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Jain A, Rathsam AM, Springer KJ, Perumbala K, Parker A, Burns PR, Manway JM. Morbidity Associated With Distal Tibial Autograft Harvest. J Foot Ankle Surg 2024; 63:345-349. [PMID: 38246336 DOI: 10.1053/j.jfas.2024.01.002] [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: 07/27/2023] [Revised: 11/29/2023] [Accepted: 01/03/2024] [Indexed: 01/23/2024]
Abstract
Distal tibial autograft harvesting has been studied in the past, but morbidity at the level of the donor site is unclear. The purpose of this retrospective review is to assess morbidity in distal tibial autograft harvesting associated with foot and ankle arthrodesis procedures. A retrospective analysis was performed utilizing patients treated in the last 13 years at a large, multicenter, academic, tertiary referral, research institution. Included patients were between the ages of 18 and 80 years old. One-hundred and seven patients (39 male; 68 female) underwent ipsilateral distal tibial bone graft (n = 110) harvesting to augment the index procedure. Patients were followed for an average of 11.2 months after surgery (Range: 1-73 months). The incidence rate of distal tibial stress fractures was 4.5%, with an overall postoperative complication rate of 8.2%. Overall, low complication rates associated with distal tibial autograft harvesting were found, supporting the use of the distal tibia as an appropriate site for autograft harvesting in foot and ankle surgery.
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Affiliation(s)
- Akshay Jain
- University of Pittsburgh Medical Center, Mercy Hospital, Pittsburgh, PA.
| | - Aaron M Rathsam
- University of Pittsburgh Medical Center, Mercy Hospital, Pittsburgh, PA
| | - Katie J Springer
- University of Pittsburgh Medical Center, Mercy Hospital, Pittsburgh, PA
| | | | | | | | - Jeffrey M Manway
- University of Pittsburgh Medical Center, Mercy Hospital, Pittsburgh, PA
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2
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Chandran M, Akesson KE, Javaid MK, Harvey N, Blank RD, Brandi ML, Chevalley T, Cinelli P, Cooper C, Lems W, Lyritis GP, Makras P, Paccou J, Pierroz DD, Sosa M, Thomas T, Silverman S. Impact of osteoporosis and osteoporosis medications on fracture healing: a narrative review. Osteoporos Int 2024:10.1007/s00198-024-07059-8. [PMID: 38587674 DOI: 10.1007/s00198-024-07059-8] [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: 10/10/2023] [Accepted: 03/06/2024] [Indexed: 04/09/2024]
Abstract
Antiresorptive medications do not negatively affect fracture healing in humans. Teriparatide may decrease time to fracture healing. Romosozumab has not shown a beneficial effect on human fracture healing. BACKGROUND Fracture healing is a complex process. Uncertainty exists over the influence of osteoporosis and the medications used to treat it on fracture healing. METHODS Narrative review authored by the members of the Fracture Working Group of the Committee of Scientific Advisors of the International Osteoporosis Foundation (IOF), on behalf of the IOF and the Société Internationale de Chirurgie Orthopédique et de Traumatologie (SICOT). RESULTS Fracture healing is a multistep process. Most fractures heal through a combination of intramembranous and endochondral ossification. Radiographic imaging is important for evaluating fracture healing and for detecting delayed or non-union. The presence of callus formation, bridging trabeculae, and a decrease in the size of the fracture line over time are indicative of healing. Imaging must be combined with clinical parameters and patient-reported outcomes. Animal data support a negative effect of osteoporosis on fracture healing; however, clinical data do not appear to corroborate with this. Evidence does not support a delay in the initiation of antiresorptive therapy following acute fragility fractures. There is no reason for suspension of osteoporosis medication at the time of fracture if the person is already on treatment. Teriparatide treatment may shorten fracture healing time at certain sites such as distal radius; however, it does not prevent non-union or influence union rate. The positive effect on fracture healing that romosozumab has demonstrated in animals has not been observed in humans. CONCLUSION Overall, there appears to be no deleterious effect of osteoporosis medications on fracture healing. The benefit of treating osteoporosis and the urgent necessity to mitigate imminent refracture risk after a fracture should be given prime consideration. It is imperative that new radiological and biological markers of fracture healing be identified. It is also important to synthesize clinical and basic science methodologies to assess fracture healing, so that a convergence of the two frameworks can be achieved.
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Affiliation(s)
- M Chandran
- Osteoporosis and Bone Metabolism Unit, Department of Endocrinology, Singapore General Hospital, DUKE NUS Medical School, Singapore, Singapore.
| | - K E Akesson
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences, Lund University, Department of Orthopedics, Skåne University Hospital, Malmö, Sweden
| | - M K Javaid
- NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK
| | - N Harvey
- MRC Lifecourse Epidemiology Centre, University of Southampton, NIHR Southampton Biomedical Research Centre, University of Southampton, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - R D Blank
- Garvan Institute of Medical Research, Medical College of Wisconsin, Darlinghurst, NSW, Australia
- Medical College of Wisconsin, Milwaukee, WI, USA
| | - M L Brandi
- Department of Biomedical, Experimental and Clinical Sciences, University of Florence, Largo Palagi 1, Florence, Italy
| | - T Chevalley
- Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - P Cinelli
- Department of Trauma Surgery, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - C Cooper
- MRC Lifecourse Epidemiology Centre, University of Southampton, NIHR Southampton Biomedical Research Centre, University of Southampton, University Hospitals Southampton NHS Foundation Trust, Southampton, UK
- NIHR Oxford Biomedical Research Unit, University of Oxford, Oxford, UK
| | - W Lems
- Department of Rheumatology, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
| | - G P Lyritis
- Hellenic Osteoporosis Foundation, Athens, Greece
| | - P Makras
- Department of Medical Research, 251 Hellenic Air Force & VA General Hospital, Athens, Greece
| | - J Paccou
- Department of Rheumatology, MABlab ULR 4490, CHU Lille, Univ. Lille, 59000, Lille, France
| | - D D Pierroz
- International Osteoporosis Foundation, Nyon, Switzerland
| | - M Sosa
- University of Las Palmas de Gran Canaria, Investigation Group on Osteoporosis and Mineral Metabolism, Canary Islands, Spain
| | - T Thomas
- Department of Rheumatology, North Hospital, CHU Saint-Etienne and INSERM U1059, University of Lyon-University Jean Monnet, Saint‑Etienne, France
| | - S Silverman
- Cedars-Sinai Medical Center and Geffen School of Medicine UCLA, Los Angeles, CA, USA
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Elgendy R, Younes A, Abu-Donia HM, Farouk RM. Efficient quantum algorithms for set operations. Sci Rep 2024; 14:7015. [PMID: 38527996 DOI: 10.1038/s41598-024-56860-2] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 03/12/2024] [Indexed: 03/27/2024] Open
Abstract
Analyzing the relations between Boolean functions has many applications in many fields, such as database systems, cryptography, and collision problems. This paper proposes four quantum algorithms that use amplitude amplification techniques to perform set operations, including Intersection, Difference, and Union, on two Boolean functions in O ( N ) time complexity. The proposed algorithms employ two quantum amplitude amplification techniques divided into two stages. The first stage uses the Younes et al. algorithm for quantum searching via entanglement and partial diffusion to prepare incomplete superpositions of the truth set of the first Boolean function. In the second stage, a modified version of Arima's algorithm, along with an oracle that represent the second Boolean function, is employed to handle the set operations. The proposed algorithms have a higher probability of success in more general and comprehensive applications when compared with relevant techniques in literature.
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Affiliation(s)
- Rehab Elgendy
- Department of Mathematics, Faculty of Science, Zagazig University, Zagazig, Egypt.
| | - Ahmed Younes
- Department of Mathematics and Computer Science, Faculty of Science, Alexandria University, Alexandria, Egypt
- School of Computer Science, University of Birmingham, Birmingham, B15 2TT, UK
| | - H M Abu-Donia
- Department of Mathematics, Faculty of Science, Zagazig University, Zagazig, Egypt
| | - R M Farouk
- Department of Mathematics, Faculty of Science, Zagazig University, Zagazig, Egypt
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Foukas AF, Hadjimichael AC, Nicolaou C, Savvidou OD, Papagelopoulos PJ. A 3D-printed load sharing implant achieved union of a 9-cm femoral segmental bone defect within three months using a hybrid Masquelet induction membrane technique. A case-report. Trauma Case Rep 2024; 49:100978. [PMID: 38312114 PMCID: PMC10835288 DOI: 10.1016/j.tcr.2024.100978] [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: 01/15/2024] [Indexed: 02/06/2024] Open
Abstract
Case A 30-year-old male was admitted in our hospital having an open left distal femoral fracture with 9-cm segmental bone defect and a closed proximal left tibial fracture. He was treated successfully using a Hybrid (Titanium Cage and Bone Graft) Masquelet Induction Membrane Technique (MIMT). His femoral fracture united 3-months post - operatively. The left tibia was treated initially with two locking plates. Following infection, a 3-cm tibial bone gap was treated with external fixation and conventional MIMT. The tibial fracture united 12-months post- operatively. Conclusion The Hybrid MIMT achieved a successful healing outcome in this challenging case.
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Affiliation(s)
- Athanasios F. Foukas
- Third Department of Orthopaedic Surgery, “KAT” General Hospital of Athens, 2, Nikis Street, 14561 Kifissia, Greece
| | - Argyris C. Hadjimichael
- Orthopaedic Department, Saint Mary's and John's Polyclinic, 2, Karditsis Street, 2045 Nicosia, Cyprus
| | - Christophoros Nicolaou
- Radiology Department, Aretaeio Private Hospital, 55-57, Andrea Avraamides, Strovolos 2024, Nicosia, Cyprus
| | - Olga D. Savvidou
- First Department of Orthopaedic Surgery, National and Kapodistrian University of Athens, Faculty of Medicine, Attikon University Hospital, 1 Rimini Street, Chaidari, 12462 Athens, Greece
| | - Panayiotis J. Papagelopoulos
- First Department of Orthopaedic Surgery, National and Kapodistrian University of Athens, Faculty of Medicine, Attikon University Hospital, 1 Rimini Street, Chaidari, 12462 Athens, Greece
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Factor S, Druckmann I, Kazum E, Atlan F, Tordjman D, Rosenblatt Y, Eisenberg G, Pritsch T. A novel pulsed electromagnetic field device as an adjunct therapy to surgical treatment of distal radius fractures: a prospective, double-blind, sham-controlled, randomized pilot study. Arch Orthop Trauma Surg 2024; 144:543-550. [PMID: 37971511 DOI: 10.1007/s00402-023-05117-0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 10/20/2023] [Indexed: 11/19/2023]
Abstract
INTRODUCTION The purpose of this study is to evaluate whether using a Fracture Healing Patch (FHP) device that generates pulsed electromagnetic fields (PEMF), applied at the fracture site immediately after open reduction and internal fixation surgery, can accelerate healing of acute distal radius fractures. METHODS In a prospective, double-blind, randomized, and sham-controlled study, thirty-two patients with DRFs treated with ORIF were included. Patients were allocated to a PEMF (active) group (n = 15) or a control (sham) group (n = 17). All patients were assessed with regard to functional Patient-Rated Wrist Evaluation (PRWE), SF12, and radiological union outcomes (X-rays and computed tomography (CT) scans) at 2, 4, 6, and 12 weeks postoperatively. RESULTS Patients treated with the FHP demonstrated significantly bone bridging at 4 weeks as assessed by CT (70% vs 54%, p = 0.05). Mean grip strength in the active group was significantly higher as compared to control (16 ± 9 kg vs 7 ± 3.5 kg, respectively, p = 0. 02). The function subscale of the PRWE was significantly better in PEMF-treated group at 6 weeks after surgery (27.2 VS 35.5, p = 0.04). No statistically significant differences were found in SF12. CONCLUSION PEMF application after ORIF of DRFs is safe, may accelerate bone healing which could lead to an earlier return to daily life activities and work. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Shai Factor
- Hand Surgery Unit, Division of Orthopedic Surgery, Tel Aviv Medical Center, 6423906, Tel Aviv, Israel.
