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Barros EA, Ballesteros C, Noboa CE, Arteaga G, Peñaherrera C, Endara F, Bravo A, Barros Castro AX. Use of metatarsal hook plates in the treatment of multifragmentary patellar fractures - A case series. Trauma Case Rep 2024; 51:101018. [PMID: 38628458 PMCID: PMC11019277 DOI: 10.1016/j.tcr.2024.101018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2024] [Indexed: 04/19/2024] Open
Abstract
The surgical management of patellar fractures typically yielded satisfactory results; however, in situations involving multifragmented patellar fractures or those affecting the inferior pole, it became imperative to employ alternative osteosynthesis techniques that enhanced stability, enabled early rehabilitation initiation, prevented implant failure, and avoided reduction loss before fracture consolidation. In this context, an unconventional osteosynthesis alternative was presented, utilizing an anatomically designed hook plate originally intended for the fifth metatarsal. This technique was successfully applied in three patients with multifragmentary patellar fractures, allowing stable fixation of small or marginal fragments through the plate's hooks without compromising vascularity. Fracture consolidation was achieved without reduction loss, and owing to its low profile, patient discomfort and irritation were minimized compared to traditional tension band or wiring techniques. This approach suggested the potential to forego early plate removal, thereby contributing to a more effective management of patellar fractures. Level of evidence IV.
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Affiliation(s)
- Edgar Alejandro Barros
- Orthopedics and Traumatology Service, Hospital Vozandes Quito and Hospital Metropolitano, Quito - Ecuador
| | - Carlos Ballesteros
- Orthopedics and Traumatology Service, Hospital Vozandes Quito and Hospital Metropolitano, Quito - Ecuador
| | - Carlos Eduardo Noboa
- Orthopedics and Traumatology Service, Hospital Vozandes Quito and Hospital Metropolitano, Quito - Ecuador
| | - Gonzalo Arteaga
- Orthopedics and Traumatology Service, Hospital Vozandes Quito and Hospital Metropolitano, Quito - Ecuador
| | - Carlos Peñaherrera
- Postgraduate Course in Orthopedics and Traumatology at the International University of Ecuador, Quito - Ecuador
| | - Francisco Endara
- Postgraduate Course in Orthopedics and Traumatology at the International University of Ecuador, Quito - Ecuador
| | - Andrés Bravo
- Posgraduate Course in Orthopedics and Traumatology at Universidad de las Americas- Quito- Ecuador
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Tosounidis T, Chalidis B. Management of geriatric acetabular fractures: Contemporary treatment strategies. World J Clin Cases 2024; 12:2151-2156. [DOI: 10.12998/wjcc.v12.i13.2151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 02/15/2024] [Accepted: 03/28/2024] [Indexed: 04/25/2024] Open
Abstract
Acetabular fractures in the geriatric population are typically low-energy fractures resulting from a fall from standing height. Compromised bone quality in the elderly, as well as this population’s concomitant medical comorbidities, render the management of such fractures challenging and controversial. Non-operative management remains the mainstay of treatment, although such a choice is associated with numerous and serious complications related to both the hip joint as well as the general condition of the patient. On the other hand, operatively treating acetabular fractures (e.g., with osteosynthesis or total hip arthroplasty) is gaining popularity. Osteosynthesis can be performed with open reduction and internal fixation or with minimally invasive techniques. Total hip arthroplasty could be performed either in the acute phase combined with osteosynthesis or as a delayed procedure after a period of non-operative management or after failed osteosynthesis of the acetabulum. Regardless of the implemented treatment, orthogeriatric co-management is considered extremely crucial, and it is currently one of the pillars of a successful outcome after an acetabular fracture.
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Affiliation(s)
- Theodoros Tosounidis
- Academic Department of Orthopaedic Surgery, Heraklion University Hospital, University of Crete, Greece, Heraklion 71500, Greece
| | - Byron Chalidis
- 1st Department of Orthopaedic, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki 57010, Greece
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3
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Kußmaul AC, Bruder J, Greiner A, Woiczinski M, Thorwächter C, Dotzauer F, Rubenbauer B, Linhart C, Böcker W, Becker CA. Uncemented hip revision cup as an alternative for T-type acetabular fractures: A cadaveric study. Orthop Traumatol Surg Res 2024; 110:103797. [PMID: 38142779 DOI: 10.1016/j.otsr.2023.103797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 11/12/2023] [Accepted: 12/07/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND The current rise in elderly patients with compromised bone quality complicates the surgical treatment of acetabular T-type fractures (AO type 62B2 fractures). There is on ongoing discussion about the treatment options, mostly consisting of an open reduction and internal fixation (ORIF) with or without primary or secondary total hip arthroplasty (THA). Yet, these patients are oftentimes unable to fulfil weight-bearing restrictions and mostly present with an unavailability of a stable anchor site. Consequently, this study investigates the feasibility of a cementless hip revision cup for acetabular T-type fractures and compares its biomechanical properties to ORIF. HYPOTHESIS The cementless hip revision cup provides sufficient biomechanical stability under the simulation of full weight-bearing. PATIENTS AND METHODS The study compared two groups of human cadaveric hip bones with T-type fractures, of whom 6 subjects were treated with ORIF (6 male; mean age: 62±17years; mean body weight: 75±15) versus 6 subjects treated with a cementless hip revision cup (2 male; 69±12 years; 73±15kg). The group-assignment was controlled for comparable BMD results (mean BMD: ORIF 110±37 mg Ca-Ha/mL versus hip revision cup 134±32 mg Ca-Ha/mL). To compare for biomechanical stability cyclic loading was applied measuring the force and dislocation of the fracture gap at standardized bone loci using an all-electric testing machine and a 3D-ultrasound measuring system. RESULTS Comparing superior pubic ramus versus iliac wing (cementless hip revision cup versus ORIF [mean±standard deviation]: 5.8±2.0 versus 7.0±3.2; p=0.032) as well as sacral ala versus iliac wing (4.6±2.2 versus 6.4±3.7; p=0.002), the cementless revision cup achieved a significantly higher stability than the plate osteosynthesis. CONCLUSION Revision cup and ORIF withstood biomechanical loading forces exceeding full weight-bearing in this biomechanical study. The results of our study suggest that the cementless hip revision cup might be promising alternative to the current standard care of ORIF with or without primary THA. LEVEL OF EVIDENCE III; case control experimental study.
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Affiliation(s)
- Adrian Cavalcanti Kußmaul
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Jan Bruder
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Axel Greiner
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Matthias Woiczinski
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Christoph Thorwächter
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Fabian Dotzauer
- Department for Trauma and Orthopaedic Surgery, Kreiskliniken Dillingen Wertingen, Wertingen, Germany
| | - Bianka Rubenbauer
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Christoph Linhart
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Wolfgang Böcker
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Christopher A Becker
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany.
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Seeher U, Bode S, Arora R. [Basic principles of surgical treatment of distal radius fractures]. Unfallchirurgie (Heidelb) 2024:10.1007/s00113-024-01429-x. [PMID: 38653814 DOI: 10.1007/s00113-024-01429-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/14/2024] [Indexed: 04/25/2024]
Abstract
Distal radius fractures are one of the most frequent fractures of the upper extremities. The decision for conservative or surgical treatment is made after appropriate diagnostics using conventional radiographic and usually computed tomography imaging examinations. If the indications for surgical treatment are present, various options for reduction and fixation are available. The spectrum ranges from closed to open procedures up to accompanying arthroscopic support. Appropriate preoperative patient education about the procedure and the planned postinterventional treatment is essential. The goal of treatment is to restore wrist function while maintaining mobility and strength with a low risk of complications. All surgical procedures share the principle of reduction to restore anatomical relationship followed by fixation. Closed procedures include fixation with Kirschner wires and the construction of an external fixator. Volar locking plate osteosynthesis has become established in recent years as the method of choice for the majority of the fractures to be treated. For special fracture patterns and the treatment of accompanying injuries, arthroscopic support can be indicated. There is no uniform consensus on the best choice of procedure. This article discusses the possible procedures including the approaches, fixation techniques and specific follow-up treatment.
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Affiliation(s)
- Ulrike Seeher
- Universitätsklinik für Orthopädie und Traumatologie, Medizinische Universität Innsbruck, Anichstr. 35, 6020, Innsbruck, Österreich.
| | - Simone Bode
- Universitätsklinik für Orthopädie und Traumatologie, Medizinische Universität Innsbruck, Anichstr. 35, 6020, Innsbruck, Österreich
| | - Rohit Arora
- Universitätsklinik für Orthopädie und Traumatologie, Medizinische Universität Innsbruck, Anichstr. 35, 6020, Innsbruck, Österreich
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Nishida M, Kamekura S, Nakada I, Kiriyama M, Maeda C, Ozone E, Goto T. Definitive internal fracture fixation followed by staged free flap coverage ("fix followed by flap" protocol) for open Gustilo type IIIB fractures. J Orthop Sci 2024:S0949-2658(24)00051-4. [PMID: 38604874 DOI: 10.1016/j.jos.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 02/26/2024] [Accepted: 03/14/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Although the concept of the "fix and flap" approach, in which definitive fracture fixation and flap coverage are completed in a single procedure at the earliest opportunity may seem ideal for the treatment of Gustilo type IIIB open fractures, the individual circumstances of patients, such as polytrauma or multiple fracture cases may not allow for the immediate fracture fixation and flap coverage ("fix and flap" approach). In our hospital, patients with Gustilo type IIIB open fractures are treated with definitive internal fixation of the fracture followed by staged flap coverage ("fix followed by flap" protocol) when the "fix and flap" approach was not feasible due to the patient's condition or difficulty in coordinating surgery schedules. The "fix followed by flap" protocol provides benefits in terms of flexibility in adjusting the surgical timetable, simplifying the planning of flap coverage following fracture fixation, and minimizing individual surgical invasion. METHODS We reviewed 10 cases of severe open fractures treated with the "fix followed by flap" protocol and evaluated their outcomes. All surgical procedures, including wound debridement, fracture fixation, and flap coverage, were performed by orthoplastic surgeons specializing in both fracture surgery and microsurgery including soft tissue reconstruction. RESULTS All free flaps survived, and no partial necrosis was observed. None of the patients developed postoperative deep infection up to the last follow-up. Fracture union was achieved in all patients with or without autologous bone grafts. The median time for union was 9.4 months (range, 4-12 months). CONCLUSIONS This study presents favorable outcomes of treatment for Gustilo type IIIB open fractures with fracture fixation followed by staged flap coverage ("fix followed by flap" protocol). Despite a delay in flap coverage, the consistency of treatment provided by orthoplastic surgeons may have contributed to the favorable outcomes in this study.
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Affiliation(s)
- Masahiro Nishida
- Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, 4-23-15 Kotobashi, Sumida-ku, Tokyo 130-8575, Japan; Orthopaedic Trauma Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura City, Kanagawa 247-8533, Japan
| | - Satoru Kamekura
- Department of Orthopedic Surgery, Tokyo Metropolitan Bokutoh Hospital, 4-23-15 Kotobashi, Sumida-ku, Tokyo 130-8575, Japan; Department of Orthopaedic Surgery, Kanto Rosai Hospital, 1-1 Kizukisumiyoshi-cho, Nakahara-ku, Kawasaki, Kanagawa 211-8510, Japan.
| | - Izumi Nakada
- Department of Orthopedic Surgery, Tokyo Metropolitan Bokutoh Hospital, 4-23-15 Kotobashi, Sumida-ku, Tokyo 130-8575, Japan; Department of Orthopaedic Surgery, National Rehabilitation Center for Children with Disabilities, 1-1-10 Komone, Itabashi-ku, Tokyo 173-0037, Japan
| | - Manami Kiriyama
- Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, 4-23-15 Kotobashi, Sumida-ku, Tokyo 130-8575, Japan; Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Chihiro Maeda
- Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, 4-23-15 Kotobashi, Sumida-ku, Tokyo 130-8575, Japan; Department of Orthopedic Surgery, Tokyo Metropolitan Bokutoh Hospital, 4-23-15 Kotobashi, Sumida-ku, Tokyo 130-8575, Japan
| | - Ei Ozone
- Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, 4-23-15 Kotobashi, Sumida-ku, Tokyo 130-8575, Japan; Department of Orthopaedic Surgery, Chiba Aoba Municipal Hospital, 1273-2 Aoba-cho, Chuo-ku, Chiba 260-0852, Japan
| | - Takahiro Goto
- Department of Orthopedic Surgery, Tokyo Metropolitan Bokutoh Hospital, 4-23-15 Kotobashi, Sumida-ku, Tokyo 130-8575, Japan
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6
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Roytman GR, Salameh M, Rizzo SE, Dhodapkar MM, Tommasini SM, Wiznia DH, Yoo BJ. Sustentaculum fracture fixation with lateral plate or medial screw fixation are equivalent. Injury 2024; 55:111532. [PMID: 38614015 DOI: 10.1016/j.injury.2024.111532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 03/25/2024] [Accepted: 04/01/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND Fixation of sustentaculum tali fractures is important to maintain the biomechanical function of the subtalar joint. A common method of fixation is securing the sustentacular fragment by way of a laterally based locking plate (LP). A medial approach with a single screw (MS) has been proposed as an alternative method of fixation. METHODS Five pairs of formalin-preserved cadaveric ankles with the subtalar joint and interosseous ligaments intact ("osseous cadavers") and four pairs of fresh-frozen cadaveric ankles with soft-tissue preserved dissected from mid-tibia down ("soft tissue cadavers") were used in the study. The left ankle was randomly assigned to one of the two fixation methods (LP or MS), while the right ankle was the opposite. These same steps for fixation were repeated for six synthetic ankle models. All models were loaded with a body mass of 80 kg. Statistical differences between LP and MS stiffness were determined using a paired t-test in cadavers and un-paired t-tests in synthetic ankles. RESULTS For osseous cadaveric ankles, LP demonstrated a mean stiffness of 232.95(SD: 59.96) N/mm, while MS was 239.72(SD:131.09) N/mm (p = 0.9293). For soft tissue cadaveric ankles, LP mean stiffness was 133.58(SD:37.84) N/mm, while MS was 134.88(SD:20.75) N/mm (p = 0.9578). For synthetic ankles, LP mean stiffness was 220.40(SD:81.93) N/mm, while MS was 261.50(SD:100.21) N/mm (p = 0.6116). CONCLUSIONS Across all three models, there was no significant difference between LP and MS methods. Retrospective observational studies are recommended to assess patient outcomes from each of the methods.
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Affiliation(s)
- Gregory R Roytman
- Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, CT, USA; Biomedical Engineering, Yale University School of Engineering & Applied Science, New Haven, CT, USA.
| | - Motasem Salameh
- Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, CT, USA
| | - Sarah E Rizzo
- Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, CT, USA
| | - Meera M Dhodapkar
- Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, CT, USA
| | - Steven M Tommasini
- Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, CT, USA; Biomedical Engineering, Yale University School of Engineering & Applied Science, New Haven, CT, USA
| | - Daniel H Wiznia
- Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, CT, USA; Mechanical Engineering & Materials Science, Yale University School of Engineering & Applied Science, New Haven, CT, USA
| | - Brad J Yoo
- Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, CT, USA
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7
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Krimmer H, Wolters R. [Diagnostics and classification of distal radius fractures]. Unfallchirurgie (Heidelb) 2024:10.1007/s00113-024-01425-1. [PMID: 38581459 DOI: 10.1007/s00113-024-01425-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/04/2024] [Indexed: 04/08/2024]
Abstract
Fractures of the distal radius show a wide spectrum of different fracture patterns. Although standard X‑ray images are sufficient for extra-articular fractures, the exact analysis of intra-articular fractures requires the use of computed tomography (CT) with coronal, sagittal and axial sectional images. The classification is based on the Working Group for Osteosynthesis Questions (AO) criteria. The treatment strategy can be more precisely defined by a CT-based classification. Special attention must be paid to the presence of the key corners, as they have a high risk for primary or secondary dislocation if they not adequately stabilized.
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Affiliation(s)
- Hermann Krimmer
- Zentrum für Handchirurgie, St. Elisabethen-Klinikum Ravensburg, St. Martinusstr. 113, 88212, Ravensburg, Deutschland.
| | - Roman Wolters
- Zentrum für Handchirurgie, St. Elisabethen-Klinikum Ravensburg, St. Martinusstr. 113, 88212, Ravensburg, Deutschland
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Factor S, Elbaz E, Kazum E, Pardo I, Morgan S, Ben-Tov T, Khoury A, Warschawski Y. Intertrochanteric (Reverse Oblique) Fracture Subclassifications AO/OTA 31-A3 Have No Effect on Outcomes or Postoperative Complications. Clin Orthop Surg 2024; 16:194-200. [PMID: 38562635 PMCID: PMC10973612 DOI: 10.4055/cios23204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 10/03/2023] [Accepted: 10/03/2023] [Indexed: 04/04/2024] Open
Abstract
Background Reverse oblique intertrochanteric fractures (ROFs) are unstable extracapsular hip fractures that present a mechanical challenge. These fractures are classified as AO/Orthopaedic Trauma Association (OTA) 31-A3 according to the Trauma Association classification system and can further be subclassified into 3 subtypes based on their specific characteristics. The study aimed to evaluate and compare the radiographic and clinical outcomes of the 3 subtypes of ROFs. Methods A retrospective study was conducted at a single high-volume, tertiary center, where data were collected from electronic medical records of consecutive patients who underwent surgical fixation of AO/OTA 31-A3 fractures. Patients with less than 1-year follow-up, pathological fractures, and revision surgery were excluded. The subtypes of fractures were classified as 31-A3.1 (simple oblique), 31-A3.2 (simple transverse), and 31-A3.3 (wedge or multi-fragmentary). The operation was done using 4 different fixation methods, and radiological evaluation was performed at routine intervals. Results The final population consisted of 265 patients (60.8% women) with a mean age of 77.4 years (range, 50-100 years) and the mean follow-up time was 35 months (range, 12-116 months). The incidence of medical complications was similar across the groups. However, there was a trend toward a higher incidence of orthopedic complications and revision rates in the 31-A3.2 group, although this was not statistically significant (p = 0.21 and p = 0.14, respectively). Conclusions Based on the findings of this study, no significant differences were observed between the groups, indicating that the subclassifications of AO/OTA 31-A3 fractures do not have a significant impact on surgical outcomes or the occurrence of postoperative complications.
