contact pressures for fixation stability, so secondary cortical porosis adjacent to the plate has not been widely investigated. Therefore, this study aimed to assess the effects of long-term locking plate fixation on cortical dimensions and density in a caprine tibial segmental ostectomy model. METHODS Data was acquired from a population of goats enrolled in ongoing orthopedic research which utilized locking plate fixation of 2 cm tibial diaphyseal segmental defects to evaluate bone healing over periods of 3, 6, 9, and 12 months. Quantitative data included tibial cortical width measurements and three-dimensionally reconstructed slab density measurements, both assessed using computed tomographic examinations performed at the time of plate removal. Additional surgical and demographic variables were analyzed for effect on cortical widths and density, and all cis-cortex measurements were compared to both the trans-cortex and to the contralateral limbs. RESULTS The tibial cis-cortex was significantly wider and more irregular than the trans-cortex at the same level. This width asymmetry differed in both magnitude and direction from the contralateral limb. The bone underlying the plate was significantly less dense than the trans-cortex, and this cortical density difference was significantly greater than that of the contralateral limb. These cortical changes were independent of both duration of fixation and degree of ostectomy bone healing. CONCLUSIONS This study provides evidence that cortical bone loss consistent with cortical porosity is a comorbidity of locking plate fixation in a caprine tibial ostectomy model. Further research is necessary to identify risk factors for locking-plate-associated bone loss and to inform clinical decisions in cases necessitating long-term locking plate fixation.
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Affiliation(s)
- Kristin M Bowers
- Large Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, USA.
| | - Lori D Terrones
- Large Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, USA
| | - Xiaocun Sun
- Office of Information Technology, University of Tennessee, Knoxville, USA
| | - Rebecca Rifkin
- Large Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, USA
| | - Elizabeth Croy
- Large Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, USA
| | - Henry S Adair
- Large Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, USA
| | - Pierre-Yves Mulon
- Large Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, USA
| | - Silke Hecht
- Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, USA
| | - David E Anderson
- Large Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, USA
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Bhashyam AR, Yeung C, Sodhi A, Xu RF, Groot OQ, Kelly S, Lozano-Calderon S. Titanium vs. carbon fiber-reinforced intramedullary nailing for humeral bone tumors. J Shoulder Elbow Surg 2023; 32:2286-2295. [PMID: 37263478 DOI: 10.1016/j.jse.2023.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 04/07/2023] [Accepted: 04/16/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND Multiple techniques have been described to treat humeral diaphyseal bone tumors requiring curettage or excision. Recent studies have suggested that carbon fiber-reinforced polyetheretherketone (CFR-PEEK) intramedullary nails (IMNs) may be preferable to titanium IMNs for patients with musculoskeletal tumors due to CFR-PEEK's high tensile strength, radiolucency, a modulus of elasticity closer to native bone, and improved postoperative surveillance/radiation dosing. In this study, we describe the rate of fixation failure for both CFR-PEEK and titanium humeral IMNs when used for humeral diaphyseal bone tumors requiring curettage or excision. METHODS This was a single-institution retrospective cohort study including 81 patients (27 CFR-PEEK and 54 titanium) treated for a humeral diaphyseal bone tumor using an IMN ± methylmethacrylate between January 2017 and December 2022. Primary outcome was revision surgery due to soft tissue complications, nonunions, structural complications such as periprosthetic fracture or IMN breakage, periprosthetic infection, tumor progression, and implant failure due to rejection or fatigue. RESULTS No failures were observed in either patients treated with titanium nails or patients treated with CFR-PEEK not requiring curettage. Fixation failure due to implant failure was observed in 2 cases-at 214 days and 469 days after surgery-where CFR-PEEK IMN was used for stabilization after a wide segmental resection for oncologic control with a cement spacer reconstruction. In both cases, the resection was larger than 6 cm, the remaining distal humerus was less than 5 cm, and failures occurred at the interface of the residual bone and spacer. Both patients were revised using a titanium distal posterolateral humeral plate fixed with screws and cables without any subsequent complications. One additional CFR-PEEK IMN required revision surgery after 744 days due to progression of the tumor and subsequent nonunion. One revision surgery was observed after 63 days for the titanium IMN because of nonunion and tumor progression. CONCLUSIONS Humeral diaphyseal bone tumors requiring large segmental resection with small residual bone and a large cement spacer may fail via tension due to bending forces at the distal portion. In this clinical scenario, the use of larger-diameter CFR-PEEK IMNs may be indicated when available. In the interim, use of intercalary allografts instead of cement spacers, additional fixation with a titanium plate distally, or the use of a titanium nail when using a cement spacer may be considered.