- Affiliated to Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Ido Druckmann
- Division of Radiology, Tel Aviv Medical Center, 6 Weitzman St., 6423906, Tel Aviv, Israel
| | - Efi Kazum
- Hand Surgery Unit, Division of Orthopedic Surgery, Tel Aviv Medical Center, 6423906, Tel Aviv, Israel
- Affiliated to Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Franck Atlan
- Hand Surgery Unit, Division of Orthopedic Surgery, Tel Aviv Medical Center, 6423906, Tel Aviv, Israel
- Affiliated to Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daniel Tordjman
- Hand Surgery Unit, Division of Orthopedic Surgery, Tel Aviv Medical Center, 6423906, Tel Aviv, Israel
- Affiliated to Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yishai Rosenblatt
- Hand Surgery Unit, Division of Orthopedic Surgery, Tel Aviv Medical Center, 6423906, Tel Aviv, Israel
- Affiliated to Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gilad Eisenberg
- Hand Surgery Unit, Division of Orthopedic Surgery, Tel Aviv Medical Center, 6423906, Tel Aviv, Israel
- Affiliated to Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tamir Pritsch
- Hand Surgery Unit, Division of Orthopedic Surgery, Tel Aviv Medical Center, 6423906, Tel Aviv, Israel
- Affiliated to Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Clarke QK. The utility of accessibility clauses in resident contracts. BMC Med Educ 2023; 23:911. [PMID: 38036999 PMCID: PMC10691096 DOI: 10.1186/s12909-023-04905-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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 11/25/2023] [Indexed: 12/02/2023]
Abstract
Resident organizations and unions have a powerful role in advocating for resident physicians with disabilities. Ongoing efforts to ensure accessibility for resident physicians with disabilities would be promoted through the inclusion of clauses in resident contracts that ensure accessible work environments.
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Affiliation(s)
- Quinten K Clarke
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
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Albayrak K, Misir A, Alpay Y, Buyuk AF, Akpinar E, Gursu SS. Effect of fracture level on the residual fracture gap during tibial intramedullary nailing for tibial shaft fractures. SICOT J 2023; 9:26. [PMID: 37565988 PMCID: PMC10416760 DOI: 10.1051/sicotj/2023023] [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: 05/04/2023] [Accepted: 07/21/2023] [Indexed: 08/12/2023] Open
Abstract
INTRODUCTION The development of fracture gap during intramedullary nailing in tibial fractures is associated with poor fracture fragment contact and increased time to union and complications. This study aimed to evaluate the effect of the fracture level in the development of the fracture gap and the effect of the fracture gap on pain, radiologic and functional outcomes, and complication rate. MATERIAL AND METHOD A total of 45 patients who underwent reamed intramedullary nailing due to closed transverse or short oblique tibial shaft fractures were divided into the proximal fracture group and the distal fracture group. The correlations between the visual analog scale (VAS) score, modified radiograph union score for tibias (RUST), and postoperative 1-year lower extremity functional scale scores, residual fracture gap, and time to union were evaluated. RESULTS The mean fracture gap amounts in the immediate postoperative anteroposterior and lateral radiographs were 5.6 ± 1.7 and 6.0 ± 1.7 mm in proximal fractures and 0.3 ± 2.4 mm and 0.4 ± 2.3 mm in distal fractures, respectively (p < 0.001 and p < 0.001, respectively). The mean time to union was 21.9 ± 2.9 weeks in the proximal fracture group and 16.7 ± 2.4 weeks in the distal fracture group (p < 0.000). The residual fracture gap amount significantly correlated with the level of fracture (r = 0.811, p < 0.001). DISCUSSION Tibial shaft fractures proximal to the isthmus level tend to develop significantly larger fracture gaps than distal fractures. It is associated with increased time to union and radiographic union scores as well as slightly higher complication and reoperation rates.
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Affiliation(s)
- Kutalmis Albayrak
- University of Health Sciences Baltalimani Bone Diseases Training and Research Hospital, Department of Orthopaedics and Traumatology 34470 Istanbul Turkey
| | - Abdulhamit Misir
- Private Safa Hospital, Department of Orthopaedics and Traumatology 34194 Istanbul Turkey
| | - Yakup Alpay
- Bahçeşehir University, Vm Medical Park Maltepe Hospital 34846 Istanbul Turkey
| | - Abdul Fettah Buyuk
- University of Missouri, Department of Orthopaedics Columbia MO 65201 USA
| | - Evren Akpinar
- University of Health Sciences Baltalimani Bone Diseases Training and Research Hospital, Department of Orthopaedics and Traumatology 34470 Istanbul Turkey
| | - Sukru Sarper Gursu
- Professor, University of Health Sciences Baltalimani Bone Diseases Training and Research Hospital, Department of Orthopaedics and Traumatology 34470 Istanbul Turkey
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Aalders MB, Dahmen J, Kerkhoffs GMMJ. Trauma-induced spontaneous union of a talar osteochondritis dissecans: case report. J ISAKOS 2023; 8:261-266. [PMID: 37236361 DOI: 10.1016/j.jisako.2023.05.002] [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: 03/03/2023] [Revised: 05/07/2023] [Accepted: 05/18/2023] [Indexed: 05/28/2023]
Abstract
We encountered a case of an 18-year-old woman with persisting ankle pain after a healed Weber-B fracture. Additional imaging through a computed tomography (CT) scan revealed a fully united fragmentous osteochondral lesion of the talus (OLT) (17 mm × 9 mm × 8 mm) of the right ankle-as opposed to a non-united OLT when the fracture was diagnosed 19 months prior to the presentation. Our proven hypothesis is that the fragmented OLT was non-symptomatic for many years, based on an osteochondritis dissecans. The ipsilateral ankle trauma induced a fresh fracture in the interface between the talus and the fragmented OLT, and consequently the destabilized fragmented OLT became symptomatic. The ankle trauma initiated fracture healing that resulted in a complete union of the OLT without clinical symptoms. The existing symptoms were established to be based on anterior osseous ankle impingement, due to the presence of osseous fragments in the medial gutter of the ankle joint. Therefore, a nettoyage of the medial gutter including a resection of the corpora libera from the medial gutter with the shaver was performed. Intraoperative macroscopic assessment of the medial osteochondritis dissecans was performed and showed union with completely intact hyaline cartilage at the level of the surrounding articular cartilage requiring no interventions. An increased range of motion was achieved. The patient recovered well with and experienced no more recognizable pain. In this article, the unstable fragmentous lesion of the patient reached spontaneous union within 19 months after destabilization. Although this is not common for an unstable fragmentous OLT, this could be a stepping stone toward an increased role of conservative treatment for fragmentary OLTs.
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Affiliation(s)
- Margot B Aalders
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands; Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam UMC, 1105 AZ, Amsterdam, the Netherlands; Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, 1105 AZ, Amsterdam, the Netherlands
| | - Jari Dahmen
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands; Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam UMC, 1105 AZ, Amsterdam, the Netherlands; Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, 1105 AZ, Amsterdam, the Netherlands.
| | - Gino M M J Kerkhoffs
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands; Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam UMC, 1105 AZ, Amsterdam, the Netherlands; Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, 1105 AZ, Amsterdam, the Netherlands
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Alborno Y, Abunimer A, Abuodeh Y, Salameh M, Kayali H, Ahmed G. The surgical outcomes of fixing ipsilateral femoral neck and shaft fractures: single versus double implants fixation. Eur J Orthop Surg Traumatol 2023; 33:1613-1618. [PMID: 35781618 PMCID: PMC10276091 DOI: 10.1007/s00590-022-03312-0] [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] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 06/06/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Combined ipsilateral femoral neck and shaft fractures are rare and present a challenging management dilemma. This study aims to assess the outcome of concomitant fixation of the ipsilateral femoral neck and shaft fracture using single versus dual surgical implants. METHODS A single-center retrospective analysis of patients who underwent fixation of ipsilateral femoral neck and shaft fractures was performed over a 13-year period. Different techniques were employed to fix the complex injury. Both the reduction and the union time were assessed radiographically. RESULTS A total of 36 patients with ipsilateral femoral neck and shaft fractures were retrospectively identified and included in the study. Twenty-four patients (66.6%) were managed with a single cephalomedullary nail, while the remaining cases were treated with two devices. All cases were operated on within an average of 3.7 ± 7.1 days. Eight patients (22.2%) developed postoperative complications. The average follow-up period was 7.3 ± 6.8 months. Although there was no statistically significant difference between the two groups, the femoral neck fractures showed shorter union time in patients treated with one implant compared to patients treated with two implants (3.0 ± 2.3 months vs. 4.2 ± 2.6 months). Another observation was that higher percentages of implant removal/failure and malunion/nonunion were seen in patients who had one implant compared to the two implants group (12.5% vs. 8.3%). CONCLUSION Early surgical fixation of both fractures is associated with good outcome results. No difference in outcome was observed between both groups.
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Affiliation(s)
- Yahya Alborno
- Department of Orthopedic Surgery, Hamad General Hospital, Doha, Qatar.
| | - Abdullah Abunimer
- Department of Orthopedic Surgery, Hamad General Hospital, Doha, Qatar
| | - Yousef Abuodeh
- Miller School of Medicine, University of Miami Hospital-Jackson Memorial Hospital, Miami, USA
| | - Motasem Salameh
- Orthopedic Surgery Department, Brown University, Providence, RI, USA
| | - Hammam Kayali
- Department of Orthopedic Surgery, Hamad General Hospital, Doha, Qatar
| | - Ghalib Ahmed
- Department of Orthopedic Surgery, Hamad General Hospital, Doha, Qatar
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Cance N, Batailler C, Canetti R, Servien E, Lustig S. Tibial tubercule osteotomy during the revision of total knee arthroplasty: The technique of a referral center with 10 years of experience. SICOT J 2023; 9:18. [PMID: 37306497 DOI: 10.1051/sicotj/2023016] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 05/07/2023] [Indexed: 06/13/2023] Open
Abstract
INTRODUCTION The Tibial Tubercle Osteotomy (TTO) technique, by lifting the distal bony attachment of the extensor mechanism, allows efficient knee exposure while preserving soft tissues and tendinous attachments. The surgical technique seems essential to obtain satisfying outcomes with a low rate of specific complications. Several tip sand tricks can be used to improve this procedure during the revision of total knee arthroplasty (RTKA). TECHNIQUE The osteotomy should be at least: 60 mm in length and 20 mm in width to allow fixation with 2 screws; and 10-15 mm thick to resist to screw compression. The proximal cut of the osteotomy must keep a proximal buttress spur of 10 mm to get primary stability and avoid the tubercle ascension. A smooth end of the TTO distally reduces the risk of a tibial shaft fracture. The strongest fixation is obtained using two bicortical 4.5 mm screws slightly ascendant. RESULTS From January 2010 to September 2020, 135 patients received an RTKA with concomitant TTO and a mean follow-up of 51 ± 26 months [24-121]. The osteotomy was healed in 95% of patients (n = 128) with a mean delay of 3.4 ± 2.7 months [1.5-24]. However, there are some specific and significant complications related to the TTO. Twenty complications (15%) related to the TTO were recorded, with 8 (6%) requiring surgery. CONCLUSION Tibial tubercle osteotomy in RTKA is an efficient procedure to improve knee exposure. To avoid tibial tubercle fracture or non-union, a rigorous surgical technique is primordial with a sufficient length and thickness of the tibial tubercle, a smooth end, a proximal step, a final good bone contact, and a strong fixation.