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Affiliation(s)
- Shai Factor
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Affiliated to the Faculty of Medicine Tel Aviv University, Tel Aviv, Israel
| | - Etay Elbaz
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Affiliated to the Faculty of Medicine Tel Aviv University, Tel Aviv, Israel
| | - Efi Kazum
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Affiliated to the Faculty of Medicine Tel Aviv University, Tel Aviv, Israel
| | - Itay Pardo
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Affiliated to the Faculty of Medicine Tel Aviv University, Tel Aviv, Israel
| | - Samuel Morgan
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Affiliated to the Faculty of Medicine Tel Aviv University, Tel Aviv, Israel
| | - Tomer Ben-Tov
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Affiliated to the Faculty of Medicine Tel Aviv University, Tel Aviv, Israel
| | - Amal Khoury
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Affiliated to the Faculty of Medicine Tel Aviv University, Tel Aviv, Israel
| | - Yaniv Warschawski
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Affiliated to the Faculty of Medicine Tel Aviv University, Tel Aviv, Israel
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Floros MC, Bortolatto JF, Lausch AJ, Valiente AJ, Sone ED, Santerre JP, Whyne C, Fialkov JA. BoneTape: A novel osteosynthetic device for the stabilization of zygomatic fractures. J Plast Reconstr Aesthet Surg 2024; 91:276-283. [PMID: 38432085 DOI: 10.1016/j.bjps.2024.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 12/15/2023] [Accepted: 02/04/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND The study aims to assess the safety and effectiveness of BoneTape™, a new resorbable bone fixation device, using a zygomatic fracture model in rabbits. METHODS The study followed BoneTape™ samples and control (sham) groups over 2-, 6-, and 12-week periods post-zygomaticomaxillary (ZM) osteotomy and zygomaticofrontal (ZF) disarticulation. The osteotomized segments were analyzed for bone healing, inflammatory response, and tissue healing. µCT imaging and histological analysis were used to examine the axial alignment, offset, and quality of new bone formation. RESULTS BoneTape™ samples demonstrated enhanced maintenance of the initial intraoperative positioning, reduced axial offset, and better alignment when compared with the control group, enabling stable bone healing under physiological loading conditions. Complete union was observed at 12-weeks in both groups. The BoneTape™ group experienced minimal immune and tissue reactions, classically associated with wound healing, and showed an increased number of giant cells at 6 and 12-weeks. CONCLUSION BoneTape™ represents a promising advancement in osteosynthesis, demonstrating efficacy in maintaining stable zygomatic reconstruction and eliciting minimal immune response in a rabbit model. This study introduces BoneTape™ as a disruptive solution specifically designed for clinical application in cranio-maxillofacial fracture fixation, with the potential to eliminate the use of over-engineered solutions while offering benefits such as ease of application and fewer biologically disruptive steps.
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Affiliation(s)
| | | | | | | | - Eli D Sone
- Institute of Biomedical Engineering, University of Toronto, Toronto, Canada; Faculty of Dentistry, University of Toronto, Toronto, Canada; Deparment of Materials Science and Engineering, University of Toronto, Toronto, Canada
| | - J Paul Santerre
- Institute of Biomedical Engineering, University of Toronto, Toronto, Canada; Translational Biology and Engineering Program, Ted Rogers Centre for Heart Research, Toronto, Canada; Faculty of Dentistry, University of Toronto, Toronto, Canada
| | - Cari Whyne
- Institute of Biomedical Engineering, University of Toronto, Toronto, Canada; Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Surgery, University of Toronto, Toronto Canada
| | - Jeffrey A Fialkov
- Institute of Biomedical Engineering, University of Toronto, Toronto, Canada; Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Surgery, University of Toronto, Toronto Canada.
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10
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Roth S, Oberthür S, Sehmisch S, Decker S. [Osteoporotic vertebral fractures of the thoracic and lumbar spine]. Unfallchirurgie (Heidelb) 2024; 127:263-272. [PMID: 38276974 DOI: 10.1007/s00113-023-01407-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/19/2023] [Indexed: 01/27/2024]
Abstract
The frequency of osteoporotic vertebral fractures in the clinical routine is increasing due to the demographic change. They are the most frequent fractures associated with osteoporosis and affect an especially morbid and vulnerable group of patients. These fractures often occur after minor trauma or spontaneously. Pain is the predominant symptom, whereas mechanical stability is mostly sufficient, in comparison to vertebral fractures after high-energy trauma, and is not a predominant indication for surgery. These fractures can be described using the classification for fractures associated with osteoporosis and the corresponding treatment recommendations are guided by them. Besides the specific treatment of osteoporotic vertebral fractures, a holistic treatment of patients taking pre-existing comorbidities into consideration is decisive. A mobilization as quickly as possible and treatment of the underlying osteoporosis are important to prevent further fractures.
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Affiliation(s)
- S Roth
- Klinik für Unfallchirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - S Oberthür
- Klinik für Unfallchirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - S Sehmisch
- Klinik für Unfallchirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - S Decker
- Klinik für Unfallchirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
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Lappen S, Siebenlist S, Leschinger T, Kadantsev P, Geyer S, Wegmann K, Müller LP, Hackl M. The importance of interdigitating screw fixation of the trochlea in double plate osteosynthesis of low transcondylar distal humerus fractures: A biomechanical study. Injury 2024; 55:111486. [PMID: 38447478 DOI: 10.1016/j.injury.2024.111486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 02/05/2024] [Accepted: 02/25/2024] [Indexed: 03/08/2024]
Abstract
OBJECTIVE The trochlea is of great importance for the stability of the elbow and its fixation in low transcondylar fractures of the distal humerus is especially challenging. The aim of this study was to determine the optimal trochlea fixation in double plate osteosynthesis of intraarticular distal humerus fractures. METHODS A low transcondylar, C3-type distal humerus fracture was created in 20 fresh-frozen human cadaveric humeri. The samples were then randomly divided into two groups of 10 specimens each. Double plate osteosynthesis was performed in both groups. In group A, the two most distal screws of the lateral plate were inserted into the trochlea fragment. In group B, these screws did not extend into the trochlea. Displacement under cyclic loading and ultimate failure loads were determined for all specimens. RESULTS Group A showed significantly less displacement under cyclic loading in each measurement interval (0.92 mm vs. 1.53 mm after 100 cycles, p = 0 0.006; 1.10 mm vs. 1.84 mm after 1000 cycles, p = 0.007; 1.18 mm vs. 1.98 mm after 2000 cycles, p = 0.008). The ultimate failure load was significantly higher in group A than in group B (345.61 ± 120.389 N vs. 238.42 ± 131.61 N, p = 0.037). CONCLUSIONS Fixation of the trochlea with interdigitating screws in double plate osteosynthesis of low-condylar type C distal humerus fractures results in superior construct stability. LEVEL OF EVIDENCE not applicable (biomechanical).
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Affiliation(s)
- Sebastian Lappen
- Department of Sports Orthopeadics, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany.
| | - Sebastian Siebenlist
- Department of Sports Orthopeadics, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Tim Leschinger
- Faculty of Medicine and University Hospital, Center for Orthopedic and Trauma Surgery, University of Cologne, Cologne, Germany
| | - Pavel Kadantsev
- Department of Sports Orthopeadics, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Stephanie Geyer
- Department of Sports Orthopeadics, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany; Department for Orthopedics, St. Vinzenz Klinik, Pfronten, Germany
| | - Kilian Wegmann
- Faculty of Medicine and University Hospital, Center for Orthopedic and Trauma Surgery, University of Cologne, Cologne, Germany; OCM (Orthopädische Chirurgie München) Clinic, München, Germany
| | - Lars-Peter Müller
- Faculty of Medicine and University Hospital, Center for Orthopedic and Trauma Surgery, University of Cologne, Cologne, Germany
| | - Michael Hackl
- Faculty of Medicine and University Hospital, Center for Orthopedic and Trauma Surgery, University of Cologne, Cologne, Germany
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Schöbel T, Gemkow M, Wendler T, Schleifenbaum S, Löffler S, Theopold J, Hepp P. Primary stability in locking plate fixation for proximal humeral fractures may be increased by using an additional nail osteosynthesis in combination with locking plate osteosynthesis-A biomechanical comparison. Clin Biomech (Bristol, Avon) 2024; 114:106235. [PMID: 38552372 DOI: 10.1016/j.clinbiomech.2024.106235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 03/25/2024] [Accepted: 03/26/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Stability is regarded as an important factor for proper healing and avoiding secondary dislocation in osteoporotic fractures of the proximal humerus. Several surgical techniques have been proposed for treatment, including intramedullary nail osteosynthesis and locking plate fixation. This study introduces a novel approach that combines both techniques and compares its primary stability with conventional methods. METHODS The study involved 25 osteoporotic humeri with two-part fracture models, which were randomly assigned to locking-plate fixation, intramedullary nailing, or a combination of both techniques. The specimens were subjected to sinusoidal loading at 250 N in 20° abduction for 5000 cycles and then to quasi-static loading until failure. Fracture movement, failure mode, and failure load were measured and compared among the groups. FINDINGS The groups fixated with intramedullary nailing and the groups fixated with intramedullary nailing and locking plate fixation showed significantly lower fracture motion than the group using locking plate fixation only (p < 0.005) and significantly higher load to failure (p = 0.007 and p = 0.0062, respectively). There was no significant difference between the group using intramedullary nailing and the group using locking-plate fixation and intramedullary nailing in fracture movement or load-to-failure (p > 0.005). INTERPRETATION The results indicate that locking plate fixation provides less primary stability than intramedullary nailing or the combined of both techniques. This combined approach may offer advantages as a treatment for complex proximal humeral fractures in osteoporotic bone, and specific implants should be developed to ensure optimal treatment.
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Affiliation(s)
- Tobias Schöbel
- Department of Orthopedic, Trauma, and Plastic Surgery, University of Leipzig, Liebigstraße 20, 04103 Leipzig, Germany.
| | - Maximilian Gemkow
- Department of Orthopedic, Trauma, and Plastic Surgery, University of Leipzig, Liebigstraße 20, 04103 Leipzig, Germany.
| | - Toni Wendler
- Department of Orthopedic, Trauma, and Plastic Surgery, University of Leipzig, Liebigstraße 20, 04103 Leipzig, Germany; ZESBO - Center for Research on Musculoskeletal Systems, Semmelweisstraße 14, 04103 Leipzig, Germany.
| | - Stefan Schleifenbaum
- Department of Orthopedic, Trauma, and Plastic Surgery, University of Leipzig, Liebigstraße 20, 04103 Leipzig, Germany; ZESBO - Center for Research on Musculoskeletal Systems, Semmelweisstraße 14, 04103 Leipzig, Germany; Fraunhofer Institute for Machine Tools and Forming Technology, Nöthnitzer Straße 44, 01187 Dresden, Germany.
| | - Sabine Löffler
- Institute of Anatomy, University of Leipzig, Liebigstraße 13, 04103 Leipzig, Germany.
| | - Jan Theopold
- Department of Orthopedic, Trauma, and Plastic Surgery, University of Leipzig, Liebigstraße 20, 04103 Leipzig, Germany.
| | - Pierre Hepp
- Department of Orthopedic, Trauma, and Plastic Surgery, University of Leipzig, Liebigstraße 20, 04103 Leipzig, Germany.
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Lim EJ, Jeong HS, Kim KJ. Posterior deltoid-sparing approach for displaced inferior or posterior glenoid fossa fractures: technical note and case series. Sci Rep 2024; 14:6500. [PMID: 38499695 PMCID: PMC10948851 DOI: 10.1038/s41598-024-56974-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 03/13/2024] [Indexed: 03/20/2024] Open
Abstract
Scapular surgery has usually been performed through the posterior Judet approach. This approach allows access to the entire posterior scapular body, but causes significant soft tissue damage and detaches the deltoid muscle. To date, there has been no clinical study of a deltoid-preserving approach to access the joint for displaced postero-inferior glenoid fractures (Ideberg type II or Ib). We describe an easy and less invasive approach to the postero-inferior glenoid fossa.
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Affiliation(s)
- Eic Ju Lim
- Department of Orthopaedic Surgery, Chungbuk National University Hospital & College of Medicine, 776, 1sunhwan-ro, Seowon-gu, Cheongju-si, Chungcheongbuk-do, Republic of Korea
| | - Ho-Seung Jeong
- Department of Orthopaedic Surgery, Chungbuk National University Hospital & College of Medicine, 776, 1sunhwan-ro, Seowon-gu, Cheongju-si, Chungcheongbuk-do, Republic of Korea.
| | - Kook-Jong Kim
- Department of Orthopaedic Surgery, Chungbuk National University Hospital & College of Medicine, 776, 1sunhwan-ro, Seowon-gu, Cheongju-si, Chungcheongbuk-do, Republic of Korea
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Markeviciute V, Puthia M, Arvidsson L, Liu Y, Törnquist E, Tengattini A, Huang J, Bai Y, Vater C, Petrolis R, Zwingenberger S, Krisciukaitis A, Smailys A, Lukosevicius S, Stravinskas M, Isaksson H, Tarasevicius S, Lidgren L, Tägil M, Raina DB. Systemically administered zoledronic acid activates locally implanted synthetic hydroxyapatite particles enhancing peri-implant bone formation: A regenerative medicine approach to improve fracture fixation. Acta Biomater 2024:S1742-7061(24)00124-7. [PMID: 38490481 DOI: 10.1016/j.actbio.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 02/11/2024] [Accepted: 03/07/2024] [Indexed: 03/17/2024]
Abstract
Fracture fixation in an ageing population is challenging and fixation failure increases mortality and societal costs. We report a novel fracture fixation treatment by applying a hydroxyapatite (HA) based biomaterial at the bone-implant interface and biologically activating the biomaterial by systemic administration of a bisphosphonate (zoledronic acid, ZA). We first used an animal model of implant integration and applied a calcium sulphate (CaS)/HA biomaterial around a metallic screw in the tibia of osteoporotic rats. Using systemic ZA administration at 2-weeks post-surgery, we demonstrated that the implant surrounded by HA particles showed significantly higher peri‑implant bone formation compared to the unaugmented implants at 6-weeks. We then evaluated the optimal timing (day 1, 3, 7 and 14) of ZA administration to achieve a robust effect on peri‑implant bone formation. Using fluorescent ZA, we demonstrated that the uptake of ZA in the CaS/HA material was the highest at 3- and 7-days post-implantation and the uptake kinetics had a profound effect on the eventual peri‑implant bone formation. We furthered our concept in a feasibility study on trochanteric fracture patients randomized to either CaS/HA augmentation or no augmentation followed by systemic ZA treatment. Radiographically, the CaS/HA group showed signs of increased peri‑implant bone formation compared with the controls. Finally, apart from HA, we demonstrated that the concept of biologically activating a ceramic material by ZA could also be applied to β-tricalcium phosphate. This novel approach for fracture treatment that enhances immediate and long-term fracture fixation in osteoporotic bone could potentially reduce reoperations, morbidity and mortality. STATEMENT OF SIGNIFICANCE: • Fracture fixation in an ageing population is challenging. Biomaterial-based augmentation of fracture fixation devices has been attempted but lack of satisfactory biological response limits their widespread use. • We report the biological activation of locally implanted microparticulate hydroxyapatite (HA) particles placed around an implant by systemic administration of the bisphosphonate zoledronic acid (ZA). The biological activation of HA by ZA enhances peri‑implant bone formation. •Timing of ZA administration after HA implantation is critical for optimal ZA uptake and consequently determines the extent of peri‑implant bone formation. • We translate the developed concept from small animal models of implant integration to a proof-of-concept clinical study on osteoporotic trochanteric fracture patients. • ZA based biological activation can also be applied to other calcium phosphate biomaterials.