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Affiliation(s)
- Abhiram R Bhashyam
- Department of Orthopaedics, Massachusetts General Hospital, Boston, MA, USA
| | - Caleb Yeung
- Department of Orthopaedics, Massachusetts General Hospital, Boston, MA, USA
| | - Alisha Sodhi
- Department of Orthopaedics, Massachusetts General Hospital, Boston, MA, USA
| | - Raylin F Xu
- Department of Orthopaedics, Massachusetts General Hospital, Boston, MA, USA
| | - Olivier Q Groot
- Department of Orthopaedics, Massachusetts General Hospital, Boston, MA, USA
| | - Sean Kelly
- Department of Orthopaedics, Massachusetts General Hospital, Boston, MA, USA
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Hsu MR, Shu HT, Luksameearunothai K, Margalit A, Yu AT, Hasenboehler EA, Shafiq B. Is there an increased risk for subtrochanteric stress fracture with the Femoral Neck System versus multiple cannulated screws fixation? J Orthop 2022; 30:127-133. [PMID: 35280450 PMCID: PMC8907549 DOI: 10.1016/j.jor.2022.02.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 02/14/2022] [Indexed: 11/26/2022] Open
Abstract
Purpose This study sought to compare the risk of subtrochanteric stress-riser fractures and biomechanical stability of the Femoral Neck System (FNS) versus multiple screw fixation (MSF). Methods Eight paired cadaveric femurs were randomly assigned to FNS or MSF. Physiologic load mimicking single leg stance at the subtrochanteric region was applied to the constructs. Results No constructs failed in the subtrochanteric region during loading. There was no significant difference in force (P = 0.364) or loading cycles (P = 0.348) between groups. Conclusion FNS constructs were not associated with an increased incidence of iatrogenic subtrochanteric fractures or biomechanical stability versus MSF.
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Affiliation(s)
- Megan R. Hsu
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Henry T. Shu
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Kitchai Luksameearunothai
- Department of Orthopaedic Surgery, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Adam Margalit
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Andrew T. Yu
- Department of Neurology, The Johns Hopkins University, Baltimore, MD, USA
| | | | - Babar Shafiq
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA,Corresponding author. Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N Caroline St 5th floor, Baltimore, MD, 21205, USA.
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Yoo J, Ma X, Lee J, Hwang J. Research Update on Stress Riser Fractures. Indian J Orthop 2021; 55:560-570. [PMID: 33995860 PMCID: PMC8081793 DOI: 10.1007/s43465-020-00291-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 10/12/2020] [Indexed: 02/04/2023]
Abstract
Stress fractures are fatigue-induced fractures which are caused by repetitive force, often from overuse. They are well-established and frequently encountered in the field of orthopedics. Stress fractures occur in the bone because of low-bone strength and high chronic mechanical stress placed on the bone. Stress riser fractures are also stress fractures that occur because of the presence of cortical defects (holes), changes in stiffness, sharp corners, and cracks (fracture lines). Periprosthetic or peri-implant fractures are good examples of stress riser fractures that occur in regions where stress forces are higher than those in the surrounding material. Most stress riser fractures are related to technical errors (iatrogenic causes) and are difficult to manage. It is possible and more effective to prevent the creation of stress riser fractures through better surgical techniques. The proper terminology for stress fractures, stress riser fractures, periprosthetic fractures, peri-implant fractures, interprosthetic fractures, and interimplant fractures is discussed. This review of the current state of knowledge, diagnosis, treatment, and prevention of stress riser fractures is based on clinical evidence and recent literature.
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Affiliation(s)
- Jehyun Yoo
- Department of Orthopaedic Surgery, Sacred Heart Hospital, Hallym University School of Medicine, Anyang, Republic of Korea
| | - Xiao Ma
- Department of Orthopaedic Surgery, Gangnam Sacred Heart Hospital, Hallym University School of Medicine, Seoul, Republic of Korea
| | - Jonghwa Lee
- Department of Orthopaedic Surgery, Gangnam Sacred Heart Hospital, Hallym University School of Medicine, Seoul, Republic of Korea
| | - Jihyo Hwang
- Department of Orthopaedic Surgery, Gangnam Sacred Heart Hospital, Hallym University School of Medicine, Seoul, Republic of Korea
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Yi PH, Della Valle CJ, Fishman EK, Fritz J. Imaging of Periprosthetic Fractures of the Hip and Knee. Semin Roentgenol 2020; 56:90-105. [PMID: 33422187 DOI: 10.1053/j.ro.2020.07.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Paul H Yi
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Craig J Della Valle
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
| | - Elliot K Fishman
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jan Fritz
- New York University Grossman School of Medicine, New York University, New York, NY..