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Affiliation(s)
- Nicolas Cance
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon North University Hospital, 69004 Lyon, France
| | - Cecile Batailler
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon North University Hospital, 69004 Lyon, France - Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406, 69622 Lyon, France
| | - Robin Canetti
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon North University Hospital, 69004 Lyon, France
| | - Elvire Servien
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon North University Hospital, 69004 Lyon, France - LIBM - EA 7424, Interuniversity Laboratory of Human Movement Science, Université Lyon 1, 69008 Lyon, France
| | - Sébastien Lustig
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon North University Hospital, 69004 Lyon, France - LIBM - EA 7424, Interuniversity Laboratory of Human Movement Science, Université Lyon 1, 69008 Lyon, France
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11
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Dot Pascuet I, Arregui Gallego D, Valdez D, Rodriguez Gangoso A, Ferrando A. [Translated article] Influence of lateralized reverse shoulder prosthesis design on tuberosity union in proximal humerus fractures. Rev Esp Cir Ortop Traumatol (Engl Ed) 2023; 67:T193-T201. [PMID: 36863524 DOI: 10.1016/j.recot.2023.02.018] [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: 10/14/2022] [Accepted: 11/22/2022] [Indexed: 03/04/2023] Open
Abstract
INTRODUCTION Proximal humerus fractures are the third most frequent type of fracture in elderly patients. Nowadays, surgical treatment is indicated one third of the time, being the reverse shoulder prosthesis an option especially in complex comminuted patterns. In this study we analyzed the effects of a lateralized reverse prosthesis in tuberosity union and its relationship with the functional results. MATERIAL AND METHODS Retrospective case study of patients with proximal humerus fractures treated with a lateralized design reverse shoulder prosthesis with one-year minimum follow-up. Tuberosity nonunion was defined as a radiological concept: absence of tuberosity, distance >1cm from the tuberosity fragment to the humeral shaft or tuberosity above the humeral tray. Subgroup analysis was performed, group 1 (n=16) tuberosity union vs. group 2 (n=19) tuberosity nonunion. Groups were compared with the following functional scores: Constant, American Shoulder and Elbow Surgeons and Subjective Shoulder Value. RESULTS A total of 35 patients were included in this study with a median age of 72.65 years. Postoperative radiographic analysis at one year after surgery revealed a tuberosity nonunion rate of 54%. Subgroup analysis revealed no statistically significant differences in terms of range of motion or functional scores. However, there were differences regarding the Patte sign (p=0.03) which was positive in a larger proportion of patients in the group with tuberosity nonunion. CONCLUSION Even though there was a large percentage of tuberosity nonunion with the use of a lateralized prosthesis design, patients obtained good results in a similar manner to those found in the union group in terms of range of motion, scores, and patient satisfaction.
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Affiliation(s)
- I Dot Pascuet
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitari Sant Joan de Reus, Reus, Tarragona, Spain
| | - D Arregui Gallego
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitari Sant Joan de Reus, Reus, Tarragona, Spain
| | - D Valdez
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitari Sant Joan de Reus, Reus, Tarragona, Spain; Facultad de Medicina, Universitat Rovira i Virgili, Reus, Tarragona, Spain
| | - A Rodriguez Gangoso
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitari Sant Joan de Reus, Reus, Tarragona, Spain; Facultad de Medicina, Universitat Rovira i Virgili, Reus, Tarragona, Spain
| | - A Ferrando
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitari Sant Joan de Reus, Reus, Tarragona, Spain; Facultad de Medicina, Universitat Rovira i Virgili, Reus, Tarragona, Spain.
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Malik SS, Malik S, Tahir M, Jordan RW, Laprus H, D'Alessandro P. Open coraco-clavicular ligament reconstruction (CCLR) in treatment of displaced distal clavicle fractures has low complication rate and excellent union rate: a systematic review. Arch Orthop Trauma Surg 2023; 143:1459-77. [PMID: 35178594 DOI: 10.1007/s00402-022-04384-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 02/05/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND It is well established that non-operative treatment of displaced distal clavicle fractures (DDCF) leads to a high non-union rate. A number of open surgical treatments in the past have shown good to excellent outcomes including shoulder function and union rate. Despite this there is no consensus on the outcome of open coraco-clavicular ligament reconstruction (CCLR). The aim of this systematic review was to assess the union rate, complications and shoulder function of open CCLR techniques in the treatment of DDCF. PATIENTS AND METHODS A review of the online databases MEDLINE and Embase was conducted on 1 January 2021 according to PRISMA guidelines. The review was registered prospectively in the PROSPERO database. Clinical studies reporting union rate, complications and shoulder function were included. The studies were appraised using the Methodological Index for Non-Randomized Studies (MINORS) tool. RESULTS The search strategy identified 18 studies eligible for inclusion with a total of 330 patients. These included 12 retrospective case series and 5 nonrandomized retrospective comparative studies and one RCT. All but one study reported on shoulder function, while all the studies reported on union rate and complications. The overall shoulder function was good to excellent using Constant-Murley score. The overall union rate was 97.6% and complication rate was 7.6%. CONCLUSION Open CCLR for displaced distal clavicle fractures that have a disruption of CC ligament, is a reliable treatment with excellent union rate and good to excellent shoulder functional scores. LEVEL OF EVIDENCE IV; Systematic review.
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Izzo A, Sgadari A, Santagata S, Coviello A, Cozzolino A, Mariconda M, Bernasconi A. Irritation from metalwork after ankle arthrodesis fixed using screws: a proportional meta-analysis and systematic review. Arch Orthop Trauma Surg 2023. [PMID: 36795152 DOI: 10.1007/s00402-023-04813-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 02/05/2023] [Indexed: 02/17/2023]
Abstract
OBJECTIVE Ankle arthrodesis (AA) is often fixed using cannulated screws. The irritation from metalwork is a relatively common complication, but there is no consensus regarding the need to remove the screws on a systematic basis. The aim of this study was to determine (1) the proportion of screws removed after AA and (2) whether predictors of screw removal could be identified. METHODS This PRISMA-compliant systematic review was part of a larger previous protocol registered on the PROSPERO platform. Multiple databases were searched including studies in which patients undergone AA using screws as exclusive fixation method were followed. Data were harvested regarding the cohort, the study design, the surgical technique, the nonunion and complication rate at the longest follow-up. Risk of bias was assessed using the modified Coleman Methodology Score (mCMS). RESULTS Forty-four series of patients from thirty-eight studies (1990 ankles, 1934 patients) were selected. The average follow-up was 40.8 months (range 12-110). In all studies, hardware was removed due to symptoms reported by patients and related to the screws. The pooled proportion of removal of metalwork was 3% (95% CI 2-4). The pooled proportion of fusion was 96% (95%CI 95-98), while the pooled proportion of complications and reoperations (excluding the removal of metalwork) stood at 15% (95% CI 11-18) and 3% (95% CI 2-4), respectively. The mean mCMS (50.8 ± 8.1, range 35-66) revealed only an overall fair quality of studies. The univariate analysis and the multivariate model showed that the year of publication (R = - 0.004; p = 0.01) and the number of screws (R = 0.08; p = 0.01) were associated with the screw removal rate. Specifically, we found that over time the removal rate decreased by 0.4% per year and that the use of three screws instead of two reduced the risk of removal of metalwork by 8%. CONCLUSIONS In this review, removal of metalwork after ankle arthrodesis using cannulated screws was needed in 3% of cases at an average follow-up of 40.8 months. It was indicated only in case of symptoms related to soft tissue irritation from screws. The use of three screws was paradoxically related to a reduced risk of removal of screws as compared to two-screw constructs. LEVEL OF EVIDENCE Level IV, systematic review of Level IV.
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Malik SS, Tahir M, Remtulla M, Malik S, Jordan RW. A systematic review and meta-analysis comparing the use of hook plates and superior plates in the treatment of displaced distal clavicle fractures. Arch Orthop Trauma Surg 2023; 143:329-52. [PMID: 34988674 DOI: 10.1007/s00402-021-04287-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 11/27/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Non-operative treatment of displaced distal clavicle fractures results in high non-union and yet there is no consensus on superior treatment modality. While there are a number of different techniques available for fixation, hook plate (HP) has been used most commonly. A number of modern techniques, including superior plate (SP), have shown less complications but equivocal union rate and shoulder function. The aim of this systematic review and meta-analysis is to compare the outcome of HP fixation with superior plate in surgical fixation of displaced distal clavicle fractures. PATIENTS AND METHODS A review of the online databases MEDLINE and Embase was conducted on 15 January 2021 according to PRISMA guidelines. The review was registered prospectively in the PROSPERO database. Clinical studies reporting union rate, complications and shoulder function were included. The studies were appraised using the Methodological Index for Non-Randomized Studies (MINORS) tool. RESULTS The search strategy identified 42 studies eligible for inclusion with a total of 1,261 patients. These included 17 hook-plate case series (n = 573), 18 superior plate case series, of which 6 used SP alone (n = 223) and 12 SP and simultaneous CCLR case series (n = 189), and 7 studies comparing HP and SP (n = 276). The overall complication rate was significantly higher with HP when compared to SP [(32.7% vs 12.7%; OR 6.31 (95% CI: 2.67-14.91)]. The overall union rates in the case series appeared comparable in the current SR; HP 96.4%, SP 96.9% and SP with simultaneous CCLR 97.9%. Shoulder function was most commonly assessed using CM score and the mean ranged from 83.8 to 97.2 in HP, 89 to 98 in SP group and 90.6 to 97.6 in SP with CCLR. Meta-analysis of CM score failed to show a significant difference for HP versus SP (pooled weighted mean difference was 2.67 (95% CI: - 0.09 to 5.43) with a trend to favour SP fixation. CONCLUSION The current review has demonstrated that HP, SP alone or with CCLR all offer excellent union rate and appear to provide comparative functional outcomes. However, HP is associated with significantly higher complication rates.