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Affiliation(s)
- Vetra Markeviciute
- Department of Orthopedics and Traumatology, Lithuanian University of Health Sciences, Kaunas, Lithuania; The Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Lund University, Lund, Sweden
| | - Manoj Puthia
- The Faculty of Medicine, Division of Dermatology and Venerology, Lund University, 221 84 Lund, Sweden
| | - Linnea Arvidsson
- The Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Lund University, Lund, Sweden
| | - Yang Liu
- The Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Lund University, Lund, Sweden; Department of Orthopedic Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine (SAHZU), Hangzhou, Zhejiang, China
| | - Elin Törnquist
- Department of Biomedical Engineering, Lund University, Lund, Sweden
| | | | - Jintian Huang
- The Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Lund University, Lund, Sweden
| | - Yiguang Bai
- The Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Lund University, Lund, Sweden; Cell, Tissue & Organ engineering laboratory, Department of Clinical Sciences Lund, Stem Cell Centre, Lund University, Lund, Sweden; Department of Orthopaedics, Nanchong Central Hospital, The Second Clinical Institute of North Sichuan Medical College Nanchong, Sichuan, China
| | - Corina Vater
- University Hospital Carl Gustav Carus at Technische Universität Dresden, University Center of Orthopedics, Trauma and Plastic Surgery, 01307 Dresden, Germany
| | - Robertas Petrolis
- Department of Physics, Mathematics and Biophysics, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Stefan Zwingenberger
- University Hospital Carl Gustav Carus at Technische Universität Dresden, University Center of Orthopedics, Trauma and Plastic Surgery, 01307 Dresden, Germany
| | - Algimantas Krisciukaitis
- Department of Physics, Mathematics and Biophysics, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Alfredas Smailys
- Department of Orthopedics and Traumatology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Saulius Lukosevicius
- Department of Radiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Mindaugas Stravinskas
- Department of Orthopedics and Traumatology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Hanna Isaksson
- Department of Biomedical Engineering, Lund University, Lund, Sweden
| | - Sarunas Tarasevicius
- Department of Orthopedics and Traumatology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Lars Lidgren
- The Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Lund University, Lund, Sweden
| | - Magnus Tägil
- The Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Lund University, Lund, Sweden
| | - Deepak Bushan Raina
- The Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Lund University, Lund, Sweden.
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Amouzadeh Omrani F, Khak M, Tavakoli Darestani R, Afzal S, Baroutkoub M, Aghaalikhani M, Barati H. Treatment options and outcomes for delayed scapular anatomical neck fractures: a case report and review of the literature. J Med Case Rep 2024; 18:94. [PMID: 38459542 PMCID: PMC10924315 DOI: 10.1186/s13256-024-04424-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 01/30/2024] [Indexed: 03/10/2024] Open
Abstract
INTRODUCTION Scapular anatomical neck fractures are among the most infrequent shoulder girdle fractures. Only seven radiologically confirmed cases of scapular anatomical neck fractures have been documented in the literature to date, of which only one case underwent delayed surgery. CASE PRESENTATION A 34-year-old male Persian patient with morbid obesity was diagnosed with a scapula anatomical neck fracture after a motor vehicle collision. The radiographic assessment of the patient indicated an increase in the scapular glenopolar angle (73.9°). Due to concurrent chest and head injuries, surgical intervention was deferred until 6 weeks following the injury. The posterolateral limited Dupont-Evrard approach was used because of the patient's extremely high body mass index. Two plates were utilized to achieve stable fixation of the glenoid neck fracture. Following a 1 year follow-up period, complete fracture union was successfully attained, resulting in a constant score of 79. CONCLUSIONS The most accurate radiographic indicators of these fractures are a superior fracture line located laterally to the coracoid process, a small inferior spike, and an elevated glenopolar angle. The only tendon attached to the glenoid is the long head of the triceps, making these fractures unstable; therefore, surgery is required in the majority of instances. The small size of the fractured component makes stabilization more difficult. Overall, anatomical scapular neck fractures are extremely uncommon and distinguished from other scapular fractures by their unique radiological and biomechanical characteristics. This case highlights the challenges encountered when managing scapular fractures in patients with morbid obesity. The delayed surgical intervention and the choice of surgical approach tailored to the patient's specific anatomical and physiological considerations proved to be effective in achieving a favorable outcome.
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Affiliation(s)
- Farzad Amouzadeh Omrani
- Department of Orthopedic Surgery, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Khak
- Musculoskeletal Translational Innovation Initiative, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Reza Tavakoli Darestani
- Department of Orthopedic Surgery, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sina Afzal
- Department of Orthopedic Surgery, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mojtaba Baroutkoub
- Department of Orthopedic Surgery, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahdi Aghaalikhani
- Department of Orthopedic Surgery, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hasan Barati
- Department of Orthopedic Surgery, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Aguado HJ, Castillón-Bernal P, Teixidor-Serra J, García-Sánchez Y, Muñoz-Vives JM, Camacho-Carrasco P, Jornet-Gibert M, Ojeda-Thies C, García-Portabella P, Pereda-Manso A, Mateos-Álvarez E, Manzano-Mozo J, Carrillo-Gómez R, País-Ortega S, García-Virto V, Noriega-González D, Álvarez-Ramos BA, Ganso-Pérez A, Cervera-Díaz C, Plata-García M, Ortega-Briones A, Berrocal-Cuadrado J, Criado del Rey-Machimbarrena D, Salvador J, Rey L, Tomás-Hernández J, Selga-Marsà J, Andrés-Peiró JV, Querolt-Coll J, Triana G, Vives-Barquiel M, Renau-Cerrillo M, Campuzano-Bitterling B, Hernández JM, Ostilla R, Carreras-Castañer A, Torner P, Díaz-Suárez R, Fernández EA, Olaya-González C, Fernández-Villán M, García de Cortázar U, Arrieta M, Escobar D, Castrillo E, Balvis P, Rodríguez-Arenas M, García-Pérez Á, Moreta J, Bidea I, Jiménez-Urrutia X, Olías-López B, Boluda-Mengod J, González-Martín D, Bárcena-Goitiandia L, López-Dorado D, Borrás-Cebrián JC, García-Aguilera D, Freile-Pazmiño PA, Suárez-Suárez MÁ, Lanuza-Lagunilla L, García-Arias A, Sánchez-Saz J, García-Coiradas J, Valle-Cruz J, Mora-Fernández J, Cano-Leira MÁ, Rieiro G, Benjumea-Carrasco A, Priego-Sánchez RJ, Sánchez-Pérez C, Guadilla-Arsuaga J, Fernández-Juan A, Sánchez P, Ricón J, Fuentes-Díaz A, García-García EM, Cuadrado-Abajo F, García-Portal G, del PozoManrique P, Castillo del Pozo V, Garcia-Navas FM, García-Paredero E, Beteta-Robles T, Guijarro-Valtueña A, Gutiérrez-Baiget G, Alonso-García N, Navas-Pernía I, Ariza-Herrera D, Vilanova J, Videla-Cés M, Serra-Porta T, Vázquez-García C, Carrasco-Becerra C, Pena-Paz S, Otero-Naveiro V, Fernández-Billón-Castrillo I, Martínez-Menduiña A, Hernández-Galera C, Fernández-Dorado F, Madrigal-López M, Murcia-Asensio A, Galián-Muñoz E, Castro-Sauras Á, Espallargas-Doñate T, Royo-Agustín M, Plaza-Salazar N, Gámez-Asunción C, Muñoz-Vicente A, Pareja-Sierra T, Benito-Santamaría J, Cuenca-Copete A, Verdejo-González A, González-Montero B, Giraldo-Vegas LA, Alonso-Viana L, Díez-Pérez EJ, Briso-Montiano R, Andrés AI, Mingo-Robinet J, Naharro-Tobío M, Escudero-Martínez E, Serrano-Sanz J, Peñalver-Matamoros JM, Fernàndez-Poch N, Martínez-Carreres L, Macho-Mier M, Martín-Hernández C, Laclériga-Giménez AF, Saló-Cuenca JC, Salamanca-Ontiveros C, Espona-Roselló J, Altemir-Martínez V, Criado-Albillos G, Cunchillos-Pascual J, Millán-Cid M, Cabello-Benavides HG, Martínez-Íñiguez-Blasco J, Sevilla-Ortega P, Cano JR, Ramírez A, Marqués-López F, Martínez-Díaz S, Carabelli GS, Slullitel PA, Astore I, Boietti BR, Hernández-Pascual C, Marín-Sánchez J, Córdova-Peralta JC, Dot-Pascuet I, Pereira-Mosquera E, Martín-Antúnez J, Pérez JM, Mandía-Martínez A, De Caso J, Martín-Marcuello J, Benito-Mateo M, Murillo-Vizuete AD, Delgado LG, dela Herrán G, Nunes N, Pérez-Coto I, González-Panisello MR, Iglesias-Fernández S, Ruete-Gil GL, Ramos-García S, Villarreal JP. Optimizing periprosthetic fracture management and in-hospital outcome: insights from the PIPPAS multicentric study of 1387 cases in Spain. J Orthop Traumatol 2024; 25:13. [PMID: 38451303 PMCID: PMC10920552 DOI: 10.1186/s10195-024-00746-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 01/01/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND The incidence of all periprosthetic fractures (PPF), which require complex surgical treatment associated with high morbidity and mortality, is predicted to increase. The evolving surgical management has created a knowledge gap regarding its impact on immediate outcomes. This study aimed to describe current management strategies for PPF and their repercussions for in-hospital outcomes as well as to evaluate their implications for the community. METHODS PIPPAS (Peri-Implant PeriProsthetic Survival Analysis) was a prospective multicentre observational study of 1387 PPF performed during 2021. Descriptive statistics summarized the epidemiology, fracture characteristics, management, and immediate outcomes. A mixed-effects logistic regression model was employed to evaluate potential predictors of in-hospital mortality, complications, discharge status, and weight-bearing restrictions. RESULTS The study encompassed 32 (2.3%) shoulder, 4 (0.3%) elbow, 751 (54.1%) hip, 590 (42.5%) knee, and 10 (0.7%) ankle PPF. Patients were older (median 84 years, IQR 77-89), frail [median clinical frailty scale (CFS) 5, IQR 3-6], presented at least one comorbidity [median Charlson comorbidity index (CCI) 5, IQR 4-7], were community dwelling (81.8%), and had outdoor ambulation ability (65.6%). Femoral knee PPF were most frequently associated with uncemented femoral components, while femoral hip PPF occurred equally in cemented and uncemented stems. Patients were managed surgically (82%), with co-management (73.9%), through open approaches (85.9%) after almost 4 days (IQR, 51.9-153.6 h), with prosthesis revision performed in 33.8% of femoral hip PPF and 6.5% of femoral knee PPF. For half of the patients, the discharge instructions mandated weight-bearing restrictions. In-hospital mortality rates were 5.2% for all PPF and 6.2% for femoral hip PPF. Frailty, age > 84 years, mild cognitive impairment, CFS > 3, CCI > 3, and non-geriatric involvement were candidate predictors for in-hospital mortality, medical complications, and discharge to a nursing care facility. Management involving revision arthroplasty by experienced surgeons favoured full weight-bearing, while an open surgical approach favoured weight-bearing restrictions. CONCLUSIONS Current arthroplasty fixation check and revision rates deviate from established guidelines, yet full weight-bearing is favoured. A surgical delay of over 100 h and a lack of geriatric co-management were related to in-hospital mortality and medical complications. This study recommends judicious hypoaggressive approaches. Addressing complications and individualizing the surgical strategy can lead to enhanced functional outcomes, alleviating the economic and social burdens upon hospital discharge. Level of Evidence Level IV case series. TRIAL REGISTRATION registered at ClinicalTrials.gov (NCT04663893), protocol ID: PI 20-2041.
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Dixon J, Rankin I, Diston N, Goffin J, Stevenson I. Surgical Rib Fracture Fixation: Early Operative Intervention Improves Outcomes. J Chest Surg 2024; 57:120-125. [PMID: 38225829 DOI: 10.5090/jcs.23.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/19/2023] [Accepted: 10/20/2023] [Indexed: 01/17/2024] Open
Abstract
Background This study aimed to assess the outcomes of patients with complex rib fractures undergoing operative or nonoperative management at our major trauma center. Methods A retrospective review of all patients who were considered for surgical stabilization of rib fractures (SSRF) at a single major trauma center from May 2016 to September 2022 was performed. Results In total, 352 patients with complex rib fractures were identified. Thirty-seven patients (11%) fulfilled the criteria for surgical management and underwent SSRF. The SSRF group had a significantly higher proportion of patients with flail chest (32 [86%] vs. 94 [27%], p<0.001) or Injury Severity Score (ISS) >15 (37 [100%] vs. 129 [41%], p<0.001). No significant differences were seen between groups for 1-year mortality. Patients who underwent SSRF within 72 hours were 6 times less likely to develop pneumonia than those in whom SSRF was delayed for over 72 hours (2 [18%] vs. 15 [58%]; odds ratio, 0.163; 95% confidence interval, 0.029-0.909; p=0.036). Prompt SSRF showed non-significant associations with shorter intensive care unit length of stay (6 days vs. 10 days, p=0.140) and duration of mechanical ventilation (5 days vs. 8 days, p=0.177). SSRF was associated with a longer hospital length of stay compared to nonoperative patients with flail chest and/or ISS >15 (19 days vs. 13 days, p=0.012), whilst SSRF within 72 hours was not. Conclusion Surgical fixation of complex rib fractures improves outcomes in selected patient groups. Delayed surgical fixation was associated with increased rates of pneumonia and a longer hospital length of stay.
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Affiliation(s)
- James Dixon
- Trauma and Orthopaedic Surgery, Aberdeen Royal Infirmary, Foresterhill Health Campus, Aberdeen, UK
| | - Iain Rankin
- Trauma and Orthopaedic Surgery, Aberdeen Royal Infirmary, Foresterhill Health Campus, Aberdeen, UK
| | | | - Joaquim Goffin
- Trauma and Orthopaedic Surgery, Aberdeen Royal Infirmary, Foresterhill Health Campus, Aberdeen, UK
| | - Iain Stevenson
- Trauma and Orthopaedic Surgery, Aberdeen Royal Infirmary, Foresterhill Health Campus, Aberdeen, UK
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18
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Melvin PR, Wheatley BM, Schimoler PJ, Kharlamov A, Miller MC, Elias JJ, Altman GT. Biomechanical comparison of composite and cadaveric humeri models in experiments on operated humeral shaft fractures. J Biomech 2024; 165:112017. [PMID: 38428374 DOI: 10.1016/j.jbiomech.2024.112017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 12/11/2023] [Accepted: 02/19/2024] [Indexed: 03/03/2024]
Abstract
A study was undertaken to determine how well contacting fracture fragments of composite bone replicated the behavior of fracture fragments in real bone. Ten composite and ten real humeral diaphyses were transected and reconstructed with limited-contact dynamic-compression plates. Two screws were placed on each side of the transection site and a calibrated electronic sensor sheet was placed between the imitated fracture fragments. After insertion of the distal screws, pressure measurements were made during insertion of the first proximal screw in compression mode, during insertion of the second screw in compression mode after loosening the first screw, and finally after retightening the first screw. The process was repeated after bending the plate. The contact area, the net compression force and the average compressive stress were computed and statistically compared. The composite bone and cadaveric bone differed in contact area and compressive stress but not in net compressive force. Plate bending did not produce a significant difference between composite and cadaveric bone. The results indicate that composite bone does not reproduce all the local fracture fragment conditions so that hardware testing in composite bone should proceed carefully. A gap between fracture fragments as is often used in comminuted fracture tests may remain as the most appropriate situation for fracture hardware testing.
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Affiliation(s)
- Patricia R Melvin
- Department of Orthopedic Surgery, Joint Implant Surgeons, 7277 Smiths Mill Road, New Albany, OH 43054, United States.
| | - Benjamin M Wheatley
- Department of Orthopedic Surgery, Allegheny Health Network, 1307 Federal St., Pittsburgh, PA, 15212, United States.
| | - Patrick J Schimoler
- Department of Orthopaedic Surgery, Allegheny Health Network, 320 E. North Ave., Pittsburgh, PA 15212, United States.
| | - Alexander Kharlamov
- Department of Orthopaedic Surgery, Allegheny Health Network, 320 E. North Ave., Pittsburgh, PA 15212, United States.
| | - Mark C Miller
- Department of Mechanical Engineering and Materials Science, University of Pittsburgh, Benedum Hall #636, Pittsburgh, PA 15261, United States.
| | - John J Elias
- Department of Research, Cleveland Clinic Akron General, 1 Akron General Avenue, Akron, OH 44307, United States.
| | - Gregory T Altman
- Department of Orthopedic Surgery, Allegheny Health Network, 1307 Federal St., Pittsburgh, PA, 15212, United States.
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Ricciardi GA, Cabrera JP, Martínez O, Matta J, Vilchis H, Perez Ríos JJ, Carazzo CA, Dittmar M, Yurac R. Predicting early complications in patients with spinal gunshot wounds: A multicenter study. Brain Spine 2024; 4:102766. [PMID: 38510628 PMCID: PMC10951780 DOI: 10.1016/j.bas.2024.102766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/17/2024] [Accepted: 02/14/2024] [Indexed: 03/22/2024]
Abstract
Introduction There is a wide variation in the clinical presentation of spinal gunshot wounds ranging from isolated minor stable fractures to extremely severe injuries with catastrophic neurological damage. Research question we aim to analyze the risk factors for early complications and impact of surgical treatment in patients with spinal gunshot wounds. Material and methods This is a multicentre retrospective case-control study to compare patients with spinal gunshot wounds who had early complications with those who did not. The following matching criteria were used: sex (1:1), injury level (1:1) and age (±5 years). Univariate and multivariate analyses were performed using logistic regression. Results Results: Among 387 patients, 36.9 % registered early complications, being persistent pain (n = 32; 15 %), sepsis/septic shock (n = 28; 13 %), pneumonia (n = 27; 13 %) and neurogenic bladder (n = 27; 12 %) the most frequently reported. After case-control matched analysis, we obtained 133 patients who suffered early complications (cases) and 133 patients who did not as control group, not differing significantly in sex (p = 1000), age (p = 0,535) and injury level (p = 1000), while the 35 % of complications group required surgical treatment versus 15 % of the non-complication group (p < 0.001). On multivariable analysis, significant predictors of complications were surgical treatment for spinal injury (OR = 3.50, 95 % CI = 1.68-7.30), dirty wound (3.32, 1.50-7.34), GCS ≤8 (3.56, 1.17-10.79), hemodynamic instability (2.29, 1.07-4.88), and multiple bullets (1.97, 1.05-3.67). Discussion and conclusion Spinal gunshot wounds are associated with a high risk of early complications, especially when spinal surgery is required, and among patients with dirty wound, low level of consciousness, hemodynamic instability, and multiple bullets.