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Retrograde intramedullary nailing below a hip arthroplasty prosthesis: a viable fixation option for periprosthetic and interprosthetic femur fractures. INTERNATIONAL ORTHOPAEDICS 2020; 44:2283-2289. [DOI: 10.1007/s00264-020-04734-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 07/14/2020] [Indexed: 10/23/2022]
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Hoellwarth JS, Tetsworth K, Kendrew J, Kang NV, van Waes O, Al-Maawi Q, Roberts C, Al Muderis M. Periprosthetic osseointegration fractures are infrequent and management is familiar. Bone Joint J 2020; 102-B:162-169. [PMID: 32009427 PMCID: PMC7002843 DOI: 10.1302/0301-620x.102b2.bjj-2019-0697.r2] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Aims Osseointegrated prosthetic limbs allow better mobility than socket-mounted prosthetics for lower limb amputees. Fractures, however, can occur in the residual limb, but they have rarely been reported. Approximately 2% to 3% of amputees with socket-mounted prostheses may fracture within five years. This is the first study which directly addresses the risks and management of periprosthetic osseointegration fractures in amputees. Methods A retrospective review identified 518 osseointegration procedures which were undertaken in 458 patients between 2010 and 2018 for whom complete medical records were available. Potential risk factors including time since amputation, age at osseointegration, bone density, weight, uni/bilateral implantation and sex were evaluated with multiple logistic regression. The mechanism of injury, technique and implant that was used for fixation of the fracture, pre-osseointegration and post fracture mobility (assessed using the K-level) and the time that the prosthesis was worn for in hours/day were also assessed. Results There were 22 periprosthetic fractures; they occurred exclusively in the femur: two in the femoral neck, 14 intertrochanteric and six subtrochanteric, representing 4.2% of 518 osseointegration operations and 6.3% of 347 femoral implants. The vast majority (19/22, 86.4%) occurred within 2 cm of the proximal tip of the implant and after a fall. No fractures occurred spontaneously. Fixation most commonly involved dynamic hip screws (10) and reconstruction plates (9). No osseointegration implants required removal, the K-level was not reduced after fixation of the fracture in any patient, and all retained a K-level of ≥ 2. All fractures united, 21 out of 22 patients (95.5%) wear their osseointegration-mounted prosthetic limb longer daily than when using a socket, with 18 out of 22 (81.8%) reporting using it for ≥ 16 hours daily. Regression analysis identified a 3.89-fold increased risk of fracture for females (p = 0.007) and a 1.02-fold increased risk of fracture per kg above a mean of 80.4 kg (p = 0.046). No increased risk was identified for bilateral implants (p = 0.083), time from amputation to osseointegration (p = 0.974), age at osseointegration (p = 0.331), or bone density (g/cm2, p = 0.560; T-score, p = 0.247; Z-score, p = 0.312). Conclusion The risks and sequelae of periprosthetic fracture after press-fit osseointegration for amputation should not deter patients or clinicians from considering this procedure. Females and heavier patients are likely to have an increased risk of fracture. Age, years since amputation, and bone density do not appear influential. Cite this article: Bone Joint J 2020;102-B(2):162–169.
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Affiliation(s)
- Jason S Hoellwarth
- Department of Orthopaedic Surgery, Macquarie University Hospital, Macquarie University, Macquarie Park, Australia
| | - Kevin Tetsworth
- Department of Orthopaedic Surgery, Royal Brisbane and Women's Hospital, Queensland, Australia
| | - John Kendrew
- Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | | | - Oscar van Waes
- Trauma Research Unit Department of Surgery, Rotterdam, The Netherlands
| | - Qutaiba Al-Maawi
- Department of Orthopaedic Surgery, Ibn Sina Training Hospital, Baghdad, Iraq
| | - Claudia Roberts
- Department of Orthopaedic Surgery, Macquarie University Hospital, Macquarie University, Macquarie Park, Australia
| | - Munjed Al Muderis
- Department of Orthopaedic Surgery, Macquarie University Hospital, Macquarie University, Macquarie Park, Australia
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Shahrdar C, McLean J, Gianulis E, Softic D, Qin X, Moore MA, Chen J. Clinical outcome and explant histology after using a cellular bone allograft in two-stage total hip arthroplasty. J Orthop Surg Res 2020; 15:16. [PMID: 31948445 PMCID: PMC6966822 DOI: 10.1186/s13018-020-1542-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 12/31/2019] [Indexed: 01/03/2023] Open
Abstract
Background Although use of cellular bone allografts (CBA) in orthopedic surgery has become increasingly common, little information is available regarding their short-term clinical performance. In these two case reports of two-stage hip arthroplasties, ViviGen Formable CBA (V-CBA) was used in stage one to fill voids left by previous metal implants. Methods The two patients had distinctly different health profiles, but each of them had previous metal implants due to a hip fracture. In the otherwise healthy 49-year-old male patient, the total hip arthroplasty (THA) was performed 7 weeks after nail removal and V-CBA backfill. In the 64-year-old female patient with Type 1 diabetes and severe osteoporosis, stage 2 was performed after 12 weeks. At the time of THA for each patient, bone containing some V-CBA was removed to accommodate the hip implant. The explants were histologically analyzed for bone matrix, mineralization, and neovascularization. Results Histological staining showed substantial new bone formation and neovascularization in both explants albeit at different levels of maturity. Conclusions Although limited, these results suggest that V-CBA may facilitate new bone formation in healthy as well as in metabolically challenged patients. Level of evidence V, case report
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