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Dot Pascuet I, Arregui Gallego D, Valdez D, Rodriguez Gangoso A, Ferrando A. Influence of lateralized reverse shoulder prosthesis design on tuberosity union in proximal humerus fractures. Rev Esp Cir Ortop Traumatol (Engl Ed) 2022:S1888-4415(22)00339-3. [PMID: 36462726 DOI: 10.1016/j.recot.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/21/2022] [Accepted: 11/22/2022] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Proximal humerus fractures are the third most frequent type of fracture in elderly patients. Nowadays, surgical treatment is indicated one third of the time, being the reverse shoulder prosthesis an option especially in complex comminuted patterns. In this study we analyzed the effects of a lateralized reverse prosthesis in tuberosity union and its relationship with the functional results. MATERIAL AND METHODS Retrospective case study of patients with proximal humerus fractures treated with a lateralized design reverse shoulder prosthesis with one-year minimum follow-up. Tuberosity nonunion was defined as a radiological concept: absence of tuberosity, distance>1cm from the tuberosity fragment to the humeral shaft or tuberosity above the humeral tray. Subgroup analysis was performed, group 1 (n=16) tuberosity union vs. group 2 (n=19) tuberosity nonunion. Groups were compared with the following functional scores: Constant, American Shoulder and Elbow Surgeons and Subjective Shoulder Value. RESULTS A total of 35 patients were included in this study with a median age of 72.65 years. Postoperative radiographic analysis at one year after surgery revealed a tuberosity nonunion rate of 54%. Subgroup analysis revealed no statistically significant differences in terms of range of motion or functional scores. However, there were differences regarding the Patte sign (p=0.03) which was positive in a larger proportion of patients in the group with tuberosity nonunion. CONCLUSION Even though there was a large percentage of tuberosity nonunion with the use of a lateralized prosthesis design, patients obtained good results in a similar manner to those found in the union group in terms of range of motion, scores, and patient satisfaction.
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Malhotra A, Krishna A, Garg SK, Gupta S, Jindal R, Jain G. Short term results with the use of PLA antibiotic coated nail in open tibia fractures: A prospective study. J Orthop 2022; 34:183-188. [PMID: 36090781 PMCID: PMC9459675 DOI: 10.1016/j.jor.2022.08.026] [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: 07/19/2022] [Revised: 08/14/2022] [Accepted: 08/23/2022] [Indexed: 10/31/2022] Open
Abstract
Background Antibiotic impregnated cement coated nails have been described in literature with promising success rates. However, they need removal at a later stage. This study focuses on use of a PLA-precoated antibiotic nail that stops eluting antibiotic after a while and can be retained later as it behaves as a standard interlocking nail in the long run. Purpose To study if PLA (polylactic acid) -antibiotic coated nails reduces infection and non-union rates and improve the functional outcome in open tibial shaft fracture cases. Materials and methods In this prospective cohort study, we included 54 patients with open tibia shaft fractures treated with wound debridement and internal fixation using a reamed PLA (polylactic acid)-antibiotic coated nail (CE-certified, OSSIPRO, MatrixTM). Results Forty patients with a Grade 2 and ten with grade 3A open tibial fracture, according to the Gustilo-Anderson classification, completed a minimum of six months of follow-up and were included in the analysis. At the final follow-up, four patients (all with grade 3A fracture) had an active infection, 10 (four of grade 2 and six of grade 3A) had non-union, the mean physical component score (SF-36 score) was 55.2 ± 20.10 (grade 2; 58.95 ± 9.99, grade 3A; 40.19 ± 16.37, P value 0.002), and the mean mental component score (SF-36 score) was 54.96 ± 23.5 (grade 2; 57.96 ± 16.63, grade 3A; 42.94 ± 23.75, P value 0.04). Furthermore, Multivariate analysis showed age and grade of fracture to be independently related to the development of infection and non-union. Conclusion Although the use PLA-antibiotic coated nail looks promising, short-term results have revealed no additional benefit in terms of reduced infection rates, improved union rates or functional outcomes. Large multicentric randomized controlled trials and a long term follow up are advised to further explore the role of PLA coated antibiotic nails in open tibial fractures.
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Affiliation(s)
- Anubhav Malhotra
- Trauma & Orthopaedics, Wirral University Teaching Hospitals NHS Trust, UK
| | - Anant Krishna
- Department of Orthopaedics, SGT Medical College Hospital, Gurugram, India
| | - Sudhir Kumar Garg
- Department of Orthopaedics, Government Medical College & Hospital, Chandigarh, India
| | | | - Rohit Jindal
- Department of Orthopaedics, Government Medical College Hospital, Chandigarh, India
| | - Gunjar Jain
- Department of Orthopaedics. AIIMS, Bhubneswar, India
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Kumar D, Ghosh A, Jindal K, Berwal P, Sharma S, Dhillon M. Antegrade vs retrograde intramedullary nailing in humerus shaft fractures: A systematic review and meta-analysis. J Orthop 2022; 34:391-397. [PMID: 36281312 PMCID: PMC9587345 DOI: 10.1016/j.jor.2022.10.003] [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: 05/18/2022] [Revised: 09/15/2022] [Accepted: 10/04/2022] [Indexed: 10/31/2022] Open
Abstract
Introduction Plate osteosynthesis, external fixators and intramedullary nails are the commonly used devices for fixation of humerus shaft fractures. Humerus nails are gradually coming into popular use. Both antegrade and retrograde nails are used for this, however no evidence clearly states the benefits of one over the other. Thus, the purpose of this study was to evaluate the available evidence comparing the complications and outcomes of antegrade versus retrograde nails. Patients and methods We followed the Preferred Reporting Items for Meta-analyses Statement (PRISMA) guidelines. All studies in any language comparing the use of antegrade and retrograde nailing for humerus fractures, with a minimum follow up of 12 months were included. The primary outcome measures were complications and time to union. Results Seven studies including 384 patients (200 antegrade, 184 retrograde) were analyzed. A significantly lower complication rate was observed with retrograde nails (OR 1.77, p = 0.04, 95% CI 1.02,3.06; p = 0.04). Antegrade nails were associated with shorter operative time (MD -13.69, p > 0.00001). There was no significant difference in time to union and intra-operative blood loss between the two techniques. Conclusion Retrograde nails have a significantly lower complication rate. However, the surgeon's experience with these devices and the location of the fracture are the primary considerations when choosing either implant. Loe Level IV.
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Affiliation(s)
- Deepak Kumar
- Department of Orthopaedics, PGIMER, Chandigarh, India
| | - Akash Ghosh
- Department of Orthopaedics, PGIMER, Chandigarh, India
| | - Karan Jindal
- Department of Orthopaedics, AIMSR, Mohali, India
| | - Prerana Berwal
- Department of Physical and Rehabilitative Medicine, PGIMER, Chandigarh, India
| | - Shivam Sharma
- Department of Physical and Rehabilitative Medicine, PGIMER, Chandigarh, India
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Boksh K, Kanthasamy S, Divall P, Abraham A. Hexapod Circular Frame Fixation for Tibial Non- union: A Systematic Review of Clinical and Radiological Outcomes. Strategies Trauma Limb Reconstr 2022; 17:172-183. [PMID: 36756293 PMCID: PMC9886030 DOI: 10.5005/jp-journals-10080-1570] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 10/19/2022] [Indexed: 01/02/2023] Open
Abstract
Introduction Tibial non-unions present with complex deformities, bone loss, infection, leg length discrepancy (LLD), and other features which influence function. Circular frame-based treatment is popular with the hexapod system used increasingly. This systematic review aims to determine the clinical and radiological outcomes of hexapod fixation when used for tibial non-unions. Materials and methods The review was performed in accordance with preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. The search strategy was applied to MEDLINE and Embase databases on 15 December 2021. Studies reporting either clinical or radiological outcomes following hexapod fixation on tibial non-unions were included. Primary outcomes were radiological union and patient-reported outcome measures (PROMs). Secondary outcomes included LLD, tibial alignment deformity (TAD), return to pre-injury activity and post-operative complications. Results After the abstract and full-text screening, 9 studies were included; there were 283 hexapod frame fixations for tibial non-unions. Infection (46.6%) and stiff hypertrophic non-union (39.2%) accounted for most non-unions treated. The average age and mean follow-up were 42.2 years and 33.1 months, respectively. The average time to union was 8.7 months with a union rate of 84.8%. A total of 90.3% of patients had TAD below 5° in all planes, with an LLD ≤1.5 cm of the contralateral leg in 90.5%. Bony and functional results were at least good in over 90% of patients when using the Association for the Study of the Method of Ilizarov (ASAMI) criteria. A total of 84% of patients returned to pre-injury activities. There were complications as follows: a total of 34% developed pin-site infection, almost 9% experienced half-pin breakage and 14% developed an equinus ankle contracture. Conclusion Hexapod frames for the treatment of tibial non-unions produce favourable functional outcomes. Complication rates are present and need to be discussed when this modality of treatment is proposed. Further comparative studies will allow for this option to be evaluated against that of the traditional Ilizarov frame and other methods of non-union surgery. How to cite this article Boksh K, Kanthasamy S, Divall P, et al. Hexapod Circular Frame Fixation for Tibial Non-union: A Systematic Review of Clinical and Radiological Outcomes. Strategies Trauma Limb Reconstr 2022;17(3):172-183.
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Affiliation(s)
- Khalis Boksh
- Department of Trauma and Orthopaedics, University Hospitals of Leicester NHS Trust, Leicester, Leicestershire, United Kingdom
| | - Senthooran Kanthasamy
- Department of Trauma and Orthopaedics, University Hospitals of Leicester NHS Trust, Leicester, Leicestershire, United Kingdom
| | - Pip Divall
- Department of Trauma and Orthopaedics, University Hospitals of Leicester NHS Trust, Leicester, Leicestershire, United Kingdom
| | - Alwyn Abraham
- Department of Trauma and Orthopaedics, University Hospitals of Leicester NHS Trust, Leicester, Leicestershire, United Kingdom
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Li Z, Yu H, Huang Y, Liu Y, Zhu G, Tan Q, Mei H, Yang G. Analysis of risk factors affecting union and refracture after combined surgery for congenital pseudarthrosis of the tibia: a retrospective study of 255 cases. Orphanet J Rare Dis 2022; 17:245. [PMID: 35739599 PMCID: PMC9229079 DOI: 10.1186/s13023-022-02375-w] [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: 10/09/2021] [Accepted: 05/29/2022] [Indexed: 11/10/2022] Open
Abstract
Background Congenital pseudarthrosis of the tibia (CPT) is a rare disease occurring in children. The aim of this study is to identify the factors affecting bone union and re-fracture after surgery for CPT and to provide reliable evidence for clinics. Methods We collected the detailed information of 255 cases with Crawford IV CPT treated by combined surgery in our hospital from 2013 to 2020. Basic characteristics were recorded. Univariate variance and logistic regression analysis were used to compare the correlations between factors and outcomes. Results 92.5% of patients achieved primary union, 7.5% of patients had non-union and 13.3% of patients had re-fracture. Logistic regression analysis showed that age at index surgery (Coef. = 0.171, 95%CI 0.015–0.327, P = 0.032), and CPT location (Coef. = − 1.337, 95%CI − 2.218–0.456, P = 0.003) had statistical differences, while no factors had significant correlation with re-fracture. Furthermore, ROC curve showed that the optimal age threshold for first surgery was 2.37 years old. Conclusions For patients with Crawford IV CPT treated by combined surgery, the younger the age at index surgery and the closer the CPT location to the distal end, the easier to achieve bone union.