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Affiliation(s)
- Guillermo A. Ricciardi
- Orthopaedics and Traumatology, Centro Médico Integral Fitz Roy, Acevedo 865, C1414, Buenos Aires, Argentina
| | - Juan P. Cabrera
- Department of Neurosurgery, Hospital Clínico Regional de Concepción, San Martín 1436, 4070022, Concepción, Bío Bío, Chile
- Faculty of Medicine, University of Concepción, Janequeo esquina, Av. Chacabuco S/N, Concepción, Bío Bío, Chile
| | - Oscar Martínez
- Hospital Universitario Dr. José E. González, Av. Dr. José Eleuterio González S/N, Mitras Centro, 64460, Monterrey, N.L., Mexico
| | - Javier Matta
- Hospital Militar Central, v. 3C No. 49 – 02, CP 110231, Bogotá, Colombia
| | - Hugo Vilchis
- Unidad Médica de Alta Especialidad, Hospital de Traumatología y Ortopedia, Lomas Verdes IMSS, Avenida Lomas Verdes 52, Sta Cruz Acatlan, 53150, Naucalpan de Juárez, Méx., Mexico
| | - Jeasson Javier Perez Ríos
- Clínica de Columna “Dr. Manuel Dufoo Olvera”, Calz. San Juan de Aragón 285, Granjas Modernas, Gustavo A. Madero, 07460, Ciudad de México CDMX, Mexico
| | - Charles A. Carazzo
- Neurosurgery, University of Passo Fundo, São Vicente de Paulo Hospital, R. Teixeira Soares, 808 - Centro, Passo Fundo, RS, 99010-080, Brazil
| | - Michael Dittmar
- Centro Médico Puerta de Hierro, Av. Empresarios, Puerta de Hierro, 45116, Zapopan, Jal., Mexico
| | - Ratko Yurac
- Department of Orthopedic and Traumatology, Universidad del Desarrollo, Av Plaza 680, 7610658, Las Condes, Región Metropolitana, Chile
- Spine Unit, Department of Traumatology, Clínica Alemana, Av Vitacura 5951, Vitacura, Región Metropolitana, Santiago, Chile
| | - the AO Spine Latin America Trauma Study Group
- Orthopaedics and Traumatology, Centro Médico Integral Fitz Roy, Acevedo 865, C1414, Buenos Aires, Argentina
- Department of Neurosurgery, Hospital Clínico Regional de Concepción, San Martín 1436, 4070022, Concepción, Bío Bío, Chile
- Faculty of Medicine, University of Concepción, Janequeo esquina, Av. Chacabuco S/N, Concepción, Bío Bío, Chile
- Hospital Universitario Dr. José E. González, Av. Dr. José Eleuterio González S/N, Mitras Centro, 64460, Monterrey, N.L., Mexico
- Hospital Militar Central, v. 3C No. 49 – 02, CP 110231, Bogotá, Colombia
- Unidad Médica de Alta Especialidad, Hospital de Traumatología y Ortopedia, Lomas Verdes IMSS, Avenida Lomas Verdes 52, Sta Cruz Acatlan, 53150, Naucalpan de Juárez, Méx., Mexico
- Clínica de Columna “Dr. Manuel Dufoo Olvera”, Calz. San Juan de Aragón 285, Granjas Modernas, Gustavo A. Madero, 07460, Ciudad de México CDMX, Mexico
- Neurosurgery, University of Passo Fundo, São Vicente de Paulo Hospital, R. Teixeira Soares, 808 - Centro, Passo Fundo, RS, 99010-080, Brazil
- Centro Médico Puerta de Hierro, Av. Empresarios, Puerta de Hierro, 45116, Zapopan, Jal., Mexico
- Department of Orthopedic and Traumatology, Universidad del Desarrollo, Av Plaza 680, 7610658, Las Condes, Región Metropolitana, Chile
- Spine Unit, Department of Traumatology, Clínica Alemana, Av Vitacura 5951, Vitacura, Región Metropolitana, Santiago, Chile
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Wang B, Shi C, Zhu A, Qiao F, Zhou J, Yang C, Sheng Y, Tang H, Tang G, Wang D. Three-dimensional printing technique aids screw insertion into the sustentaculum tali of the internal fixation of intra-articular calcaneal fractures. Orthop Traumatol Surg Res 2024:103835. [PMID: 38355011 DOI: 10.1016/j.otsr.2024.103835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 10/26/2023] [Accepted: 02/07/2024] [Indexed: 02/16/2024]
Abstract
INTRODUCTION Treating complex calcaneus fractures remains challenging. This study evaluated the influence of 3D printing and simulation on precision screw insertion into the calcaneus sustentaculum tali (ST). HYPOTHESIS 3D printing and simulation improve the treatment for calcaneal fracture. PATIENTS AND METHODS This retrospective cohort study included 85 patients admitted with 93 Sanders type II-IV intra-articular fractures from January 2015 to June 2020. Multi-slice computed tomography (MSCT) images were used in the conventional group, and MSCT data were used to construct a 3D model of the calcaneus to simulate screw insertion and verify parameter accuracy in the 3D group. RESULTS The designed parameters (upward and backward oblique angles and screw-path length) were similar to the actual values in the 3D group (p=0.428,0.287,0.585) but not in the conventional group (p=0.01,0.002,0.023). The Maryland foot functional score, accuracy rate, and average screw number were higher and operative time was shorter in the 3D group (p=0.005,0.007,0.000,0.000). DISCUSSION Preoperative simulation using the 3D printing model helped guide the screws into the ST more accurately, lending better-quality treatment for Sanders type II-IV calcaneal fractures. LEVEL OF PROOF III; Retrospective case-control study.
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Affiliation(s)
- Bing Wang
- Department of Traumatic Orthopedics, The Affiliated Suqian Hospital of Xuzhou Medical University, No 138. Huanghe Road, Suqian City, Jiangsu Province, China
| | - Ce Shi
- Department of Traumatic Orthopedics, The Affiliated Suqian Hospital of Xuzhou Medical University, No 138. Huanghe Road, Suqian City, Jiangsu Province, China
| | - Aixiang Zhu
- Department of Traumatic Orthopedics, The Affiliated Suqian Hospital of Xuzhou Medical University, No 138. Huanghe Road, Suqian City, Jiangsu Province, China
| | - Fenglei Qiao
- Department of Medical Imaging, The Affiliated Suqian Hospital of Xuzhou Medical University, No 138. Huanghe Road, Suqian City, Jiangsu Province, China
| | - Jingjing Zhou
- Department of Medical Imaging, The Affiliated Suqian Hospital of Xuzhou Medical University, No 138. Huanghe Road, Suqian City, Jiangsu Province, China
| | - Chun Yang
- Department of Traumatic Orthopedics, The Affiliated Suqian Hospital of Xuzhou Medical University, No 138. Huanghe Road, Suqian City, Jiangsu Province, China
| | - Yachao Sheng
- Department of Traumatic Orthopedics, The Affiliated Suqian Hospital of Xuzhou Medical University, No 138. Huanghe Road, Suqian City, Jiangsu Province, China
| | - Honglan Tang
- Department of Traumatic Orthopedics, The Affiliated Suqian Hospital of Xuzhou Medical University, No 138. Huanghe Road, Suqian City, Jiangsu Province, China
| | - Guangsheng Tang
- School of Basic Medicine, Xuzhou Medical University, No 209. Tongshan Road, Xuzhou City, Jiangsu Province, China; School of Medical Imaging, Xuzhou Medical University, No 209. Tongshan Road, Xuzhou City, Jiangsu Province, China
| | - Deguang Wang
- School of Basic Medicine, Xuzhou Medical University, No 209. Tongshan Road, Xuzhou City, Jiangsu Province, China; School of Medical Imaging, Xuzhou Medical University, No 209. Tongshan Road, Xuzhou City, Jiangsu Province, China.
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Pradana AS, Mustamsir E, Phatama KY, Putra DP, Oktafandi IGNAA. Arthroscopic assisted percutaneous fixation in ankle pilon fracture: A case report. Int J Surg Case Rep 2024; 115:109300. [PMID: 38281380 PMCID: PMC10839263 DOI: 10.1016/j.ijscr.2024.109300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 01/18/2024] [Accepted: 01/19/2024] [Indexed: 01/30/2024] Open
Abstract
INTRODUCTION Results of operative fixation for ankle fractures had been suboptimal, with cases of posttraumatic osteoarthritis occurring following the surgeries. Intra-articular injuries have been suggested as the cause of this problem. This case report aims to present an ankle pilon fracture Ruedi Allgower type II case treated with percutaneous fixation and arthroscopy evaluation. PRESENTATION OF CASE Female, 17 years old, complained of pain and swelling at the right ankle. The physical examination revealed swelling, deformity, tenderness, and limited range of motion at the right ankle. The radiological examination showed a Ruedi Allgower type II pilon fracture with right ankle dislocation. The patient underwent closed reduction, arthroscopy to evaluate her right ankle and percutaneous internal fixation. The post-surgery evaluation showed a stable ankle. DISCUSSION Patients undergoing ankle fracture surgery may benefit from ankle arthroscopy because it may increase visualization of articular reductions, assess and repair cartilage and ligament damage, remove loose bodies, decrease soft tissue exposure, preservative vascularity, and evaluate syndesmosis. Moreover, rapid arthroscopic evaluation has a low complication rate. The ability of arthroscopy to improve syndesmotic instability diagnosis suggests that arthroscopy may play a significant role in managing ankle fractures. CONCLUSION Arthroscopy-assisted internal fixation provides more benefits and information as a single case report, and more studies are warranted; regarding patients' intra-articular injuries, preventing future complications, such as posttraumatic osteoarthritis.
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Affiliation(s)
- Ananto Satya Pradana
- Orthopaedics and Traumatology Department, Faculty of Medicine, Universitas Brawijaya - Saiful Anwar General Hospital, Malang, East Java, Indonesia.
| | - Edi Mustamsir
- Orthopaedics and Traumatology Department, Faculty of Medicine, Universitas Brawijaya - Saiful Anwar General Hospital, Malang, East Java, Indonesia
| | - Krisna Yuarno Phatama
- Orthopaedics and Traumatology Department, Faculty of Medicine, Universitas Brawijaya - Saiful Anwar General Hospital, Malang, East Java, Indonesia
| | - Domy Pradana Putra
- Orthopaedics and Traumatology Department, Faculty of Medicine, Universitas Brawijaya - Saiful Anwar General Hospital, Malang, East Java, Indonesia
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Pires RE, Rabelo JMG, Cimini CA, Casas EBDL, Neder Filho AT, Giordano V, Kfuri M, de Andrade MAP. Biomechanics of internal fixation in Hoffa fractures - A comparison of four different constructs. Injury 2024; 55:111219. [PMID: 38029682 DOI: 10.1016/j.injury.2023.111219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 11/02/2023] [Accepted: 11/13/2023] [Indexed: 12/01/2023]
Abstract
OBJECTIVE Compare the biomechanical effectiveness of four different bone-implant constructs in preventing fracture displacement under axial loading. METHODS Twenty artificial femora had a standardized coronally oriented fracture of the lateral femoral condyle, representing a Hoffa fracture classified as a Letenneur type I. Four different fixation constructs were applied to the synthetic bones for biomechanical testing. The constructs consisted of a posterolateral (PL) buttressing locking plate in conjunction with two cannulated lag screws inserted from posterior to anterior (PA) - Group 1; Two cannulated screws inserted from anterior to posterior (AP) without plating- Group 2; A posterolateral (PL) buttressing locking plate in isolation - Group 3; and a combination of two lag screws from anterior to posterior (AP) in addition to a horizontal one-third tubular locking plate - Group 4. An axial load was applied to the fracture site with a constant displacement speed of 20 mm/min, and the test was interrupted when a secondary displacement was detected determining a fixation failure. We recorded the maximum applied force and the maximum fracture displacement values. RESULTS Group 1 demonstrated the highest overall bone-implant axial stiffness with the lowest secondary displacement under loading. Groups 3 and 4 showed equivalent mechanical behavior. Group 2 presented the lowest mechanical stiffness to axial loading. The combination of the one-third tubular locking plate with anterior-to-posterior lag screws (Group 4) resulted in 302 % increase in fixation stiffness when compared to anterior-to-posterior lag screws only (Group 2). CONCLUSIONS This study confirms the mechanical superiority of having a plate applied parallel to the main fracture plane in the setting of coronally oriented femoral condyle fractures. The addition of a horizontal plate, perpendicular to the main fracture plane, significantly increased the resistance to shearing forces at the fracture site when compared to constructs adopting just cannulated screws. LEVEL OF EVIDENCE Biomechanical study.
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Affiliation(s)
- Robinson Esteves Pires
- Department of the Locomotor Apparatus, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil.
| | - João Marcos Guimarães Rabelo
- Department of Structural Engineering, School of Engineering, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Carlos Alberto Cimini
- Department of Structural Engineering, School of Engineering, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Estevam Barbosa de Las Casas
- Department of Structural Engineering, School of Engineering, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | | | | | - Mauricio Kfuri
- Department of Orthopedics, University of Missouri, Columbia, MO, United States
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Bhumiwat P, Fossum BW, Dey Hazra RO, Ganokroj P. Treatment of Unfixable Inferior Pole Fractures of the Patella Using an All-Suture Internal Fixation Technique. Clin Orthop Surg 2024; 16:168-172. [PMID: 38304204 PMCID: PMC10825245 DOI: 10.4055/cios23111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 07/25/2023] [Accepted: 07/25/2023] [Indexed: 02/03/2024] Open
Abstract
Inferior pole fractures of the patella are a type of patellar fracture that has various complexities. Most current techniques are associated with hardware-related complications, which is one of the main concerns when treating this complex fracture. We present a new technique that does not require metal implant removal, causes little to no irritation of the quadriceps muscle, and provides strong fixation that allows for early range of motion postoperatively.
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Affiliation(s)
- Pongpak Bhumiwat
- Department of Orthopaedic Surgery, Faculty of Medicine
Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | | | - Phob Ganokroj
- Department of Orthopaedic Surgery, Faculty of Medicine
Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Steadman Philippon Research Institute, Vail, CO,
USA
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24
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Hutaif M, Issa MAN, Humaid H. Assessing the effectiveness of intramedullary nailing for tibial shaft fractures in a low-income setting: a prospective study in Yemen. Eur J Orthop Surg Traumatol 2024; 34:995-1002. [PMID: 37828298 DOI: 10.1007/s00590-023-03753-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 09/25/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND Tibial shaft fractures are common injuries that can be treated with various methods, including interlocked intramedullary nail (IMN). However, there is limited data on the clinical outcomes of IMN for tibial shaft fractures in Yemen. OBJECTIVE To evaluate the clinical outcomes of primary IMN for tibial shaft fractures in Yemen. METHODS This was a prospective study of 134 patients who underwent primary IMN for tibial shaft fractures et al.-Thawra Modern General Hospital in Sana'a, Yemen, between June 2016 and June 2020. The patients were between 18 and 70 years old, and the fractures were classified according to the AO classification system. The fractures were treated with IMN using a standard technique. The patients were followed up for a minimum of 2 years. The outcome measures included union time, complications, and functional scores. RESULTS The mean union time was 17 weeks. The overall complication rate was 18.7%. The most common complications were infection (8.2%), delayed union (6.7%), and nonunion (3.7%). The mean functional scores at the final follow-up were 91.4 for the Knee Society Score and 90.2 for the American Orthopaedic Foot and Ankle Society Score. CONCLUSION Primary IMN is an effective and reliable method for treating tibial shaft fractures in Yemen, with acceptable union time, complication rate, and functional outcomes.
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Affiliation(s)
| | | | - Hakim Humaid
- Orthopedic Department, Sanaa University, Sanaa, Yemen.
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Eelsing R, Ahmadi AM, Halm JA, Schepers T. Geographical Differences in Wound Complication Rates Following the Sinus Tarsi Approach in Displaced Intra-articular Calcaneal Fractures: A Systematic Review of the Literature. Clin Orthop Surg 2024; 16:134-140. [PMID: 38304215 PMCID: PMC10825260 DOI: 10.4055/cios23241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 10/12/2023] [Indexed: 02/03/2024] Open
Abstract
Background The sinus tarsi approach (STA) has gained popularity for the treatment of displaced intra-articular calcaneal fractures. No large studies comparing wound complications worldwide after STA surgery are available. The aim of this systematic review was to compare postoperative wound complication (POWC) and postoperative wound infection (POWI) rates following STA surgery between continents and countries and their differences in climate. Methods A literature search was performed using the databases of PubMed, Embase, and the Cochrane Library. Studies published before January 1, 2000, including < 10 patients and written in a language other than English were excluded. Results In total, 86 studies containing 4,392 surgeries via STA from 20 different countries were included. The mean POWC was 5.9% and the mean POWI was 4.4%. The highest median POWC rate was in North America (8.5%) and the lowest in South America (2.0%). No significant differences were found in the POWC and POWI rates between countries (p = 0.178 and p = 0.570, respectively), but significant differences were found between the POWC and POWI rates between continents (p = 0.011 and p = 0.036, respectively). The number of surgeries per year and climate differences, as represented by mean local temperature, were not correlated with both the POWC/POWI rates and functional outcome scores. Conclusions Significant differences between the POWC and POWI rates were found between continents but not between individual countries. With a mean POWC of 5.9% and a mean POWI rate of 4.4%, STA has an intrinsic low risk for complications given the minimally invasive nature of the approach and is inevitably becoming the gold standard for calcaneal surgery.
