Combined Technique for the Treatment of Infected Nonunions of the Distal Femur With Bone Loss: Short Supracondylar Nail-Augmented Acute Shortening/Lengthening

Shortening/re-lengthening and nailing versus bone transport for the treatment of segmental femoral bone defects

Segmental femoral bone defects are a severe challenge for orthopedic trauma surgeons. The objective of this study was to compare the efficacy of the shortening/re-lengthening and nailing (SRN) technique with the traditional bone transport (BT) technique in treating patients with such defects. A retrospective study was conducted involving 46 patients with segmental femoral bone defects, with 21 cases treated using the SRN technique (SRN group) and 25 cases managed with the traditional BT technique (BT group). The mean length of the bone defect was 5.8 ± 1.1 cm in the SRN group and 6.1 ± 1.6 cm in the BT group. Various parameters including time in frame, external fixation index, self-rating anxiety scale (SAS) scores, bone healing scores, limb function scores, and complications were recorded. The mean time in frame for the SRN group was 3.7 ± 1.4 months, significantly shorter than the 9.4 ± 3.7 months observed in the BT group (p < 0.05). Furthermore, the mean external fixation index for the SRN group was 0.62 ± 0.12 months/cm, significantly lower than the 1.50 ± 0.19 months/cm observed in the BT group (p < 0.05). There were no significant differences in bone healing scores between the SRN and BT groups (p = 0.237). The SAS scores and incidence of complications were significantly lower in the SRN group compared to the BT group (p < 0.05). Overall, the SRN technique demonstrated superior clinical efficacy compared to the traditional BT technique for the management of segmental femoral bone defects, with shorter time in frame, lower external fixation index, and reduced complications. Therefore, the SRN technique may be considered an optimal choice for treating patients with such conditions.

A scoping review of the outcome reporting following surgery for chronic osteomyelitis of the lower limb

Chronic osteomyelitis (COM) of the lower limb in adults can be surgically managed by either limb reconstruction or amputation. This scoping review aims to map the outcomes used in studies surgically managing COM in order to aid future development of a core outcome set. A total of 11 databases were searched. A subset of studies published between 1 October 2020 and 1 January 2011 from a larger review mapping research on limb reconstruction and limb amputation for the management of lower limb COM were eligible. All outcomes were extracted and recorded verbatim. Outcomes were grouped and categorized as per the revised Williamson and Clarke taxonomy. A total of 3,303 records were screened, of which 99 studies were included. Most studies were case series (77/99; 78%) and assessed one method of reconstruction (68/99; 69%). A total of 511 outcomes were reported, which were grouped into 58 distinct outcomes. Overall, 143/511 of all outcomes (28%) were provided with a clear, in-text definition, and 231 outcomes (45%) had details reported of how and when they were measured. The most commonly reported outcome was 'recurrence of osteomyelitis' (62; 12%). The single-most patient-reported outcome measure was 'pain'. This study has highlighted significant inconsistencies in the defining, reporting, and measuring of outcomes across studies investigating surgical management for chronic osteomyelitis of the lower limb in adults. Future studies should clearly report complete details of how outcomes are defined and measured, including timing. The development of a standardized core outcome set would be of significant benefit in order to allow evidence synthesis and comparison across studies.

Bone Bricks: The Effect of Architecture and Material Composition on the Mechanical and Biological Performance of Bone Scaffolds

Large bone loss injuries require high-performance scaffolds with an architecture and material composition resembling native bone. However, most bone scaffold studies focus on three-dimensional (3D) structures with simple rectangular or circular geometries and uniform pores, not able to recapitulate the geometric characteristics of the native tissue. This paper addresses this limitation by proposing novel anatomically designed scaffolds (bone bricks) with nonuniform pore dimensions (pore size gradients) designed based on new lay-dawn pattern strategies. The gradient design allows one to tailor the properties of the bricks and together with the incorporation of ceramic materials allows one to obtain structures with high mechanical properties (higher than reported in the literature for the same material composition) and improved biological characteristics.