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Affiliation(s)
- Zhuoyang Li
- Department of Orthopedics, College of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Hui Yu
- Department of Orthopedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong, China
| | - Yiyong Huang
- Department of Orthopedics, Hunan Children's Hospital, Hunan, China
| | - Yaoxi Liu
- Department of Orthopedics, Hunan Children's Hospital, Hunan, China
| | - Guanghui Zhu
- Department of Orthopedics, Hunan Children's Hospital, Hunan, China
| | - Qian Tan
- Department of Orthopedics, Hunan Children's Hospital, Hunan, China
| | - Haibo Mei
- Department of Orthopedics, Hunan Children's Hospital, Hunan, China.
| | - Ge Yang
- Department of Orthopedics, Hunan Children's Hospital, Hunan, China.
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Nino S, Parry JA, Avilucea FR, Haidukewych GJ, Langford JR. Retrograde intramedullary nailing of comminuted intra-articular distal femur fractures results in high union rate. Eur J Orthop Surg Traumatol 2021; 32:1577-1582. [PMID: 34623470 DOI: 10.1007/s00590-021-03140-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 06/15/2021] [Accepted: 09/27/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Retrograde intramedullary nailing of intra-articular distal femur fractures with metaphyseal and/or epiphyseal comminution is controversial and considered a contraindication to nailing. The purpose of this study was to report union rate, complications, and secondary procedures after open reduction and retrograde intramedullary nailing of comminuted, intra-articular, distal femur fractures. MATERIALS AND METHODS A retrospective review performed at an urban level one trauma center identified 16 patients AO/Orthopedic Trauma Association (OTA) 33-C2 and 33-C3 femur fractures treated with open reduction, lag screws, and retrograde intramedullary nail fixation. Radiographic union, complications, secondary operations were reviewed. RESULTS At the 3-month follow-up 12 (86%) of the 14 patients with radiographs had healed. At last follow-up, all 16 femur fractures achieved radiographic union after the index procedure. No patient required a revision procedure for delayed union or nonunion. Complications occurred in 6 (38%) patients, including failed distal interlocking screws (n = 2), knee arthrofibrosis (n = 3), superficial wound infection (n = 1), and wound dehiscence (n = 1). Three (19%) patients required secondary procedures, which included knee manipulation under anesthesia (n = 3), distal interlocking screw removal (n = 2), and closure of a wound dehiscence (n = 1). CONCLUSIONS Comminuted intra-articular distal femur fractures that can be successfully treated with retrograde IMN fixation will reliably go on to union with a complication rate that is favorable to that reported for plate fixation. LEVEL OF EVIDENCE Level IV, retrospective case-series.
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Affiliation(s)
- Samantha Nino
- Department of Orthopaedics, Orlando Health, Orlando, FL, USA
| | - Joshua A Parry
- Department of Orthopaedics, Denver Health Medical Center, University of Colorado School of Medicine, 777 Bannock St, MC 0188, Denver, CO, 80204, USA.
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Peat F, Ordas-Bayon A, Krkovic M. Do Poller screws effect union in tibial shaft fractures treated with intramedullary nailing? Injury 2021; 52:3132-3138. [PMID: 33627250 DOI: 10.1016/j.injury.2021.02.040] [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: 11/18/2020] [Revised: 02/04/2021] [Accepted: 02/15/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Tibial shaft fractures are a commonly encountered challenge presented to orthopaedic trauma surgeons. Intramedullary nailing (IMN) is often the treatment of choice and whilst effective, complications of delayed and/or non-union can cause significant morbidity and necessitate additional operative procedures. The use of Poller screws during IMN are a recognised way of aiding fracture reduction, however the clinical benefits of this are debated. This study evaluated the outcome of tibial shaft fractures treated with IMN with or without the addition of Poller screws. METHODS Retrospective cohort study of all patients undergoing IMN following tibial shaft fractures over a 5-year period. 154 operated tibial shaft fractures were identified, with patients divided into 3 groups - Group 1: IM nailing alone, Group 2: IMN + 1 conventional Poller screw, or Group 3: IMN + 2 Poller screws placed Epicentrically across the fracture site. Data collected included demographics, length of stay, fracture type, position and AO classification grade, operative time, and operating surgeons' grade. Primary outcome measure was the incidence of delayed and/or non-union. Secondary outcomes were differences in rates of infection and additional orthopaedic procedures between the 3 groups. RESULTS Overall 139/154 fractures (90.3%) achieved a timely union. There was a statistically significant difference (p = 0.05) in fracture union between the 3 groups, with 75/88 fractures healing in group 1 (IMN alone) compared to 44/46 in Group 2 (IMN + 1 Poller screw) and 20/20 in group 3 (IMN + 2 Poller screws). There was no statistical difference in the incidence of superficial infection, (p = 0.95) additional procedures (p = 0.23) or deep infection (p = 0.65) between the 3 groups. CONCLUSION The addition of Poller screws appear to be a safe and effective adjunct in the treatment of tibial shaft fractures via IMN. Further prospective randomised trials are needed to fully elucidate both the role and potential benefits of Poller screw augmentation in acute lower limb fracture management.
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Affiliation(s)
- Fidel Peat
- Department of Trauma and Orthopaedic Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road CB2 0QQ Cambridge, Cambridgeshire, United Kingdom.
| | - Alejandro Ordas-Bayon
- Department of Trauma and Orthopaedic Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road CB2 0QQ Cambridge, Cambridgeshire, United Kingdom.
| | - Matija Krkovic
- Department of Trauma and Orthopaedic Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road CB2 0QQ Cambridge, Cambridgeshire, United Kingdom.
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22
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Abstract
Fuzzy mixed graph (FMG) can be used to model some graphical intercommunication network systems if there are many directed and undirected relations between some vertices. In inverse fuzzy graph, the membership value of edges are greater than or equal to the minimum of the membership value of the corresponding vertices. In inverse fuzzy mixed graph (IFMG), directed and undirected relations exist between some vertices and it can be used to analyze many graphical problems of real life such that the membership values of edges are greater than or equal to the minimum of the membership value of the corresponding pair of vertices. In this article, the concept of IFMG is introduced first with some of its properties. Then some isomorphic properties are studied and complement of IFMG is given. Different types of operations like union, intersection, product and join between two IFMGs are defined and investigated some of their related results. An algorithm of the proposed method is executed to identify some vertices. An application is depicted using the concept IFMG to examine the order of vertices in a social network group according to communication gaps.
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Affiliation(s)
- Soumitra Poulik
- Department of Applied Mathematics with Oceanology and Computer Programming, Vidyasagar University, Midnapore, 721102 India
| | - Ganesh Ghorai
- Department of Applied Mathematics with Oceanology and Computer Programming, Vidyasagar University, Midnapore, 721102 India
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Ng N, Nicholson JA, Chen P, Yapp LZ, Gaston MS, Robinson CM. Adolescent mid-shaft clavicular fracture displacement does not predict non union or inferior functional outcome at long-term follow-up. Bone Joint J 2021; 103-B:951-957. [PMID: 33934646 DOI: 10.1302/0301-620x.103b5.bjj-2020-1929.r1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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] [Indexed: 11/05/2022]
Abstract
AIMS The aim of this study was to define the complications and long-term outcome following adolescent mid-shaft clavicular fracture. METHODS We retrospectively reviewed a consecutive series of 677 adolescent fractures in 671 patients presenting to our region (age 13 to 17 years) over a ten-year period (2009 to 2019). Long-term patient-reported outcomes (abbreviated version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) score and EuroQol five-dimension three-level (EQ-5D-3L) quality of life score) were undertaken at a mean of 6.4 years (1.2 to 11.3) following injury in severely displaced mid-shaft fractures (Edinburgh 2B) and angulated mid-shaft fractures (Edinburgh 2A2) at a minimum of one year post-injury. The median patient age was 14.8 years (interquartile range (IQR) 14.0 to 15.7) and 89% were male (n = 594/671). RESULTS The majority of fractures were mid-shaft (n = 606) with angulation (Edinburgh 2A2, n = 241/606, 39.8%) or displacement (Edinburgh 2B1/2, n = 263/606, 43.4%). Only 7% of the displaced mid-shaft fractures underwent acute fixation (n = 18/263). The incidence of refracture over ten years following nonoperative management of mid-shaft fractures was 3.2% (n = 19/588) and all united without surgery. Fracture type, severity of angulation, or displacement were not associated with refracture. One nonunion occurred following nonoperative management in a displaced mid-shaft fracture (0.4%, n = 1/245). Of the angulated fractures, 61 had angulation > 30°, of which 68.9% (n = 42/61) completed outcome scores with a median QuickDASH of 0.0 (IQR 0.0 to 0.6), EQ-5D-3L 1.0 (1.0 to 1.0), and 98% satisfaction with shoulder function. For the displaced fractures, 127 had displacement beyond one cortical width of bone for which completed outcome scores were provided in 72.4% (n = 92/127). Of these 15 had undergone acute fixation. Following nonoperative treatment, the median QuickDASH was 0.0 (IQR 0.0 to 2.3), EQ-5D-3L 1.0 (1.0 to 1.0), and satisfaction with shoulder function was 95%. There were no significant differences in the patients' demography or functional outcomes between operative and nonoperative treatments. CONCLUSION Nonoperative management of adolescent mid-shaft clavicle fractures results in excellent functional outcomes at long-term follow-up. Nonunion is exceptionally rare following nonoperative management and the relative indications for surgical intervention in adults do not appear to be applicable to adolescents. Cite this article: Bone Joint J 2021;103-B(5):951-957.
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Affiliation(s)
- Nathan Ng
- Department of Orthopaedic Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Jamie A Nicholson
- Department of Orthopaedic Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Pengchi Chen
- Department of Orthopaedic Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Liam Z Yapp
- Department of Orthopaedic Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | - C Mike Robinson
- Department of Orthopaedic Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
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van den Heuvel SBM, Doorgakant A, Birnie MFN, Blundell CM, Schepers T. Open Ankle Arthrodesis: a Systematic Review of Approaches and Fixation Methods. Foot Ankle Surg 2021; 27:339-347. [PMID: 33419696 DOI: 10.1016/j.fas.2020.12.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 10/20/2020] [Revised: 12/07/2020] [Accepted: 12/29/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Open ankle arthrodesis (OAA) remains the most widely used operation in end-stage ankle osteoarthritis. However, there is a large variation in terms of approach and fixation methods. The aim of this systematic review was to assess the effect of different approaches and fixation methods on the union rate, complication rate and functional outcome in OAA. METHODS A search of the online databases PubMed, Embase, and Cochrane library was performed to identify patients who underwent OAA with screw- and/or plate-fixation. RESULTS We identified 38 studies, including 1250 patients (1290 ankles). The union rate was 98% (95% CI 0.95-0.99) for the anterior, 96% (95% CI 0.92-0.98) for the lateral and 96% (95% CI 0.68-1.00) for the combined medial/lateral approach. Screw-fixation achieved an overall union rate of 96% (95% CI 0.93-0.98) and plate-fixation 99% (95% CI 0.96-0.99). The overall complication rate was 14%, 16% and 31% for the anterior, lateral and combined medial/lateral approaches respectively. It stood at 18% for screw-fixation and 9% for plate-fixation. The infection rate was 4%, 6% and 8% for the anterior, lateral and combined approaches respectively. Screw-fixation had an infection rate of 6% and plate-fixation 3%. The postoperative AOFAS scores were 76.8, 76.5 and 67.6 for the anterior, lateral and combined approaches respectively and 74.9 for screw- compared to 78.5 for plate-fixation. These differences did not reach statistical significance. CONCLUSION This study, the first of its kind, found little difference in terms of results between approach and fixation method used in OAA. LEVEL OF EVIDENCE Level IIa.