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Affiliation(s)
- Robin Eelsing
- Department of Surgery, Amsterdam UMC, location University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Movement Sciences, AMS - Musculoskeletal Health, Amsterdam, Netherlands
| | - Ahmad Masih Ahmadi
- Department of Surgery, Amsterdam UMC, location University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Movement Sciences, AMS - Musculoskeletal Health, Amsterdam, Netherlands
| | - Jens Anthony Halm
- Department of Surgery, Amsterdam UMC, location University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Movement Sciences, AMS - Musculoskeletal Health, Amsterdam, Netherlands
| | - Tim Schepers
- Department of Surgery, Amsterdam UMC, location University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Movement Sciences, AMS - Musculoskeletal Health, Amsterdam, Netherlands
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Cong LL, Jiang PP, Guo H, Wang H, Che XD, Wang CF, Li WJ, Li PC. [Meta-analysis of the role of fibular fixation in tibiofibular fractures]. Zhongguo Gu Shang 2024; 37:74-80. [PMID: 38286455 DOI: 10.12200/j.issn.1003-0034.20220290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/31/2024]
Abstract
OBJECTIVE To compare the role and importance of fibular fixation in tibiofibular fractures by Meta-analysis. METHODS The literature related to the comparison of the efficacy of fixation of the fibula with or without fixation on the treatment of tibiofibular fractures was searched through the databases of China Knowledge Network, Wipu, Wanfang, The Cochrane Library, Web of science and Pubmed, and statistical analysis was performed using RevMan 5.3 software. The rates of malrotation, rotational deformity, internal/external deformity, anterior/posterior deformity, non-union, infection, secondary surgery and operative time were compared between the fibula fixation and non-fixation groups. RESULTS A total of 11 publications were included, six randomised controlled trials and five case-control trials, eight of which were of high quality. A total of 813 cases were included, of which 383 were treated with fibula fixation and 430 with unfixed fibulae.Meta-analysis results showed that fixation of the fibulae in the treatment of tibiofibular fractures reduced the rates of postoperative rotational deformity[RR=0.22, 95%CI(0.10, 0.45), P<0.000 1] and internal/external deformity[RR=0.34, 95%CI(0.14, 0.84), P=0.02] and promoted fracture healing [RR=0.76, 95%CI(0.58, 0.99), P=0.04]. In contrast, the rates of poor reduction [RR=0.48, 95% CI(0.10, 2.33), P=0.36], anterior/posterior deformity[RR=1.50, 95%CI(0.76, 2.96), P=0.24], infection[RR=1.43, 95%CI(0.76, 2.72), P=0.27], secondary surgery[RR=1.32, 95%CI(0.82, 2.11), P=0.25], and operative time[MD=10.21, 95%CI(-17.79, 38.21), P=0.47] were not statistically significant (P>0.05) for comparison. CONCLUSION Simultaneous fixation of the tibia and fibula is clinically more effective in the treatment of tibiofibular fractures.
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Affiliation(s)
- Lin-Lin Cong
- Department of Biochemistry and Molecular Biology, College of Basic Medicine, Shanxi Medical University, Taiyuan 030001, Shanxi, China; Key Laboratory of Bone and Soft Tissue Injury, Second Hospital of Shanxi Medical University, Taiyuan 030001, Shanxi, China
| | - Pin-Pin Jiang
- Key Laboratory of Bone and Soft Tissue Injury, Second Hospital of Shanxi Medical University, Taiyuan 030001, Shanxi, China; Department of Orthopedics, the Second Hospital of Shanxi Medical University, Taiyuan 030001, Shanxi, China
| | - Hua Guo
- Key Laboratory of Bone and Soft Tissue Injury, Second Hospital of Shanxi Medical University, Taiyuan 030001, Shanxi, China; Department of Orthopedics, the Second Hospital of Shanxi Medical University, Taiyuan 030001, Shanxi, China
| | - Hang Wang
- Key Laboratory of Bone and Soft Tissue Injury, Second Hospital of Shanxi Medical University, Taiyuan 030001, Shanxi, China; Shanxi Medical University, Taiyuan 030001, Shanxi, China
| | - Xian-da Che
- Key Laboratory of Bone and Soft Tissue Injury, Second Hospital of Shanxi Medical University, Taiyuan 030001, Shanxi, China; Department of Orthopedics, the Second Hospital of Shanxi Medical University, Taiyuan 030001, Shanxi, China
| | - Chun-Fang Wang
- Laboratory Animal Center, Shanxi Medical University, Taiyuan 030001, Shanxi, China
| | - Wen-Jin Li
- Department of Stomatology, the Second Clinical School of Medicine, Shanxi Medical University, Taiyuan 030001, Shanxi, China
| | - Peng-Cui Li
- Key Laboratory of Bone and Soft Tissue Injury, Second Hospital of Shanxi Medical University, Taiyuan 030001, Shanxi, China
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Kenmegne GR, Zou C, Lin Y, Yin Y, Huang S, Fang Y. Traumatic bilateral acetabular fracture secondary to high-energy trauma in healthy adults. BMC Surg 2024; 24:12. [PMID: 38172770 PMCID: PMC10765676 DOI: 10.1186/s12893-023-02302-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 12/25/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Bilateral acetabular fracture is a very rare presentation among the trauma patients, as the pattern and the degree of the forces required to fracture both acetabula is very unique. The primary purpose of this study is to report a series of adult patients presenting with post-traumatic bilateral acetabular fracture without any history of pathological or metabolic bone disease. PATIENTS AND METHODS In this retrospective study, 18 cases of traumatic bilateral acetabular fracture were included. There was predominance of both column (four patients on left and six on right) followed by anterior column (two patients left and four on right) and posterior wall (three patients left and right). They were treated surgically through open reduction and internal fixation. All cases were followed up for at least 13 months. Matta's criteria were used for radiological evaluation on plain radiographs. Functional outcome was evaluated using the Merle d'Aubigne and postel score at final follow-up. RESULTS No patients were lost during the follow-up period; there was one case of surgical site infection. There were three cases of postoperative osteoarthritis, one case of heterotrophic ossification, one case of persistent sciatic nerve palsy and one case of lateral femoral cutaneous nerve palsy. The radiological evaluation according to Matta's criteria revealed anatomic reduction in 12 patients, imperfect reduction in three patients while other three patients had poor reduction. According to modified Merle d'Aubigne and Postel score, 10 cases were rated as excellent, five cases as good and three cases presented fair (one case) to poor (two cases) results. CONCLUSION We report an unusual case series of bilateral acetabular fracture successfully managed surgically with good clinical outcome. With the increasing incidence of route traffic accidents, such cases would probably be recurrent in the upcoming years.
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Affiliation(s)
- Guy Romeo Kenmegne
- Department of Orthopedics, West China Hospital of Sichuan University, Chengdu, 610041, China
- Trauma center, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Chang Zou
- Department of Orthopedics, West China Hospital of Sichuan University, Chengdu, 610041, China
- Trauma center, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Yixiang Lin
- Department of Orthopedics, West China Hospital of Sichuan University, Chengdu, 610041, China
- Trauma center, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Yijie Yin
- Department of Orthopedics, West China Hospital of Sichuan University, Chengdu, 610041, China
- Trauma center, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Shenbo Huang
- Department of Orthopedics, West China Hospital of Sichuan University, Chengdu, 610041, China
- Trauma center, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Yue Fang
- Department of Orthopedics, West China Hospital of Sichuan University, Chengdu, 610041, China.
- Trauma center, West China Hospital of Sichuan University, Chengdu, 610041, China.
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Agres AN, Alves SA, Höntzsch D, El Attal R, Pohlemann T, Schaser KD, Joeris A, Hess D, Duda GN. Improved weight bearing during gait at 6 weeks post-surgery with an angle stable locking system after distal tibial fracture. Gait Posture 2024; 107:169-176. [PMID: 37845132 DOI: 10.1016/j.gaitpost.2023.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 07/12/2023] [Accepted: 09/25/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND Functional recovery after intramedullary nailing of distal tibial fractures can be monitored using ipsilateral vertical ground reaction forces (vGRF), giving insight into recovery of patients' gait symmetry. Previous work compared patient cohorts to healthy controls, but it remains unclear if these metrics can identify treatment-based differences in return to function post-surgery. RESEARCH QUESTION Is treatment of a distal tibial fracture with intramedullary nailing with an angle stable locking system (ASLS) associated with higher ipsilateral vGRF and improved symmetry compared to conventional intramedullary nailing at an early time point? METHODS Thirty-nine patients treated with ASLS intramedullary nailing were retrospectively compared to thirty-nine patients with conventional locking. vGRFs were collected at 1, 6, 12, 26, and 52 weeks post-surgery during standing and gait. Discrete metrics of ipsilateral vGRF (maximal force, impulse) and asymmetry were compared between treatments at each time point. Time-scale comparisons of ipsilateral vGRF and lower limb asymmetry were additionally performed for gait trials. Mann-Whitney Test or a two-way analysis of variance tested discrete comparisons; statistical non-parametric mapping tested time-scale data between treatment groups. RESULTS During gait, ASLS-treated patients applied more load on the operated limb (17-38% stance, p = 0.015) and consequently loaded limbs more symmetrically (8-37% stance, p = 0.008) during the loading response at 6 weeks post-surgery compared to conventional IM treatment. Discrete measures of symmetry at the same time point identified treatment-based differences in maximal force (p = 0.039) and impulse (p = 0.012), with ASLS-treated patients exhibiting more symmetry. No differences were identified in gait trials at later time points nor from all standing trials. SIGNIFICANCE During the initial loading response of gait, increased ipsilateral vGRF and improved weightbearing symmetry were identified in ASLS patients at 6 weeks post-surgery compared to conventional IM nailing. Early and objective metrics of dynamic movement are suggested to identify treatment-based differences in functional recovery.
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Affiliation(s)
- Alison N Agres
- Julius Wolff Institute, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Sónia A Alves
- Julius Wolff Institute, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Dankward Höntzsch
- BG Unfallklinik and University Hospital Tübingen, Schnarrenbergstraße 95, 72076 Tübingen, Germany
| | - René El Attal
- Orthopaedics, Traumatology and Sport Traumatology, Akademisches Lehrkrankenhaus, Carinagasse 47, 6800 Feldkirch, Austria
| | - Tim Pohlemann
- Department for Trauma, Hand and Reconstructive Surgery, Saarland University Medical Center, Kirrbergerstr. 1, 66421 Homburg, Germany
| | - Klaus-Dieter Schaser
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, Fetscherstraße 74, 01307 Dresden, Germany
| | - Alexander Joeris
- AO Innovation Translation Center, AO Foundation, Stettbachstrasse 6, 8600 Dübendorf, Switzerland
| | - Denise Hess
- AO Education Institute, AO Foundation, Stettbachstrasse 6, 8600 Dübendorf, Switzerland
| | - Georg N Duda
- Julius Wolff Institute, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
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Gupta R, Judkins L, Friday CS, Ulsh JB, Kovach SJ, Mehta S, Tomonto C, Manogharan G, Hast MW. Functionally graded 3D printed plates for rib fracture fixation. Clin Biomech (Bristol, Avon) 2024; 111:106151. [PMID: 37989063 PMCID: PMC10842059 DOI: 10.1016/j.clinbiomech.2023.106151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 11/09/2023] [Accepted: 11/10/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND Design freedom offered by additive manufacturing allows for the implementation of functional gradients - where mechanical stiffness is decreased along the length of the implant. It is unclear if such changes will influence failure mechanisms in the context of rib fracture repair. We hypothesized that our novel functionally graded rib implants would be less stiff than controls and decrease occurrence of secondary fracture at implant ends. METHODS Five novel additively manufactured rib implants were tested along with a clinically used Control implant. Fracture reconstructions were modeled with custom synthetic rib bones with a transverse B1 fracture. Ribs were compressed in a cyclic two-point bend test for 360,000 cycles followed by a ramp to failure test. Differences in cyclic stiffness, 3D interfragmentary motions, ramp-to-failure stiffness, maximum load, and work to failure were determined. FINDINGS The Control group had lower construct stiffness (0.76 ± 0.28 N/mm), compared to all novel implant designs (means: 1.35-1.61 N/mm, p < 0.05) and rotated significantly more about the bending axis (2.7° ± 1.3°) than the additively manufactured groups (means between 1.2° - 1.6°, p < 0.05). All constructs failed via bone fracture at the most posterior screw hole. Experimental implants were stiffer than Controls, and there were few significant differences between functional gradient groups. INTERPRETATION Additively manufactured, functionally graded designs have the potential to change the form and function of trauma implants. Here, the impact of functional gradients was limited because implants had small cross-sectional areas.
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Affiliation(s)
- Richa Gupta
- McKay Orthopaedic Research Lab, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Lauren Judkins
- Department of Mechanical Engineering, Pennsylvania State University, University Park, PA, USA
| | - Chet S Friday
- McKay Orthopaedic Research Lab, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Joseph B Ulsh
- McKay Orthopaedic Research Lab, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Stephen J Kovach
- McKay Orthopaedic Research Lab, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Samir Mehta
- McKay Orthopaedic Research Lab, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Guha Manogharan
- Department of Mechanical Engineering, Pennsylvania State University, University Park, PA, USA
| | - Michael W Hast
- McKay Orthopaedic Research Lab, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA.
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Khoshabi K, Manafi Rasi A, Zandi R, Amouzadeh Omrani F, Tavakoli Darestani R, Athari M, Afzal S. Outcomes of the Modified Stoppa Approach in Acetabular Fracture Management: Incidence of Nerve Injuries. Arch Bone Jt Surg 2024; 12:123-127. [PMID: 38420525 PMCID: PMC10898801 DOI: 10.22038/abjs.2023.75631.3498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 12/03/2023] [Indexed: 03/02/2024]
Abstract
Objectives Displaced acetabular fractures are complex injuries that necessitate precise surgical intervention. Obturator nerve injuries occur in approximately 2% of cases. The modified Stoppa approach, offering enhanced exposure of the quadrilateral plate, has gained attraction as an alternative technique for anterior acetabular fractures. However, its proximity to the obturator nerve poses a risk of iatrogenic injury. This study aimed to investigate the incidence of nerve injuries and functional outcomes in patients undergoing the modified Stoppa approach for traumatic acetabular fractures. Methods This retrospective study involved 86 patients with anterior column fractures, whose data were prospectively collected. The fractures were treated using the modified Stoppa approach. Exclusion criteria were pathological fractures, alternative surgical approaches, prior nerve injuries, hip issues, refusal to participate, or inadequate follow-up. Data collection involved pre-operative imaging, thorough post-operative neurological assessments, and post-operative radiographic evaluation. Functional outcomes were assessed using the Harris Hip Score (HHS). Results Most patients were male (n=54) with a mean age of 40±17.3 years. Post-operative infection occurred in six cases, with resolution in four through antibiotics and two necessitating device removal. Obturator nerve damage was detected in 14 patients, comprising nine traumatic and five iatrogenic cases. During the follow-up, symptoms improved in all patients, except for the four patients with iatrogenic nerve damage. Conclusion Traumatic nerve injuries generally heal naturally over time. In contrast, iatrogenic injuries have a less optimistic prognosis, potentially resulting in lasting neurological deficits.