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Affiliation(s)
- Stein B M van den Heuvel
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, P.O. Box 22660, 1100 DD Amsterdam, the Netherlands
| | - Ashtin Doorgakant
- Trauma and Orthopaedic Department, Warrington and Halton Teaching Hospitals NHS Foundation Trust, Warrington, United Kingdom
| | - Merel F N Birnie
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, P.O. Box 22660, 1100 DD Amsterdam, the Netherlands
| | - Chris M Blundell
- Sheffield Foot and Ankle Unit, Orthopaedic Department, Northern General Hospital, Sheffield, United Kingdom
| | - Tim Schepers
- Department of Surgery, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, P.O. Box 22660, 1100 DD Amsterdam, the Netherlands.
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Wang P, Wu Y, Rui Y, Wang J, Liu J, Ma Y. Masquelet technique for reconstructing bone defects in open lower limb fracture: Analysis of the relationship between bone defect and bone graft. Injury 2021; 52:988-95. [PMID: 33386161 DOI: 10.1016/j.injury.2020.12.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 11/06/2020] [Accepted: 12/13/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The aim of this study was to retrospectively analyze the experience of treating long segmental bone defects. Bone union was used as the criteria for the assessment of the quantitative relationship between tibial bone defects and bone grafts, which could help reduce the complication incidence in patients. METHODS A total of 45 patients with tibial bone defects treated with the Masquelet technique at the Ninth People's Hospital of Wuxi Affiliated to Soochow University between February 2013 and December 2017 were recruited. The age, sex, body mass index (BMI), complications, site of bone defect, length of bone defect, time from the first to the second stage of operation, and postoperative complications (including deep infection, absorption of bone graft, and bone union) were assessed. RESULTS Forty-two patients, including 17 males (40.5%) and 25 females (59.5%), with segmental bone defect, met the inclusion criteria. The mean age of the patients was 38.5 years (22-55 years). Nineteen patients (45.2%) underwent multiple traumas. The mean length of the bone defect was 6.3 cm. Six patients experienced complications, resulting in the incidence of complications of 14.3%. The relationship between the length of bone defect and volume of bone grafts was Y = 7.210 + 6.954 × X in patients treated with steel plates; Y = 10.962 + 5.029 × X for patients treated with intramedullary nails, and Y = 11.498 + 5.474 × X regardless of methods of internal fixation. CONCLUSION Masquelet technique is effective and safe for the treatment of long segmental tibial bone defects. The present study revealed the quantitative relationship between the size of bone defects and bone grafts, thus providing evidence for the selection of treatment strategies for long segmental bone defects in clinical practices, as well as helping to reduce the incidence of complications in Masquelet technique.
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Iqbal F, Zamir M, Ahmed N, Kamal SW, Memon N. Ball tipped guide wire for broken nail removal: a case report. SICOT J 2021; 7:10. [PMID: 33683195 PMCID: PMC7938723 DOI: 10.1051/sicotj/2021010] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 02/10/2021] [Indexed: 11/20/2022] Open
Abstract
A broken intramedullary nail is a well-known complication of non-union of femur shaft fractures. Numerous surgical techniques have been presented before in patients with non-union of long bone fractures. We report the surgical technique used to perform removal of the broken distal segment of a nail in a patient who achieved uneventful union after intramedullary nailing of closed femur shaft fracture. A ball-tipped guidewire was inserted through the broken segment of the femur nail. A pre-bend plain wire was then inserted. With the help of a vise-grip, both wires were twisted in order to make a secure handle between guidewires and a broken implant. With the help of a mallet upward-directed blows were applied to extract a broken segment of the nail. We found ball-tipped guidewire technique a useful and effective technique in removing the broken distal portion of the nail.
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Affiliation(s)
- Faizan Iqbal
- Department of Orthopaedic Surgery, Patel Hospital, 75300 Karachi, Pakistan
| | - Mehroze Zamir
- Department of Orthopaedic Surgery, Patel Hospital, 75300 Karachi, Pakistan
| | - Nasir Ahmed
- Department of Orthopaedic Surgery, Patel Hospital, 75300 Karachi, Pakistan
| | - Syed Wajahat Kamal
- Department of Orthopaedic Surgery, Patel Hospital, 75300 Karachi, Pakistan
| | - Nouman Memon
- Department of Orthopaedic Surgery, Patel Hospital, 75300 Karachi, Pakistan
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Kang JW, Cha SM, Kim SG, Choi IC, Suh DH, Park JW. Tips and tricks to achieve osteotomy healing and prevent refracture after ulnar shortening osteotomy. J Orthop Surg Res 2021; 16:110. [PMID: 33541409 PMCID: PMC7863478 DOI: 10.1186/s13018-021-02266-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 12/10/2020] [Accepted: 01/26/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Parallel osteotomy is essential for favorable osteotomy reduction and healing and technically challenging during diaphyseal ulnar shortening osteotomy (USO). This study aimed to evaluate the advantages of guided osteotomy for parallel osteotomy and reduction osteotomies, healing over freehand osteotomy. It also aimed to identify surgical factors affecting healing after diaphyseal USO. METHODS Between June 2005 and March 2016, 136 wrists that had undergone diaphyseal USO for ulnar impaction syndrome (UIS) were evaluated. The wrists were divided into two groups according to the osteotomy technique (group 1: freehand osteotomy, 74 wrists; group 2: guided osteotomy, 62 wrists). The osteotomy reduction gap and time to osteotomy healing (union and consolidation) were compared between the groups. A multiple regression test was performed to identify the surgical factors affecting healing. The cut-off length of the reduction gap to achieve osteotomy union on time and the cut-off period to decide the failure of complete consolidation were statistically calculated. RESULTS The baseline characteristics did not differ between the two groups. The osteotomy reduction gap and time to osteotomy union, and complete consolidation were shorter in group 2 than in group 1 (p = 0.002, < 0.001, 0.002). The osteotomy reduction gap was a critical surgical factor affecting both time to osteotomy union and complete consolidation (p < 0.001, < 0.001). The use of a dynamic compression plate affected only the time to complete consolidation (p < 0.001). The cut-off length of the osteotomy reduction gap to achieve osteotomy union on time was 0.85 mm. The cut-off period to decide the failure of complete consolidation was 23.5 months after osteotomy. CONCLUSIONS The minimal osteotomy reduction gap was the most important for timely osteotomy healing in the healthy ulna, and guided osteotomy was beneficial for reducing the osteotomy reduction gap.
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Affiliation(s)
- Jong Woo Kang
- Department of Orthopedic Surgery, Korea University Anam Hospital, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841 South Korea
| | - Soo Min Cha
- Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Sang-gyun Kim
- Department of Orthopedic Surgery, Korea University Anam Hospital, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841 South Korea
| | - In Cheul Choi
- Department of Orthopedic Surgery, Anam Hospital, College of Medicine, Korea University, Seoul, Korea
| | - Dong Hun Suh
- Department of Orthopedic Surgery, Korea University Anam Hospital, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841 South Korea
| | - Jong Woong Park
- Department of Orthopedic Surgery, Anam Hospital, College of Medicine, Korea University, Seoul, Korea
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Liu Y, Wang J. Environmental pollution, environmental regulation, and labor income share. Environ Sci Pollut Res Int 2020; 27:45161-45174. [PMID: 32779069 DOI: 10.1007/s11356-020-10408-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 03/24/2020] [Accepted: 08/04/2020] [Indexed: 06/11/2023]
Abstract
China has maintained great economic growth in the past and reached the status of a middle-income country. Meanwhile, the relationships among environmental pollution, environmental regulation, and economic growth have attracted wide attention. In addition, some studies have shown that economic growth is not balanced in the division of income between labor and capital, and this has become one of the most important issues in China. The conflict over the environment and income distribution is supposed to cause social welfare loss; therefore, we want to examine the impact of environmental pollution and environmental governance on labor income share. Our empirical results show that the relationship between environmental pollution and share of labor income is positive at the present stage. However, the relationship is not linear but rather an inverted-U shape in the long run. In addition, we tested the effects of environmental regulation on labor income share and found an inverted-U-shaped relationship. Although growing concern about environmental pollution adds to the pressure on the government, our statistical results suggest that there is no perfect way to resolve environmental problems. Additionally, labor unions are expected to play a different role in income distribution.
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Affiliation(s)
- Yulin Liu
- School of Public Administration, Chongqing University, Chongqing, China
| | - Jun Wang
- School of Public Administration, Chongqing University, Chongqing, China.
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Abstract
BACKGROUND First metatarso-phalangeal joint fusion is the current gold standard for severe hallux rigidus. Data regarding the union rate and the re-operation rate when IOFix (an Intra-osseous fixation device, Extremity medical, New Jersey, USA) is used for hallux rigidus fusion is limited but promising. The aim of this study was to review our outcomes with the IOFix implant. METHODS We have conducted a retrospective chart review, following the approval of the hospital IRB committee. Exclusion criteria included bilateral operations on the same patient, multiple surgeries, charcot foot or other structural foot abnormalities (except hallux valgus), rheumatoid arthritis and a recent foot trauma. We collected demographic data, physical examination documentation, functional score evaluations (AOFAS), and Plain radiographic studies. RESULTS Thirty patients were included in the study. The mean age was 60.36 ± 9.12 (range 36 to 77) years, 18 (60%) female patients and 12 (40%) male. Fourteen (53.33%) were left side pathologies. The average follow up period was 36.2 ± 12.31 (range 12 to 54) months. Union was obtained in 28 (93.33%) patients, of whom none had requested a hardware removal due to a prominent hardware during a minimum of 2 year follow up period. The mean postoperative AOFAS score was 80.5 ± 10.87 (range 35 to 90). A more stringent inclusion criteria and fusion definitions would have led to an exclusion of two more patients and a dropout of two patients from the "fused" group, which would have led to a fusion rate of 85.71%. CONCLUSIONS This is the largest series of hallux rigidus patients that were operated with an IOFix device. The rates of fusion and hardware removal in MTPJ1 arthrodesis performed with an IOFix implant were found to be similar at most when compared to previously described rates that were obtained with other cheaper and more simple fixation devices. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- David Segal
- Department of Orthopaedic Surgery, Meir Medical Center, 59 Tchernichovski st, Kfar Saba, Israel. .,Tel Aviv University, Tel Aviv, Israel.
| | - Nissim Ohana
- Department of Orthopaedic Surgery, Meir Medical Center, 59 Tchernichovski st, Kfar Saba, Israel.,Tel Aviv University, Tel Aviv, Israel
| | - Meir Nyska
- Department of Orthopaedic Surgery, Meir Medical Center, 59 Tchernichovski st, Kfar Saba, Israel.,Tel Aviv University, Tel Aviv, Israel
| | - Ezequiel Palmanovich
- Department of Orthopaedic Surgery, Meir Medical Center, 59 Tchernichovski st, Kfar Saba, Israel.,Tel Aviv University, Tel Aviv, Israel
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Chalidis B, Kitridis D, Givissis P. Tibial tubercle osteotomy in revision total knee arthroplasty: A systematic review. World J Orthop 2020; 11:294-303. [PMID: 32572366 PMCID: PMC7298452 DOI: 10.5312/wjo.v11.i6.294] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 02/28/2020] [Revised: 05/08/2020] [Accepted: 05/20/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Tibial tubercle osteotomy (TTO) is a well-established surgical technique to deal with a stiff knee in revision total knee arthroplasty (RTKA). However, several reports have described potential osteotomy-related complications such as non-union, tibial tubercle migration and fragmentation, and metalware related pain.
AIM To evaluate the literature and estimate the efficiency of TTO in RTKA in terms of osteotomy union, knee mobility and complications.
METHODS MEDLINE, Scopus, and the Cochrane Central Register of Controlled Trials were investigated for completed studies until February 2020. The principle outcome of the study was the incidence of union of the osteotomy. Secondary outcomes were the knee range of motion as well as the TTO-related and overall procedure complication rate.
RESULTS Fifteen clinical studies with a total of 593 TTOs were included. The TTO union rate was 98.1%. Proximal migration and anterior knee pain were the most common TTO-related complications accounting for 6.9% and 6.4% of all cases, respectively. However, only 2.2% of cases suffering from anterior knee pain needed hardware removal. Knee flexion was improved from 82.9° preoperatively to 100.1° postoperatively and total knee range of motion was increased from 73.4° before surgery to 97° after surgery. Stiffness requiring manipulation under anesthesia was recorded in 4.6% of cases. No major complications were reported.
CONCLUSION The current systematic review supports the use of TTO in RTKA, as it is associated with high union rate, significant improvement in knee motion and low osteotomy-related complication risk that rarely leads to secondary tibial tubercle procedures.
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Affiliation(s)
- Byron Chalidis
- 1st Orthopaedic Department, Aristotle University of Thessaloniki, George Papanikolaou Hospital, Thessaloniki 55210, Greece
| | - Dimitrios Kitridis
- 1st Orthopaedic Department, Aristotle University of Thessaloniki, George Papanikolaou Hospital, Thessaloniki 55210, Greece
| | - Panagiotis Givissis
- 1st Orthopaedic Department, Aristotle University of Thessaloniki, George Papanikolaou Hospital, Thessaloniki 55210, Greece
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Abboud A, Masrouha K, Hanna T, Saghieh S. Union Following Biological and Rigid Fixations of Distal Tibia Extra-articular Fractures. Arch Bone Jt Surg 2020; 8:162-167. [PMID: 32490046 DOI: 10.22038/abjs.2019.36760.1972] [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] [Indexed: 11/06/2022]
Abstract
Background Distal tibia fractures are among the most common bony injuries, with a significant rate of nonunion and delayed union. There are multiple methods for the management of distal tibia fractures. Among the plating methods, there are bridge plating and compression plating techniques. There is still a lack of evidence about whether one method has a higher rate of union than the other. The present study aimed to assess the union rate of extra-articular distal tibia fractures using biological fixation with bridge plating and rigid fixation with compression plating. Methods This retrospective analysis was performed on 41 adult patients with distal tibia fractures. The subjects were divided into two groups based on the fixation method, namely bridge plating and compression plating. Baseline characteristics, fracture characteristics, and union status were analyzed and compared in this study. Results Baseline and fracture characteristics were similar between the groups. Only higher translation in any planes was noted in the bridge plating group (2.80±3.04 mm; P<0.001). As for union status, the rates of the union during 3 months and delayed/no union were similar between the two groups (P=0.18). During a 6-month follow-up, 92% and 93.8% of the patients achieved union in the bridge plating and compression plating groups, respectively. Conclusion Rates of delayed union and nonunion are similar regarding extra-articular distal tibia fractures treated with either bridge plating or compression plating.
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Affiliation(s)
- Abdallah Abboud
- Division of Orthopedic Surgery, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Karim Masrouha
- Division of Orthopedic Surgery, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Tammam Hanna
- Division of Orthopedic Surgery, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Said Saghieh
- Division of Orthopedic Surgery, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
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Singh KA, Chandankere V, Shah H. Does the timing of treatment affect complications of pediatric femoral neck fractures? J Orthop 2020; 22:207-212. [PMID: 32425419 DOI: 10.1016/j.jor.2020.04.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 03/30/2020] [Revised: 04/05/2020] [Accepted: 04/30/2020] [Indexed: 11/16/2022] Open
Abstract
Objectives Pediatric femoral neck fractures were reviewed to compare complications with the time of presentation. Methods 34 pediatric femoral neck fractures were studied to detect union time, avascular necrosis, premature physis fusion, and the neck-shaft angle. All complications were comparable between both groups. Results The mean union time was more in late presented group. Four children developed AVN. The neck shaft angle and pre mature fusion of growth plate were same in both groups. Conclusions The frequency of the complications except union time in pediatric neck femur fracture is comparable in early and late presented groups.
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Affiliation(s)
- Kumar Amerendra Singh
- Department of Orthopaedics, Kasturba Hospital, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | | | - Hitesh Shah
- Department of Orthopaedics, Kasturba Hospital, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
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Byun SE, Vintimilla DR, Bedeir YH, Dean CS, Parry JA, Hak DJ, Mauffrey C. Evaluation of callus formation in distal femur fractures after carbon fiber composite versus stainless steel plate fixation. Eur J Orthop Surg Traumatol 2020; 30:1103-1107. [PMID: 32356122 DOI: 10.1007/s00590-020-02681-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 04/02/2020] [Accepted: 04/22/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Carbon-fiber-reinforced polyetheretherketone (CFR) composite plates have a more favorable stress modulus than stainless steel (SS) plates that may confer an advantage to bridge plating. The purpose of this study was to compare callus formation after CFR and SS plating of distal femur fractures. METHODS A retrospective review identified distal femoral fractures treated with CFR (n = 10) and SS (n = 21) plate fixation. Callus formation was measured using the modified Radiographic Union Score for Tibia (mRUST) at 3- and 6-month follow-up by three orthopedic trauma surgeons. Loss of alignment, implant failure, and revision surgeries were reviewed. RESULTS At 3 months, the mRUST in the CFR and SS groups was 9.0 (range, 6.3-12.3) and 6.9 (range, 4.3-11.7), respectively (p = 0.01). At 6 months, the mRUST in the CFR and SS groups was 11.4 (range, 7.7-16.0) and 10.5 (range, 6.0-15.7), respectively (p = 0.3). CFR and SS groups had a loss of fracture alignment in 1 (10%) and 1 (5%) patient, respectively (p = 0.5), and an unplanned revision surgery in 0 (0%) and 3 (15%) patients, respectively (p = 0.2). All three revisions surgeries in the SS group were for nonunion repair. CONCLUSIONS Treatment of distal femur fractures with CFR versus SS plating resulted in greater callus formation at 3 months. At 6 months, there was no difference in callus formation between groups. A larger series of patients is necessary to determine if the observed early increased callus formation confers a benefit to clinical outcomes. LEVEL OF EVIDENCE Therapeutic level III.
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Affiliation(s)
| | | | - Yehia H Bedeir
- University of Alexandria Medical Center, El-Hadara University Hospital, Alexandria, Egypt
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Catlin A. Nursing strike, America, 2019: Concept analysis to guide practice. Nurs Outlook 2020; 68:468-75. [PMID: 32359777 DOI: 10.1016/j.outlook.2020.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 02/25/2020] [Accepted: 03/03/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND In 2018 a nursing 'sympathy strike' occurred. Although unionized nurses were directed to participate, many expressed questions about what a strike or sympathy strike was. Literature revealed no seminal article to define the term. A concept analysis for the nursing workforce was created. METHOD The Hybrid Method of Concept Analysis, (theoretical literature analysis, qualitative stakeholder interviews; applicability) was used. 33 articles and 7 books were reviewed. Nine interviews took place. RESULTS The literature and interviews agreed on the definition, antecedents, and consequences of a nursing strike. Strikes in the United States were defined as "a last resort effort, after significant bargaining on the issue between nurses and management has not allowed for agreement, where a work stoppage occurs and nurses leave the bedside." Interviews alone introduced the concept of duty to patients. A model case, contrary case and borderline case are offered. CONCLUSION This study contains recommendations for practice.
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Shah JK, Szukics P, Gianakos AL, Liporace FA, Yoon RS. Equivalent union rates between intramedullary nail and locked plate fixation for distal femur periprosthetic fractures - a systematic review. Injury 2020; 51:1062-1068. [PMID: 32115204 DOI: 10.1016/j.injury.2020.02.043] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [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: 09/03/2019] [Revised: 01/14/2020] [Accepted: 02/09/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND The incidence of periprosthetic fracture following total knee arthroplasty continues to rise as the number of knee arthroplasty procedures increases. Management of periprosthetic fractures can be complex, with locked compression plating (LCP) and intramedullary nailing (IMN) being the most commonly used treatment options. We performed a systematic review to report and compare the clinical and radiographic outcomes of patients treated with intramedullary nail fixation versus plate fixation for periprosthetic fractures of the distal femur. METHODS Several databases were screened. Studies evaluating intramedullary nail fixation or locked plate fixation for distal femur periprosthetic fractures were included. Primary and secondary variables as mentioned below, when included, were analyzed and compared. RESULTS One prospective comparative study, 9 retrospective comparative studies, and 28 retrospective case series with 1,188 patients were included in this review. No statistically significant differences were found between IMN and LCP when analyzing union rate or time to union. Plating demonstrated a statistically significant decrease in the overall complication rate and reoperation rate when compared with IMN (p<0.003). IMN demonstrated a slightly higher percentage of patients reaching full weight bearing status and a quicker time to full weight bearing (100% and 7.6 weeks) when compared to plating (94% and 15.8 weeks). A higher percentage of patients treated with IMN returned to preinjury activity when compared to those treated with plating (70.8% vs. 61.6%). CONCLUSIONS Both intramedullary nail and locked plate fixation offer unique benefits in terms of clinical and radiographic outcomes for treatment of periprosthetic distal femur fractures after total knee arthroplasty. While the standard of care remains controversial, an increase in the recent literature has allowed for better clarification of the significant clinicoradiologic advantages and disadvantages of both popular treatment options.
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Affiliation(s)
- Jay K Shah
- Division of Orthopedic Surgery, Department of Orthopedic Surgery, Jersey City Medical Center - RWJ Barnabas Health, Jersey City, NJ 07302, United States
| | - Patrick Szukics
- Division of Orthopedic Surgery, Rowan University School of Osteopathic Medicine, Stratford, NJ 08084, United States
| | - Arianna L Gianakos
- Division of Orthopedic Surgery, Department of Orthopedic Surgery, Jersey City Medical Center - RWJ Barnabas Health, Jersey City, NJ 07302, United States
| | - Frank A Liporace
- Division of Orthopedic Surgery, Department of Orthopedic Surgery, Jersey City Medical Center - RWJ Barnabas Health, Jersey City, NJ 07302, United States
| | - Richard S Yoon
- Division of Orthopedic Surgery, Department of Orthopedic Surgery, Jersey City Medical Center - RWJ Barnabas Health, Jersey City, NJ 07302, United States.