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Affiliation(s)
- Kamyar Khoshabi
- Department of Orthopedic Surgery, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Manafi Rasi
- Department of Orthopedic Surgery, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Zandi
- Department of Orthopedic Surgery, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzad Amouzadeh Omrani
- Department of Orthopedic Surgery, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Tavakoli Darestani
- Department of Orthopedic Surgery, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - MirBahador Athari
- Department of Orthopedic Surgery, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sina Afzal
- Department of Orthopedic Surgery, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Huang S, Zhu J, Xing H, Yang R, Ye J, Ye F, Wu Q, Lan S. Finite element analysis and a pilot study of different fixation constructs for Danis-Weber A and B lateral malleolus fractures. BMC Musculoskelet Disord 2023; 24:981. [PMID: 38114924 PMCID: PMC10729578 DOI: 10.1186/s12891-023-07115-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 12/13/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Displaced lateral malleolus fractures are typically stabilised through open reduction and internal fixation. The biomechanically and clinically efficacy of locking plates and lag screws, particularly in Weber A and B distal fibular fractures remains a subject of contention. This study examines two locking plate designs for lateral malleolus fractures, evaluating their performance with and without interfragmentary screws using finite element models. METHODS Utilising CT images of a healthy adult male volunteer, a three-dimensional finite element model was constructed. The Fibula-specific Flank Multiaxial Locking Anatomic Plate (FMLP) and the Conventional Locking Plate (CLP) were subjected to stabilisation, both with and without an interfragmentary screw, mimicking the Danis-Weber A and B lateral malleolus oblique fracture fixation. Loads of 140 N and 70 N, equivalent to 20% of the body weight, were applied to simulate the single-leg and two-leg standing conditions in the axial direction. The von Mises stress (VMS) distributions and element displacements were subsequently analyzed. RESULTS In the Danis-Weber A fracture model group, the FMLP with an interfragmentary screw fixation exhibited the lowest peak VMS values: 51.9 MPa in the fibula, 89.0 MPa in the plate, and 61.3 MPa in the screws for simulating single-leg conditions. Under two-leg standing conditions, these peak VMS values decreased to 25.9 MPa in the fibula, 44.5 MPa in the plate, and 30.6 MPa in the screws, respectively. Furthermore, the overall structural peak displacements during single-leg standing for both Weber-A and B fractures with different implants ranged from 1.61 to 2.54 mm. While standing on two feet, the ranged was from 0.80 to 1.27 mm. An interfragmentary screw at the oblique fracture site resulted in reduced the peak value of VMS in the fibula, plate, screws, consequently decreased the overall structural displacement for FMLP and CLP fixation in lateral malleolus fractures. CONCLUSIONS The current finite element analysis (FEA) demonstrates that FMLP exhibits superior mechanical characteristics in Danis-Weber A and B lateral malleolus fractures compared to CLP. The inclusion of an interfragmentary screw, combined with locking plate design, enhances stability for simple oblique distal fibular fractures. The FMLP presents itself as potential as an alternative for lateral malleolus fractures from a biomechanical perspective. Nevertheless, further verification of these results is imperative through subsequent clinical studies.
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Affiliation(s)
- Shuming Huang
- Department of Orthopedic Surgery, Lishui Hospital, Zhejiang University School of Medicine, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Municipal Central Hospital, Lishui, Zhejiang, 323000, People's Republic of China
| | - Junkun Zhu
- Department of Orthopedic Rehabilitation, Lishui Hospital, Zhejiang University School of Medicine, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Municipal Central Hospital, Zhejiang323000, Lishui, People's Republic of China
| | - Hailin Xing
- Department of Orthopedic Surgery, Lishui Hospital, Zhejiang University School of Medicine, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Municipal Central Hospital, Lishui, Zhejiang, 323000, People's Republic of China
| | - Ruifeng Yang
- Department of Orthopedic Surgery, Lishui Hospital, Zhejiang University School of Medicine, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Municipal Central Hospital, Lishui, Zhejiang, 323000, People's Republic of China
| | - Jifei Ye
- Department of Orthopedic Surgery, Lishui Hospital, Zhejiang University School of Medicine, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Municipal Central Hospital, Lishui, Zhejiang, 323000, People's Republic of China
| | - Fang Ye
- Department of Orthopedic Surgery, Lishui Hospital, Zhejiang University School of Medicine, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Municipal Central Hospital, Lishui, Zhejiang, 323000, People's Republic of China
| | - Quanzhou Wu
- Department of Orthopedic Surgery, Lishui Hospital, Zhejiang University School of Medicine, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Municipal Central Hospital, Lishui, Zhejiang, 323000, People's Republic of China
| | - Shuhua Lan
- Department of Orthopedic Surgery, Lishui Hospital, Zhejiang University School of Medicine, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Municipal Central Hospital, Lishui, Zhejiang, 323000, People's Republic of China.
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Jo WR, Lee CY, Kwon SM, Kim CH, Kwon MY, Kim JH, Ko YS. Does the Surgical Approach Matter in Treating Odontoid Fractures? A Comparison of Mechanical Complication Rates Between Anterior Versus Posterior Surgical Approaches: A Meta-Analysis and Systematic Review. Korean J Neurotrauma 2023; 19:409-421. [PMID: 38222835 PMCID: PMC10782099 DOI: 10.13004/kjnt.2023.19.e64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/06/2023] [Accepted: 12/08/2023] [Indexed: 01/16/2024] Open
Abstract
Objective Odontoid fractures are treated surgically through the anterior or posterior approach. Each surgical approach has its advantages and disadvantages, so the preferred approach remains debatable. There are few meta-analyses or systemic reviews on the mechanical complications of surgical treatment for odontoid fractures. This meta-analysis aimed to compare the operation-related morbidity, including mechanical complications, and mortality of patients with odontoid fractures, treated via the anterior or posterior approach. Methods A systematic search was performed on PubMed/Medline, Embase, and the Cochrane Library for the studies up to October 2023 on the complication rate of the surgical treatment of odontoid fractures, related to the surgical approach. The risk ratios (RR) with the 95% confidence intervals (CIs) were pooled to assess the mechanical complication rates, other complications, revision surgery, and mortality, depending on the surgical approach. Results A total of 1,519 studies were retrieved using the search strategy, and 782 patients from 15 articles were included in this meta-analysis. Mechanical complications were significantly more frequent in the anterior surgical group with low heterogeneity. The incidences of fracture nonunion and revision surgery were also higher in the anterior surgery group. However, there was no significant difference in systemic complications and mortality rates between the two groups. Conclusion The posterior approach was more advantageous than the anterior approach in terms of mechanical complications, fusion rates, and incidence of revision surgery. However, further studies, should be performed to strengthen these results.
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Affiliation(s)
- Woong Rae Jo
- Department of Neurosurgery, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Chang-Young Lee
- Department of Neurosurgery, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Sae Min Kwon
- Department of Neurosurgery, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Chang-Hyun Kim
- Department of Neurosurgery, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Min-Yong Kwon
- Department of Neurosurgery, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Jae Hyun Kim
- Department of Neurosurgery, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Young San Ko
- Department of Neurosurgery, Keimyung University Dongsan Hospital, Daegu, Korea
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Ai Y, Alemayehu DG, Mao G, Liang Y, Cao R, Hu J, Yang Y, Ren Z. Feasibility of Two-Screw Anterior Fixation for Odontoid Fractures in a Chinese Population: A Morphometric Study Based on Computed Tomography. Clin Orthop Surg 2023; 15:983-988. [PMID: 38045572 PMCID: PMC10689213 DOI: 10.4055/cios23094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 07/03/2023] [Accepted: 07/26/2023] [Indexed: 12/05/2023] Open
Abstract
Background To evaluate the feasibility of treating odontoid fractures in the Chinese population with two cortical screws based on computed tomography (CT) scans and describe a new measurement strategy to guide screw insertion in treating these fractures. Methods A retrospective review of cervical computed tomographic scans of 128 patients (aged 18-76 years; men, 55 [43.0%]) was performed. The minimum external transverse diameter (METD), minimum external anteroposterior diameter (MEAD), maximum screw length (MSL), and screw projection back angle (SPBA) of the odontoid process were measured on coronal and sagittal CT images. Results The mean values of METD and MEAD were 10.0 ± 1.1 mm and 12.0 ± 1.0 mm, respectively, in men and 9.2 ± 1.0 mm and 11.0 ± 1.0 mm, respectively, in women. Both measurements were significantly higher in men (p < 0.001). In total, 87 individuals (68%) had METD > 9.0 mm that could accommodate two 3.5-mm cortical screws. The mean MSL value and SPBA range were 34.4 ± 2.9 mm and 13.5°-24.2°, respectively, with no statistically significant difference between men and women. Conclusions The insertion of two 3.5-mm cortical screws was possible for anterior fixation of odontoid fractures in 87 patients (68%) in our study, and there was a statistically significant difference between men and women.
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Affiliation(s)
- Yixiang Ai
- Department of Orthopedics, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Dereje Gobena Alemayehu
- Department of Orthopedics, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Genwen Mao
- Department of Orthopedics, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | | | - Ran Cao
- Xi’an Jiaotong University, Xi’an, China
| | - Jiale Hu
- Xi’an Jiaotong University, Xi’an, China
| | - Yimin Yang
- Department of Orthopedics, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Zhiwei Ren
- Department of Orthopedics, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
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Brouwer de Koning SG, de Winter N, Moosabeiki V, Mirzaali MJ, Berenschot A, Witbreuk MMEH, Lagerburg V. Design considerations for patient-specific bone fixation plates: a literature review. Med Biol Eng Comput 2023; 61:3233-3252. [PMID: 37691047 DOI: 10.1007/s11517-023-02900-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 07/29/2023] [Indexed: 09/12/2023]
Abstract
In orthopedic surgery, patient-specific bone plates are used for fixation when conventional bone plates do not fit the specific anatomy of a patient. However, plate failure can occur due to a lack of properly established design parameters that support optimal biomechanical properties of the plate.This review provides an overview of design parameters and biomechanical properties of patient-specific bone plates, which can assist in the design of the optimal plate.A literature search was conducted through PubMed and Embase, resulting in the inclusion of 78 studies, comprising clinical studies using patient-specific bone plates for fracture fixation or experimental studies that evaluated biomechanical properties or design parameters of bone plates. Biomechanical properties of the plates, including elastic stiffness, yield strength, tensile strength, and Poisson's ratio are influenced by various factors, such as material properties, geometry, interface distance, fixation mechanism, screw pattern, working length and manufacturing techniques.Although variations within studies challenge direct translation of experimental results into clinical practice, this review serves as a useful reference guide to determine which parameters must be carefully considered during the design and manufacturing process to achieve the desired biomechanical properties of a plate for fixation of a specific type of fracture.
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Affiliation(s)
| | - N de Winter
- Medical Physics, OLVG Hospital, Oosterpark 9, 1091 AC, Amsterdam, The Netherlands
| | - V Moosabeiki
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime, and Materials Engineering, Delft University of Technology, Delft, The Netherlands
| | - M J Mirzaali
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime, and Materials Engineering, Delft University of Technology, Delft, The Netherlands
| | - A Berenschot
- Medical Library, Department of Research and Epidemiology, OLVG Hospital, Amsterdam, The Netherlands
| | | | - V Lagerburg
- Medical Physics, OLVG Hospital, Oosterpark 9, 1091 AC, Amsterdam, The Netherlands.
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Pourabbas B, Emad J, Dehghani J, Heidari S, Vosoughi AR. Mechanical evaluation of the effect of the rod to rod distance on the stiffness of uniplanar external fixator frames. Musculoskelet Surg 2023; 107:397-403. [PMID: 37029888 DOI: 10.1007/s12306-023-00782-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 03/26/2023] [Indexed: 04/09/2023]
Abstract
PURPOSE To investigate the effect of the rod-to-rod distance on the mechanical stability of single-rod and double-rod external fixator frames. METHODS Four different constructs, one single-rod and three double-rod constructs with different rod-rod distances, were subjected to the axial, bending, and torsional forces. The stiffness of different configurations was calculated. RESULTS Single-rod configuration had statistically the lowest stiffness when subjected to the axial, bending, and torsional forces. Maximum stiffness against the axial and anterior-posterior bending forces was achieved when the rod-rod distance was adjusted to 50 mm (halfway between the first rod and the end of the Schanz pins). There was no statistically significant difference in lateral bending stiffness among different double-rod configurations (p value: 0.435). The maximum stiffness against torsional forces was achieved when the rod-rod distance was adjusted to 100 mm (the second rod at the end of the Schanz pins). CONCLUSION Double-rod uniplanar external fixator frames are significantly stiffer than the single-rod constructs, and however, the rod-rod distance can significantly affect the construct stiffness. We found that a frame with 50 mm rod-rod distance was the optimum fixator among tested configurations that allowed a balance between axial, bending, and torsional stiffness of the construct.
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Affiliation(s)
- B Pourabbas
- Bone and Joint Diseases Research Center, Department of Orthopedic Surgery, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - J Emad
- Bone and Joint Diseases Research Center, Department of Orthopedic Surgery, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - S Heidari
- Bone and Joint Diseases Research Center, Department of Orthopedic Surgery, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - A R Vosoughi
- Bone and Joint Diseases Research Center, Department of Orthopedic Surgery, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
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Ferreira ROM, Pasqualotto E, Viana P, Schmidt PHS, Andrighetti L, Chavez MP, Flausino F, de Oliveira Filho GR. Surgical versus non-surgical treatment of flail chest: a meta-analysis of randomized controlled trials. Eur J Trauma Emerg Surg 2023; 49:2531-2541. [PMID: 37526708 DOI: 10.1007/s00068-023-02339-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 07/23/2023] [Indexed: 08/02/2023]
Abstract
PURPOSE Conflicting evidence exists on the choice of surgical or non-surgical treatment of flail chest injuries. We aimed to perform a meta-analysis comparing outcomes in patients presenting flail chest undergoing surgical or non-surgical treatment. METHODS Embase, PubMed, and Cochrane databases were searched for randomized controlled trials (RCTs) comparing surgery to no surgery in patients with acute unstable chest wall injuries. We computed weighted mean differences (WMDs) for continuous outcomes and risk ratios (RRs) for binary endpoints, with 95% confidence intervals (CIs). Random effects meta-analyses were performed. Heterogeneity was assessed using I2 statistics. RESULTS Six RCTs (544 patients) were included, and surgical treatment was used in 269 (49.4%). Compared to no surgery, surgery reduced mechanical ventilation days (WMD - 4.34, 95% CI - 6.98, - 1.69; p < 0.01; I2 = 87%; GRADE: very low; PI - 13.51, 4.84); length of intensive care unit stay (WMD - 4.62, 95% CI - 7.19, - 2.05; p < 0.01; I2 = 78%; GRADE: low; PI - 12.86, 3.61) and the incidence of pneumonia (RR 0.50, 95% CI 0.31, 0.81; p = 0.005; I2 = 54%; GRADE: moderate; PI 0.13, 1.91). No difference in mortality (RR 0.56, 95% CI 0.19, 1.65; p = 0.27; I2 = 23%; GRADE: moderate; PI 0.04, 7.25), length of hospital stay (WMD - 5.39, 95% CI - 11.38, - 0.60; p = 0.08; I2 = 89%; GRADE: very low; PI - 11.38, 0.60), or need for tracheostomy (RR 0.59, 95% CI 0.34, 1.03; p = 0.06; I2 = 54%; GRADE: moderate; PI 0.11, 3.24) was found. CONCLUSIONS Our results suggest that surgical treatment is advantageous compared to non-surgical treatment for patients with flail chest secondary to rib fractures.
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Affiliation(s)
- Rafael Oliva Morgado Ferreira
- Federal University of Santa Catarina, R. João Pio Duarte, 144, Córrego Grande, Florianópolis, SC, 88037-000, Brazil.
| | - Eric Pasqualotto
- Federal University of Santa Catarina, R. João Pio Duarte, 144, Córrego Grande, Florianópolis, SC, 88037-000, Brazil
| | - Patrícia Viana
- University of the Extreme South of Santa Catarina, Criciúma, Santa Catarina, Brazil
| | | | - Leonardo Andrighetti
- Federal University of Santa Catarina, R. João Pio Duarte, 144, Córrego Grande, Florianópolis, SC, 88037-000, Brazil
| | - Matheus Pedrotti Chavez
- Federal University of Santa Catarina, R. João Pio Duarte, 144, Córrego Grande, Florianópolis, SC, 88037-000, Brazil
| | - Felippe Flausino
- Federal University of Santa Catarina, R. João Pio Duarte, 144, Córrego Grande, Florianópolis, SC, 88037-000, Brazil
- Joana de Gusmão Children's Hospital, Florianópolis, Santa Catarina, Brazil
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Fu G, Zhang Y, Ke S, Zhu D, Wu J, Su D, Ge H, Chen J, MB YZ, Lin F, Chen J, Li R. Treatment of Distal Third Humeral Shaft Fracture with Intramedullary Nail Combined with Anterior Minimally Invasive Plate Osteosynthesis. Orthop Surg 2023; 15:3101-3107. [PMID: 37817420 PMCID: PMC10693993 DOI: 10.1111/os.13893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 08/21/2023] [Accepted: 08/22/2023] [Indexed: 10/12/2023] Open
Abstract
OBJECTIVE The treatment of distal third humeral shaft fracture is difficult. Studies have shown that anterior minimally invasive plate has lower probability of complication and higher healing rate. However there is no applicable anatomical plate at present. This study is to investigate the clinical effect of intramedullary nail combined with anterior minimally invasive plate in the treatment of distal humeral shaft fractures. METHODS The data of 83 patients with lower humerus shaft fracture treated from September 2015 to January 2020 were analyzed. According to different treatment methods, they were divided into two groups: 40 patients were treated with intramedullary nailing combined with minimally invasive anterior plate fixation (group A), and 43 patients were treated with double plate fixation through posterior approach (group B). General preoperative data, operative time, intraoperative blood loss, total incision length, fracture healing time, shoulder and elbow visual analogue scale (VAS) score, Constant-Murley shoulder function score, Mayo elbow function score, and complications were recorded and compared between the two groups. Two independent sample t-tests was used for follow-up, age, BMI, operation time, intraoperative bleeding, total incision length, fracture healing time, Constant-Murley score and Mayo score, and rank sum test was used for VAS score of shoulder and elbow. RESULTS There was no significant difference in preoperative general data between the two groups (p > 0.05), indicating comparability. There were no significant differences in operation time, total incision length, fracture healing time, Constant-Murley shoulder function score at the last follow-up, Mayo elbow function score, and shoulder and elbow VAS pain score between 2 groups (p > 0.05). The amount of intraoperative blood loss in observation group was 76.98 ± 16.46, which was significantly less than that in control group, and the difference was statistically significant (p < 0.01). There were no radial nerve injury, musculocutaneous nerve injury, incision infection and fracture nonunion in the observation group. In the control group, four cases of iatrogenic radial nerve injury, three cases of incision infection and three cases of fracture nonunion were found. The complication rate was 23.3% (10/43). There was statistical difference in the incidence of complications between the two groups (p < 0.01). CONCLUSION A humeral intramedullary nail combined with an anterior minimally invasive plate in the treatment of distal humeral shaft fracture has the advantages of less soft tissue damage, less blood transfusion, high fracture healing rate and low risk of iatrogenic radial nerve injury, which is an effective method for clinical treatment of this type of fracture.
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Affiliation(s)
- Gang Fu
- Department of Orthopaedics, Fuzhou Second Hospital, Fujian Trauma Orthopaedics Emergency and Rehabilitation Clinical Medical Research CenterFuzhou Trauma Medical CenterFuzhouChina
| | - Yichong Zhang
- Department of Trauma & OrthopedicsPeking University People's HospitalBeijingChina
| | - Shuyujiong Ke
- Department of Orthopaedics, Fuzhou Second Hospital, Fujian Trauma Orthopaedics Emergency and Rehabilitation Clinical Medical Research CenterFuzhou Trauma Medical CenterFuzhouChina
| | - Dengke Zhu
- Department of Orthopaedics, Fuzhou Second Hospital, Fujian Trauma Orthopaedics Emergency and Rehabilitation Clinical Medical Research CenterFuzhou Trauma Medical CenterFuzhouChina
| | - Jingxiang Wu
- Department of Orthopaedics, Fuzhou Second Hospital, Fujian Trauma Orthopaedics Emergency and Rehabilitation Clinical Medical Research CenterFuzhou Trauma Medical CenterFuzhouChina
| | - Dengbang Su
- Department of Orthopaedics, Fuzhou Second Hospital, Fujian Trauma Orthopaedics Emergency and Rehabilitation Clinical Medical Research CenterFuzhou Trauma Medical CenterFuzhouChina
| | - Hui Ge
- Department of Orthopaedics, Fuzhou Second Hospital, Fujian Trauma Orthopaedics Emergency and Rehabilitation Clinical Medical Research CenterFuzhou Trauma Medical CenterFuzhouChina
| | - Jianlong Chen
- Department of Orthopaedics, Fuzhou Second Hospital, Fujian Trauma Orthopaedics Emergency and Rehabilitation Clinical Medical Research CenterFuzhou Trauma Medical CenterFuzhouChina
| | - Yan Zhang MB
- Department of Trauma & OrthopedicsPeking University People's HospitalBeijingChina
| | - Fengfei Lin
- Department of Orthopaedics, Fuzhou Second Hospital, Fujian Trauma Orthopaedics Emergency and Rehabilitation Clinical Medical Research CenterFuzhou Trauma Medical CenterFuzhouChina
| | - Jianhai Chen
- Department of Trauma & OrthopedicsPeking University People's HospitalBeijingChina
| | - Renbin Li
- Department of Orthopaedics, Fuzhou Second Hospital, Fujian Trauma Orthopaedics Emergency and Rehabilitation Clinical Medical Research CenterFuzhou Trauma Medical CenterFuzhouChina
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Tian W, Jia FS, Zheng JM, Jia J. Treatment of Unstable Sacral Fractures with Robotically-aided Minimally Invasive Triangular Fixation. Orthop Surg 2023; 15:3182-3192. [PMID: 37873590 PMCID: PMC10694018 DOI: 10.1111/os.13907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 08/27/2023] [Accepted: 08/30/2023] [Indexed: 10/25/2023] Open
Abstract
OBJECTIVE The treatment of unstable sacral fractures is huge challenge to surgeons. Robotically-aided minimally invasive triangular fixation (RoboTFX) is the most advanced technique up to now. This study is to evaluate the clinical outcomes of unstable sacral fractures treated with RoboTFX. METHODS From March 2017 to October 2021, 48 consecutive patients with unstable sacral fractures were included in the study. All patients received surgical treatment with triangular fixation (TFX). Patients were divided into four groups according to the number of fractures (uni- or bilateral) and surgical method employed (RoboTFX or traditional open TFX). Between these four groups, clinical data on operation time, intraoperative bleeding, intraoperative fluoroscopy time, infection rate, fracture healing rates, insertion accuracy, Majeed pelvic outcome score, Mears' criterion, and Gibbons score were compared. Quantitative data were expressed as mean ± standard deviation and compared using Student's t-test. Categorical variable were compared using the Pearson's χ2 test. RESULTS Comparing unilateral RoboTFX versus open TFX, neither fracture healing rate, infection rate, Majeed pelvic outcome score, Mears' radiological evaluation criterion, nor Gibbons score of the two groups were statistically significantly different (p > 0.05). However, operation time, intraoperative bleeding, intraoperative fluoroscopy time, and insertion accuracy in the RoboTFX group were all significantly better than those of the traditional open group (p < 0.05). Likewise, operation time, intraoperative bleeding, intraoperative fluoroscopy time, and accuracy of fixation insertion of the bilateral RoboTFX group were significantly better than those of the bilateral open group (p < 0.05). Meanwhile infection rate, fracture healing rate, Majeed score, Mears' criterion, and Gibbons score of two groups were not significantly different (p > 0.05). CONCLUSION RoboTFX has the advantages of less operation time, less intraoperative bleeding and fluoroscopy, more accurate fixation insertion, and a higher healing rate compared to traditional open methods in the treatment of unstable sacral fractures. However, RoboTFX requires a few critical considerations, and the indications of its operation should be strictly evaluated.
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Affiliation(s)
- Wei Tian
- Department of Orthopaedic Trauma, Tianjin Hospital, Tianjin University, Tianjin, China
| | - Feng-Shuang Jia
- Department of Orthopaedic Trauma 2nd, Third People's Hospital of Jinan City, Jinan, China
| | - Jia-Ming Zheng
- Academy of Clinical Medicine, West China Medical School, Sichuan University, Chengdu, China
| | - Jian Jia
- Department of Orthopaedic Trauma, Tianjin Hospital, Tianjin University, Tianjin, China
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Fredj AB, Rbai H, Chatbouri F, Berriri M, Daadoucha A, Boughattas A. Clinical and radiographic outcomes after paediatric supracondylar humeral fractures treated with combined intramedullary and lateral wire fixation: our experience in fifty-one cases. Int Orthop 2023; 47:2901-2906. [PMID: 36897363 DOI: 10.1007/s00264-023-05765-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 03/03/2023] [Indexed: 03/11/2023]
Abstract
PURPOSE Displaced supracondylar humerus fractures in children are known for their high rate of complications and require urgent surgical treatment. Basically, there are two methods of fracture fixation: the lateral pin technique and the crossed pin technique. However, the best technique remains debated. The aim of this study was to evaluate the clinical and radiographic outcomes of our method of fixation using combined intramedullary and lateral wires for treatment of displaced supracondylar humeral fractures in paediatric patients. METHOD Fifty-one paediatric patients were treated for displaced supracondylar humeral fractures. The method of fracture fixation used consists of two Kirschner wires inserted one intramedullary and the other laterally. Clinical and radiographic outcomes were assessed at last follow-up. RESULTS According to Gartland's classification, 17 fractures (33%) were type 2 and 34 (67%) were type 3. The mean follow-up period was 7.8 months. Functional outcome according to Flynn's criteria was satisfactory in all cases with 92% graded as excellent or good. Cosmetic outcome according to Flynn's criteria was satisfactory in all cases. Radiologically, at last follow-up, the mean Baumann angle was 69° (63-82°) and the mean lateral capitellohumeral angle was 41° (32-50°). CONCLUSION Patients managed with combined intramedullary and lateral wires experience satisfactory results. Moreover, this technique, without risk for the ulnar nerve, can be interesting in the treatment of infrafossal fractures and fractures with anterior displacement.
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Affiliation(s)
- Aymen Ben Fredj
- Orthopaedics Department, Ibn El Jazzar Hospital, Université de Sousse Faculté de Médecine de Sousse, Sousse, Tunisia.
| | - Hedi Rbai
- Orthopaedics Department, Ibn El Jazzar Hospital, Université de Sousse Faculté de Médecine de Sousse, Sousse, Tunisia
| | - Farouk Chatbouri
- Orthopaedics Department, Ibn El Jazzar Hospital, Université de Sousse Faculté de Médecine de Sousse, Sousse, Tunisia
| | - Marouene Berriri
- Orthopaedics Department, Ibn El Jazzar Hospital, Université de Sousse Faculté de Médecine de Sousse, Sousse, Tunisia
| | - Abderrahmen Daadoucha
- Radiology Department, Ibn El Jazzar Hospital, Université de Sousse Faculté de Médecine de Sousse, Sousse, Tunisia
| | - Anouar Boughattas
- Orthopaedics Department, Ibn El Jazzar Hospital, Université de Sousse Faculté de Médecine de Sousse, Sousse, Tunisia
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Ma G, Chen S, Yang X, Kou X. Traumatic comminuted fracture with discontinuous lumbar fracture: A case report. Asian J Surg 2023; 46:5039-5041. [PMID: 37419795 DOI: 10.1016/j.asjsur.2023.06.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 06/09/2023] [Indexed: 07/09/2023] Open
Affiliation(s)
- Guifu Ma
- Department of Orthopedics, Gansu Provincial Hospital, Lanzhou, 730000, China
| | - Shaolong Chen
- Department of Orthopedics, Gansu Provincial Hospital, Lanzhou, 730000, China
| | - Xinxin Yang
- Department of Orthopedics, Gansu Provincial Hospital, Lanzhou, 730000, China
| | - Xianshuai Kou
- The First Clinical Medical College of Gansu University of Chinese Medicine(Gansu Provincial Hospital), Lanzhou, 730000, China.
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Ansoms P, Barzegari M, Vander Sloten J, Geris L. Coupling biomechanical models of implants with biodegradation models: A case study for biodegradable mandibular bone fixation plates. J Mech Behav Biomed Mater 2023; 147:106120. [PMID: 37757617 DOI: 10.1016/j.jmbbm.2023.106120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 09/05/2023] [Accepted: 09/10/2023] [Indexed: 09/29/2023]
Abstract
In fracture fixation, biodegradable implant materials are an interesting alternative to conventional non-biodegradable materials as the latter often require a second implant removal surgery to avoid long-term complications. In this study, we present an in silico strategy to design/study biodegradable metal implants focusing on mandibular fracture fixation plates of WE43 (Mg alloy). The in silico strategy is composed of an orchestrated interaction between three separate computational models. The first model simulates the mass loss of the degradable implant based on the chemistry of Mg biodegradation. A second model estimates the loading on the jaw plate in the physiological environment, incorporating a phenomenological dynamic bone regeneration process. The third model characterizes the mechanical behavior of the jaw plate and the influence of material degradation on the mechanical behavior. A sensitivity analysis was performed on parameters related to choices regarding numerical implementation and parameter dependencies were implemented to guarantee robust and correct results. Different clinical scenarios were tested, related to the amount of screws used to fix the plate. The results showed a lower initial strength when more screw holes were left open, as well as a faster decrease over time in strength due to the increased area available for surface degradation. The obtained degradation results were found to be in accordance with previously reported data of in vivo studies with biodegradable plates. The combination of these three models allows for the design of patient-specific biodegradable fixation implants able to deliver the desired mechanical behavior tuned to the bone regeneration process.
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Affiliation(s)
- Pieter Ansoms
- Biomechanics Section, Department of Mechanical Engineering, KU Leuven, Leuven, Belgium.
| | - Mojtaba Barzegari
- Biomechanics Section, Department of Mechanical Engineering, KU Leuven, Leuven, Belgium.
| | - Jos Vander Sloten
- Biomechanics Section, Department of Mechanical Engineering, KU Leuven, Leuven, Belgium.
| | - Liesbet Geris
- Biomechanics Section, Department of Mechanical Engineering, KU Leuven, Leuven, Belgium; Biomechanics Research Unit, GIGA in Silico Medicine, University of Liège, Belgium; Skeletal Biology and Engineering Research Center, Department of Development and Regeneration, KU Leuven, Leuven, Belgium.
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Videla-Cés M, Comas-Aguilar M, Endemaño-Lucio A, Sánchez-Navés R, Romero-Pijoan E, Videla S. Percutaneous helical plate fixation in humeral shaft fractures with proximal extension. Injury 2023; 54 Suppl 6:110750. [PMID: 38143117 DOI: 10.1016/j.injury.2023.04.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/05/2023] [Accepted: 04/14/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND Humeral shaft fractures with extension to the proximal third are increasingly frequent and technically more demanding. Surgical management of proximal metaphyseal junction humeral fractures is challenging. The aim of this study was to assess the safety, reproducibility, and possibility of early and completed rehabilitation in the percutaneous treatment with helical plates in humeral shaft fractures with proximal extension. PATIENTS AND METHODS This was a descriptive, retrospective, single-centre cohort study based on consecutive patients with proximal metaphyseal junction humeral fractures (MIPO-helical-plate-Broggi's cohort). Surgical technique (minimally invasive approach and osteosynthesis): percutaneous treatment with a twisted plate (helical plates). STUDY VARIABLES i): Intraoperative and postoperative (up to 1 year after surgery) safety; ii) Reproducibility of the surgical technique [number (percentage) of patients with surgical technique success]. The surgical technique success was defined as the recovering without neurovascular, implant failures and infection issues after one year follow up; and iii) Early and completed (3 months) rehabilitation [number (percentage) of patients]. A descriptive analysis was performed. RESULTS Between April 2010 to January 2022, we received 443 humeral shaft fractures at our unit. Of these, 350 fractures were treated surgically. 157 (44.9%) were treated using the minimally invasive approach and osteosynthesis technique with extramedullary implants, of which 46 (46/157, 29.3%, 9 men and 37 women) were performed with almost orthogonally twisted Philos® helical plates. The median (range) age was 67 (51-94) years. STUDY OUTCOMES i) Safety: None intraoperative events were gathered. No neurovascular, implant failure and infection issues were reported one year after surgery.; ii) Reproducibility of the surgical technique: only 1 failure (2%, 95%CI:0-11%), who was reoperated; and iii) Early and 3 month of rehabilitation was completed in 45 (98%, 95%CI:89-100%) patients. Forty-five (98%, 95%CI:89-100%) patients recovered their previous function the year after surgery. CONCLUSIONS The treatment of humeral shaft fractures with proximal extension based on a minimally invasive approach and osteosynthesis: percutaneous treatment with a twisted plate (helical plates), as this is a submuscular and extraperiosteal technique, is a safe and reproducible technique, and promotes early rehabilitation. In our opinion, it is surgical technique whose main requirement is a good knowledge of topographic anatomy.
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Affiliation(s)
- Miquel Videla-Cés
- Orthopaedic and Trauma Surgery Department. Complex Hospitalari Moisès Broggi, Sant Joan Despí, Barcelona, Catalonia, Spain.
| | - Marta Comas-Aguilar
- Orthopaedic and Trauma Surgery Department. Complex Hospitalari Moisès Broggi, Sant Joan Despí, Barcelona, Catalonia, Spain; Orthopaedic and Trauma Surgery Department. Hospital Universitari de Girona Doctor Josep Trueta, Girona, Catalonia, Spain
| | - Amaia Endemaño-Lucio
- Orthopaedic and Trauma Surgery Department. Complex Hospitalari Moisès Broggi, Sant Joan Despí, Barcelona, Catalonia, Spain
| | - Rubén Sánchez-Navés
- Orthopaedic and Trauma Surgery Department. Complex Hospitalari Moisès Broggi, Sant Joan Despí, Barcelona, Catalonia, Spain
| | - Eudald Romero-Pijoan
- Orthopaedic and Trauma Surgery Department. Complex Hospitalari Moisès Broggi, Sant Joan Despí, Barcelona, Catalonia, Spain
| | - Sebastián Videla
- Clinical Research Support Unit (HUB-IDIBELL), Clinical Pharmacology Department, Bellvitge University Hospital / Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Pharmacology Unit, Department of Pathology and Experimental Therapeutics, School of Medicine and Health Sciences, IDIBELL, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
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Morita T, Takigawa T, Ishihara T, Taoka T, Ishimaru T, Kanazawa T, Tada K, Omori T, Yagata Y, Toda K, Nakago K, Ito Y. Minimally invasive surgery technique for unstable pelvic ring fractures with severe vertical shear displacement: A retrospective study. Orthop Traumatol Surg Res 2023; 109:103528. [PMID: 36565742 DOI: 10.1016/j.otsr.2022.103528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 10/18/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Unstable pelvic fractures, especially vertical shear fractures, require surgery for correct reduction, rigid fixation, and improved postoperative outcomes. Herein, we assess the effectiveness of our minimally invasive procedure for the management of unstable pelvic fractures. HYPOTHESIS We hypothesized that this procedure would be useful for the management of unstable pelvic fractures. PATIENTS AND METHODS This study included 28 patients with unstable pelvic fractures (vertical shear injuries; AO types C1-3) treated using minimally invasive surgery for spinopelvic fixation (MIS-SP) between 2014 and 2020 (mean follow-up time, 15 months). The MIS-SP requires four percutaneous pedicle screws and four iliac screw insertions. Subsequently, reduction and fixation are performed. RESULTS The mean preoperative displacement of the posterior pelvic elements in craniocaudal correction was 17.6 (range, 9.0-32.2) mm. The mean length of the craniocaudal reduction was 16.5 (8.1-30.1) mm, with a mean reduction rate of 93.5% (78%-100%). The mean length of the mediolateral reduction was 11.3 (3.9-19.6) mm, with a mean reduction rate of 87.3% (76%-100%). DISCUSSION Our novel reduction and fixation procedure is a powerful, minimally invasive option for the treatment of unstable pelvic ring fractures. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Takuya Morita
- Department of Orthopedic Surgery, Kobe Red Cross Hospital, 1-3-1, Wakihamakaigandori, Chuo-ku, Kobe City 651-0073, Hyogo, Japan.
| | - Tomoyuki Takigawa
- Department of Orthopedic Surgery, Kobe Red Cross Hospital, 1-3-1, Wakihamakaigandori, Chuo-ku, Kobe City 651-0073, Hyogo, Japan
| | - Takeshi Ishihara
- Department of Orthopedic Surgery, Kobe Red Cross Hospital, 1-3-1, Wakihamakaigandori, Chuo-ku, Kobe City 651-0073, Hyogo, Japan
| | - Takuya Taoka
- Department of Orthopedic Surgery, Kobe Red Cross Hospital, 1-3-1, Wakihamakaigandori, Chuo-ku, Kobe City 651-0073, Hyogo, Japan
| | - Takahiko Ishimaru
- Department of Orthopedic Surgery, Kobe Red Cross Hospital, 1-3-1, Wakihamakaigandori, Chuo-ku, Kobe City 651-0073, Hyogo, Japan
| | - Tomoko Kanazawa
- Department of Orthopedic Surgery, Kobe Red Cross Hospital, 1-3-1, Wakihamakaigandori, Chuo-ku, Kobe City 651-0073, Hyogo, Japan
| | - Keitaro Tada
- Department of Orthopedic Surgery, Hyogo Emergency Medical Center, 1-3-1, Wakihamakaigandori, Chuo-ku, Kobe City 651-0073, Hyogo, Japan
| | - Takao Omori
- Department of Orthopedic Surgery, Kobe Red Cross Hospital, 1-3-1, Wakihamakaigandori, Chuo-ku, Kobe City 651-0073, Hyogo, Japan
| | - Yukihisa Yagata
- Department of Orthopedic Surgery, Hyogo Emergency Medical Center, 1-3-1, Wakihamakaigandori, Chuo-ku, Kobe City 651-0073, Hyogo, Japan
| | - Kazukiyo Toda
- Department of Orthopedic Surgery, Kobe Red Cross Hospital, 1-3-1, Wakihamakaigandori, Chuo-ku, Kobe City 651-0073, Hyogo, Japan
| | - Kie Nakago
- Department of Orthopedic Surgery, Kobe Red Cross Hospital, 1-3-1, Wakihamakaigandori, Chuo-ku, Kobe City 651-0073, Hyogo, Japan
| | - Yasuo Ito
- Department of Orthopedic Surgery, Kobe Red Cross Hospital, 1-3-1, Wakihamakaigandori, Chuo-ku, Kobe City 651-0073, Hyogo, Japan
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Azi ML, Valderrama-Molina CO, Carabelli G, Cruz MAA, Bidolegui F, Gómez A, Velarde JE, Pires RE, Xicará JA, Belangero WD, Giordano V. Treatment of fracture-related infection in Latin America (FRILA). Proposal for a multicentre regional registry. Injury 2023; 54 Suppl 6:110898. [PMID: 38143112 DOI: 10.1016/j.injury.2023.110898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 06/04/2023] [Accepted: 06/12/2023] [Indexed: 12/26/2023]
Abstract
Postoperative bone infection is a severe complication in the treatment of fractures. The management of this pathology is challenging, but recent advances have been made to achieve standardization that can help diagnosis and decision-making. However, we are unaware of studies validating these models in Latin America. Therefore, this study aims to collect data from patients with fracture-related infections treated in different institutions in Latin America to create a registry that will assist in future clinical decision-making regarding the diagnostic process and the surgical and medical treatment of these patients.
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Affiliation(s)
- Matheus Lemos Azi
- Manoel Victorino Hospital, Secretary of Health for the State of Bahia, Bahia, Brazil.
| | | | - Guido Carabelli
- Instituto de Ortopedia y Traumatología "Carlos E. Ottolenghi", Hospital Italiano de Buenos Aires, Argentina
| | | | - Fernando Bidolegui
- Orthopaedic Trauma Service, Sirio y Libanes Hospital, Buenos Aires, Argentina
| | - Amparo Gómez
- Hospital Universitario de la Samaritana, Bogota, Colombia
| | | | | | | | - William Dias Belangero
- School of Medical Sciences, University of Campinas, Rua Tessalia Vieira de Camargo 126, Cidade Universitaria, 13083-887, Campinas, Sao Paulo, Brazil
| | - Vincenzo Giordano
- Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rio de Janeiro, Brazil; Clínica São Vicente, Rede D'or São Luiz, Rio de Janeiro, Brazil
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Villán-Gaona JL, Valderrama-Molina CO, Altamirano-Cruz MA, Montero-Oropeza Y. Surgical management of iliac wing fractures: Proposal of a new classification system. Injury 2023; 54 Suppl 6:110837. [PMID: 38143137 DOI: 10.1016/j.injury.2023.110837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 05/14/2023] [Accepted: 05/17/2023] [Indexed: 12/26/2023]
Abstract
INTRODUCTION Isolated fractures of the iliac wing are a rare injury, usually occurring in high-energy trauma, and are associated with other non-musculoskeletal and soft tissue injuries that could compromise the patient's life. Surgical indications are unclear, and there is limited information on the most frequent fracture patterns. METHODS A descriptive multicenter case series study of isolated fractures of the iliac wing treated surgically in three referral trauma hospitals in Latin America. The different fracture patterns are described, the "iliac ring" concept is proposed, and a classification is made. RESULTS Twenty-eight patients were included; 24 were male, the median age was 31 years RIQ (24-46), the most frequent trauma mechanism was a traffic accident, and in 14 patients, the ISS >16. The most frequent associated injury was to the appendicular skeleton at another level in 13 patients. In the new classification, according to the number of fragments, 11 patients were classified as type A (1 fragment), ten patients as type B (two fragments), and seven patients as type C (three or more fragments). The most compromised anatomical area was the crest and anterosuperior iliac spines in 26 patients, followed by the fossa and anteroinferior iliac spine in 17 and 8 patients, respectively. DISCUSSION The patterns of isolated fractures of the iliac wing allow the identification of three types of fractures. Identifying these patterns can help the surgeon decide to perform surgery in these scenarios and choose the fixation technique according to the number and location of the fragments.
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Affiliation(s)
| | | | - Marco Antonio Altamirano-Cruz
- Polytrauma and Pelvis and Acetabulum Surgery Department. Hospital de Especialidades Centro Médico Nacional de Occidente - IMSS Belisario Domínguez 1000, Guadalajara, Jalisco, Mexico
| | - Yuri Montero-Oropeza
- Polytrauma and Pelvis and Acetabulum Surgery Department. Hospital de Traumatología y Ortopedia Lomas Verdes, Instituto Mexicano del Seguro Social. Unidad Médica de Alta Especialidad. Av. Lomas Verdes # 52, Col. Santa Cruz Acatlán, Mexico
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Oliveira PR, Leonhardt MC, Panico CT, Silva JB, Carvalho VC, Kojima KE, Silva JS, Lima ALL. Infection after intramedullary nailing of femoral and tibial diaphyseal fractures. Injury 2023; 54 Suppl 6:110821. [PMID: 38143135 DOI: 10.1016/j.injury.2023.05.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 04/20/2023] [Accepted: 05/13/2023] [Indexed: 12/26/2023]
Abstract
PURPOSE Management of fracture-related infection (FRI) after intramedullary fixation (IF) is a challenge. The aim of the present study is to describe a series of 26 patients with FRI after IF and to evaluate factors possibly related to the outcome. METHODS Baseline variables were obtained at the time of IF: age, sex, body mass index, affected bone, open fracture, substance abuse, use of an external fixator, type of nail, reaming, soft-tissue reconstruction and surveillance culture result. After diagnosis of the infection, information was obtained about the time interval between IF and diagnosis and classification according to both the Willeneger and Roth and Makridis systems. Treatment modalities were grouped and analysed according to: use of antimicrobials, surgical debridement, nail removal or retention and spacer use. Cultures of bone or deep soft tissues were performed. Patients were followed up for 12 months, and outcomes (remission, relapse, death and loss of follow-up) were evaluated, as well as fracture consolidation. RESULTS Remission was observed in 42.3% of patients. There was no significant association between any baseline variable and outcome. There was a significant association between Makridis stage 2 classification and recurrence or death. Treatment strategy was not significantly associated with outcome, and 65.4% of cases had positive culture results, with Enterobacter cloacae as the predominant agent. Consolidation was observed in 81.8% of patients and was not significantly related to the outcome. CONCLUSION There was a significant association between Makridis classification and the outcome. Consolidation rate was not associated with the outcome regarding the treatment of the infection.
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Affiliation(s)
- Priscila R Oliveira
- Instituto de Ortopedia e Traumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil.
| | - Marcos C Leonhardt
- Instituto de Ortopedia e Traumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil
| | - Caroline T Panico
- Instituto de Ortopedia e Traumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil
| | - Julia B Silva
- Departamento de Moléstias Infecciosas e Parasitárias, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil
| | - Vladimir C Carvalho
- Instituto de Ortopedia e Traumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil
| | - Kodi E Kojima
- Instituto de Ortopedia e Traumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil
| | - Jorge S Silva
- Instituto de Ortopedia e Traumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil
| | - Ana Lucia L Lima
- Instituto de Ortopedia e Traumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil
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Christodoulou N, Asimakopoulos D, Kapetanos K, Seah M, Khan W. Principles of management of hand fractures. J Perioper Pract 2023; 33:342-349. [PMID: 36408867 PMCID: PMC10623595 DOI: 10.1177/17504589221119739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The optimal management of hand fractures requires a multidisciplinary approach. Initial assessment should include a thorough medical history and clinical examination, followed by appropriate radiological imaging. These are crucial in determining the appropriate management. Following joint stabilisation to allow fractures to unite, early mobilisation is needed to maximise the functional restoration of the hand. In this review, the principles of operative and non-operative management of these injuries are discussed.
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Affiliation(s)
| | | | | | - Matthew Seah
- Division of Trauma and Orthopaedic Surgery, University of Cambridge, Cambridge, UK
| | - Wasim Khan
- Division of Trauma and Orthopaedic Surgery, University of Cambridge, Cambridge, UK
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Zhang M, Jiang W, Wang ZX, Zhou ZM. Using shape-memory alloy staples to treat comminuted manubrium sterni fractures: A case report. World J Clin Cases 2023; 11:7386-7392. [PMID: 37969455 PMCID: PMC10643072 DOI: 10.12998/wjcc.v11.i30.7386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/22/2023] [Accepted: 10/08/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Comminuted manubrium sterni fractures are rare, and internal fixation methods are limited. This report explored a practical and feasible method of internal fixation for comminuted manubrium sterni fractures. CASE SUMMARY A 17-year-old female was injured in a car accident for which she underwent debridement and suturing of her head and anterior chest wounds in another hospital. Eight days later, the patient was transferred to our hospital for surgical treatment. The manubrium sterni was found intraoperatively to be split into three irregular fragments with obvious overlap and separation displacement. Meanwhile, a manubriosternal joint dislocation and left first rib cartilage fracture were observed. The retraction force of the shape-memory alloy staples was used to pull the fracture fragments together. Two more titanium locking plates were then used to fix the manubrium sterni and corpus sterni longitudinally, and the left first rib cartilage fracture was repositioned and fixed with a titanium locking plate. A postoperative computed tomography scan showed reduced and rigid fixation of the comminuted manubrium sterni fractures. The patient recovered well with no significant complaints of discomfort. The patient was discharged 10 days postoperatively after the stitches had been removed. CONCLUSION Shape-memory alloy staples had the advantage of being safe and effective during the repositioning and internal fixation of comminuted manubrium sterni fractures. Therefore, they provided a new surgical option for comminuted manubrium sterni fractures.
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Affiliation(s)
- Min Zhang
- Department of Thoracic Surgery, Central Hospital Affiliated to Shenyang Medical College, Shenyang 110024, Liaoning Province, China
| | - Wei Jiang
- Department of Thoracic Surgery, Central Hospital Affiliated to Shenyang Medical College, Shenyang 110024, Liaoning Province, China
| | - Ze-Xue Wang
- Department of Thoracic Surgery, Central Hospital Affiliated to Shenyang Medical College, Shenyang 110024, Liaoning Province, China
| | - Zhi-Ming Zhou
- Department of Thoracic Surgery, Central Hospital Affiliated to Shenyang Medical College, Shenyang 110024, Liaoning Province, China
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Zhao L. A comparative study on the clinical efficacy of microplate trans-carpometacarpal joint fixation and non-trans-carpometacarpal joint fixation in treating fractures with dislocation or subluxation of the base of the fourth and fifth metacarpal bones. J Orthop Surg Res 2023; 18:736. [PMID: 37770964 PMCID: PMC10540348 DOI: 10.1186/s13018-023-04225-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 09/21/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND This study aimed to compare the clinical efficacy of microplate trans-carpometacarpal joint fixation and non-trans-carpometacarpal joint fixation in treating fractures and dislocation or subluxation of the base of the fourth and fifth metacarpal bones. METHOD From 2015 to 2021, 100 cases of metacarpal basal fractures with dislocation or subluxation were randomly divided into the trans-carpometacarpal joint fixation group (group A) and non-trans-carpometacarpal joint fixation group (group B). Group A (n = 50) comprised 44 males and 6 females, with an average age of 28.8 ± 6.1 y and an Orthopedic Trauma Association (OTA) fracture classification of type B1 (n = 29) or C1 (n = 21). Group B (n = 50) comprised 45 males and 5 females, with an average age of 28.9 ± 5.7 y and an OTA fracture classification of type B1 (n = 28) or C1 (n = 22). All patients were complicated with dislocation or subluxation. The surgery time, fracture healing time, postoperative handgrip strength, and total active motion (TAM) scores of the ring and little fingers were recorded and compared between the two groups. The clinical efficacy of patients was evaluated using scoring methods such as DASH (disabilities of the arm, shoulder and hand), visual analogue scale (VAS), and Mayo at 3, 6, and 12 months after surgery. RESULTS There was no significant difference in the general indexes, surgery time, or fracture healing time between the two groups (P > 0.05). There were no significant differences in handgrip strength and TAM scores of the ring and little fingers between the two groups at 3 and 12 months postoperatively (P > 0.05), but there were significant differences in these indexes 6 months postoperatively (P < 0.05). There were no significant differences in the DASH, VAS, and Mayo scores at 3 and 12 months postoperatively (P > 0.05), but there were significant differences between the two groups in the DASH and Mayo scores (P < 0.05) but not the VAS score (P > 0.05) 6 months postoperatively. CONCLUSION In the treatment of fourth and fifth metacarpal basal fractures with dislocation or subluxation, both microplate transarticular fixation and non-transarticular fixation could achieve fracture fixation and healing, and each method had advantages and disadvantages. The clinically appropriate fixation method should be selected according to the experience of the surgeon and the degree and type of fracture and dislocation.
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Affiliation(s)
- Liang Zhao
- Department of Hand and Foot Surgery, Shunyi District Hospital, No. 3 Guangming South Street, Shunyi District, Beijing, 101300, China.
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Patel M, Ahmad M, Agrawal N, Patil ST, Santoshi JA, Rathinam B, Gandhi KR. The use of precontoured plates for midshaft clavicle fractures is not always the best course of treatment. Anat Cell Biol 2023:acb.23.109. [PMID: 37743614 DOI: 10.5115/acb.23.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 07/27/2023] [Accepted: 08/08/2023] [Indexed: 09/26/2023] Open
Abstract
Plate fixation has become the preferred approach for treating displaced midshaft clavicle fractures. However, plate fixation of the clavicle presents several unique challenges, including its complex bony architecture and its immediate subcutaneous location. In many cases, we have observed that precontoured implants do not conform to the clavicular anatomy, and many patients complain of postoperative implant-related discomfort. A total of 111 clavicles, both left and right sides, were examined to match two commonly used designs of anatomical pre-contoured superior anterior clavicle plates, with and without lateral extension. The anteroposterior (AP) plane congruence of the plate to the underlying bone, the vertical gap between the bone and plate, and the length of the plate that was off the bone either anteriorly and/or posteriorly at both ends of the clavicle were measured. The scoring system was used to determine the fit of the implant on the clavicle as anatomic, good, or poor. We found that the maximum superior bow of the clavicle was lateral to the midline by 30.75 mm and 30.5 mm on the right and left sides, respectively. The magnitude of the bow was 4.28 mm and 4.46 mm on the right and left sides, respectively. We also found that the plate was a poor fit in 75.86% of cases on the left side and 73.5% of cases on the right side. Manipulating the plates during surgery was very difficult in the AP plane.
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Affiliation(s)
- Manmohan Patel
- Department of Anatomy, All India Institute of Medical Sciences, Bhopal, India
| | - Mohtashim Ahmad
- Department of Anatomy, All India Institute of Medical Sciences, Bhopal, India
| | - Natwar Agrawal
- Department of Anatomy, NSCB Medical College, Jabalpur, India
| | | | | | - Bertha Rathinam
- Department of Anatomy, All India Institute of Medical Sciences, Bhopal, India
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