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Furuhata R, Takahashi M, Hayashi T, Inagawa M, Kono A, Matsumura N, Kamata Y, Arino H, Morioka H. Treatment of distal clavicle fractures using a Scorpion plate and influence of timing on surgical outcomes: a retrospective cohort study of 105 cases. BMC Musculoskelet Disord 2020; 21:146. [PMID: 32131803 PMCID: PMC7057610 DOI: 10.1186/s12891-020-3169-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 02/26/2020] [Indexed: 12/13/2022] Open
Abstract
Background Plate fixation is an established method for treating unstable distal clavicle fractures. However, the appropriate timing of surgery for acute distal clavicle fractures remains unclear. The present study aimed to evaluate the clinical outcomes of osteosynthesis using a Scorpion plate and to assess the influence of surgery timing on the surgical outcomes for acute unstable distal clavicle fractures. Methods We retrospectively reviewed 105 patients who underwent fixation for acute unstable distal clavicle fractures (Neer type II and V) using the Scorpion plate between 2008 and 2018. Patients were divided into early (45 patients) and delayed (60 patients) treatment groups based on the timing of the surgical intervention (within or after 7 days). The outcomes were postoperative complications (nonunion, peri-implant fracture, plate loosening, plate-related pain, and stiffness). We evaluated the outcomes from X-ray radiographs and clinical notes. Results Among the 105 patients, nonunion, plate loosening, plate-related pain, and stiffness were observed in six patients (5.7%), four patients (3.8%), seven patients (6.7%), and one patient (1.0%), respectively. The nonunion rate was significantly higher in the delayed treatment group than that in the early treatment group (P = 0.036). Although the difference was not significant, plate loosening and stiffness were only observed in the delayed treatment group. Conclusion Our results demonstrated that osteosynthesis using Scorpion plates achieved satisfactory surgical outcomes for unstable distal clavicle fractures. In addition, this study suggested that performing surgery within 6 days after injury is recommended to reduce postoperative complications.
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Affiliation(s)
- Ryogo Furuhata
- Department of Orthopaedic Surgery, National Hospital Organization Tokyo Medical Center, 2-5-1, Higashigaoka, Meguro-ku, Tokyo, 152-8902, Japan.
| | - Masaaki Takahashi
- Department of Orthopaedic Surgery, National Hospital Organization Tokyo Medical Center, 2-5-1, Higashigaoka, Meguro-ku, Tokyo, 152-8902, Japan
| | - Teppei Hayashi
- Department of Orthopaedic Surgery, National Hospital Organization Tokyo Medical Center, 2-5-1, Higashigaoka, Meguro-ku, Tokyo, 152-8902, Japan
| | - Miyu Inagawa
- Department of Orthopaedic Surgery, National Hospital Organization Tokyo Medical Center, 2-5-1, Higashigaoka, Meguro-ku, Tokyo, 152-8902, Japan
| | - Aki Kono
- Department of Orthopaedic Surgery, National Hospital Organization Tokyo Medical Center, 2-5-1, Higashigaoka, Meguro-ku, Tokyo, 152-8902, Japan
| | - Noboru Matsumura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Yusaku Kamata
- Department of Orthopaedic Surgery, National Hospital Organization Tokyo Medical Center, 2-5-1, Higashigaoka, Meguro-ku, Tokyo, 152-8902, Japan
| | - Hiroshi Arino
- Department of Orthopaedic Surgery, National Hospital Organization Tokyo Medical Center, 2-5-1, Higashigaoka, Meguro-ku, Tokyo, 152-8902, Japan
| | - Hideo Morioka
- Department of Orthopaedic Surgery, National Hospital Organization Tokyo Medical Center, 2-5-1, Higashigaoka, Meguro-ku, Tokyo, 152-8902, Japan
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Bourgeois M, Loisel F, Bertrand D, Nallet J, Gindraux F, Adam A, Lepage D, Sergent P, Leclerc G, Rondot T, Garbuio P, Obert L, Pluvy I. Management of forearm bone loss with induced membrane technique. Hand Surg Rehabil 2020; 39:171-177. [PMID: 32061857 DOI: 10.1016/j.hansur.2020.02.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 07/14/2019] [Revised: 02/05/2020] [Accepted: 02/06/2020] [Indexed: 12/15/2022]
Abstract
There are very few published studies describing the treatment of segmental bone defects of the forearm using the induced membrane technique. The objectives of this study were to evaluate the time to bone union, the function of the joints above and below the treated bone segment and the patients' quality of life over the long-term. We performed a retrospective study in all patients treated by the induced membrane for a forearm bone defect over at 13-year period. Demographics, bone union, complications, functional outcomes and occupational status were collected. Six patients were included: 2 posttraumatic injuries, 1 osteomyelitis, 1 septic arthritis, 1 aseptic nonunion, 1 tumor. The average defect length was 64mm (48-110). All defects were treated with internal fixation. Bone graft was harvested from the iliac crest in two patients, the femur (using the Reamer Irrigator Aspirator technique) in three patients and the radius in one patient. Five patients achieved bone union after a mean of 4months (3-6). Three complications were observed: 1 radioulnar instability, 1 infection of the fixation device, 1 abscess. At an average 8½ years' follow-up, the pain level on the VAS was 0.6 (0-3), the Mayo Elbow Performance Score was 98 (90-100), the Herzberg score was 108 (85.6-140) and the QuickDASH was 14.9 (2.7-35). All patients returned to work. Using the induced membrane technique avoids the complications associated with vascularized autograft and yields good functional outcome and quality of life.
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Affiliation(s)
- M Bourgeois
- Service de chirurgie orthopédique, traumatologique et plastique, CHRU de Besançon, boulevard Fleming, 25030 Besançon cedex, France.
| | - F Loisel
- Service de chirurgie orthopédique, traumatologique et plastique, CHRU de Besançon, boulevard Fleming, 25030 Besançon cedex, France; EA 4662 nanomédecine, imagerie, thérapeutique, UFR sciences & techniques, université de Franche-Comté, 16, route de Gray, 25030 Besançon cedex, France
| | - D Bertrand
- Service de chirurgie orthopédique, traumatologique et plastique, CHRU de Besançon, boulevard Fleming, 25030 Besançon cedex, France
| | - J Nallet
- Service de chirurgie orthopédique, traumatologique et plastique, CHRU de Besançon, boulevard Fleming, 25030 Besançon cedex, France
| | - F Gindraux
- Service de chirurgie orthopédique, traumatologique et plastique, CHRU de Besançon, boulevard Fleming, 25030 Besançon cedex, France; EA 4662 nanomédecine, imagerie, thérapeutique, UFR sciences & techniques, université de Franche-Comté, 16, route de Gray, 25030 Besançon cedex, France
| | - A Adam
- Service de chirurgie orthopédique, traumatologique et plastique, CHRU de Besançon, boulevard Fleming, 25030 Besançon cedex, France
| | - D Lepage
- Service de chirurgie orthopédique, traumatologique et plastique, CHRU de Besançon, boulevard Fleming, 25030 Besançon cedex, France; EA 4662 nanomédecine, imagerie, thérapeutique, UFR sciences & techniques, université de Franche-Comté, 16, route de Gray, 25030 Besançon cedex, France
| | - P Sergent
- Service de chirurgie orthopédique, traumatologique et plastique, CHRU de Besançon, boulevard Fleming, 25030 Besançon cedex, France
| | - G Leclerc
- Service de chirurgie orthopédique, traumatologique et plastique, CHRU de Besançon, boulevard Fleming, 25030 Besançon cedex, France
| | - T Rondot
- Service de chirurgie orthopédique, traumatologique et plastique, CHRU de Besançon, boulevard Fleming, 25030 Besançon cedex, France
| | - P Garbuio
- Service de chirurgie orthopédique, traumatologique et plastique, CHRU de Besançon, boulevard Fleming, 25030 Besançon cedex, France; EA 4662 nanomédecine, imagerie, thérapeutique, UFR sciences & techniques, université de Franche-Comté, 16, route de Gray, 25030 Besançon cedex, France
| | - L Obert
- Service de chirurgie orthopédique, traumatologique et plastique, CHRU de Besançon, boulevard Fleming, 25030 Besançon cedex, France; EA 4662 nanomédecine, imagerie, thérapeutique, UFR sciences & techniques, université de Franche-Comté, 16, route de Gray, 25030 Besançon cedex, France
| | - I Pluvy
- Service de chirurgie orthopédique, traumatologique et plastique, CHRU de Besançon, boulevard Fleming, 25030 Besançon cedex, France; EA 4662 nanomédecine, imagerie, thérapeutique, UFR sciences & techniques, université de Franche-Comté, 16, route de Gray, 25030 Besançon cedex, France
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Busel G, Barrick B, Auston D, Achor K, Watson D, Maxson B, Infante A, Sanders R, Mir HR. Patella fractures treated with cannulated lag screws and fiberwire® have a high union rate and low rate of implant removal. Injury 2020; 51:473-477. [PMID: 31679830 DOI: 10.1016/j.injury.2019.10.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 04/26/2019] [Revised: 09/20/2019] [Accepted: 10/01/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVES The purpose of this study is to report the results of open reduction internal fixation of patella fractures (OTA 34 A-C) using cannulated lag screws and FiberWire® (Arthrex, Naples, FL, USA) with regard to union and symptomatic implant removal. DESIGN Retrospective review of prospectively collected database. SETTING Urban Level 1 trauma center and Level 2 trauma center METHODS: All displaced intra-articular patella fractures (OTA 34 A-C) treated with ORIF by cannulated lag screws and FiberWire® tension band/cerclage between January 1, 2009 and August 1, 2018. Three hundred and eighty seven consecutive patients were identified. Fifty fractures were included in the final analysis. MAIN OUTCOME MEASUREMENT All patients were followed to clinical and radiographic union. Nonunion was defined as lack of clinical and radiographic union, fracture displacement, and/or return to OR for revision surgery. Rate of symptomatic implant removal was recorded. RESULTS Average age was 57.7 years (range 21-86). Average follow up was 20.6 months (range 6-98 months). Average time to clinical and radiographic union was 3.1 months (range 3-7 months). Four fractures were open. There was a 96% (48/50) rate of primary union, with one patients requiring revision surgery to achieve union, and one developing an asymptomatic radiographic nonunion. The rate of symptomatic implant removal was 8% (4/50). Only 1 of the 4 was operated for a prominent suture knot, and the remaining 3 were for prominent screw removal. Knee range of motion averaged 0.37° extension to 119° flexion (range, 0-150°). CONCLUSION Patella fractures can be treated with cannulated lag screws and FiberWire® with a high rate of primary union (96%) and a low rate of symptomatic implant removal (8%). The implant removal rate compares favorably with alternative constructs, with an equivalent rate of fracture union.
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Affiliation(s)
- Gennadiy Busel
- Health Partners, Minneapolis, MN, United States of America.
| | - Brett Barrick
- Saint Francis Health System, Tulsa, OK, United States of America
| | - Darryl Auston
- OrthoONE North Suburban Medical Center, Thornton, CO, United States of America
| | - Kyle Achor
- Florida Orthopaedic Institute, Tampa, FL, United States of America
| | - David Watson
- Florida Orthopaedic Institute, Tampa, FL, United States of America
| | - Ben Maxson
- Florida Orthopaedic Institute, Tampa, FL, United States of America
| | - Anthony Infante
- Florida Orthopaedic Institute, Tampa, FL, United States of America
| | - Roy Sanders
- Florida Orthopaedic Institute, Tampa, FL, United States of America
| | - Hassan R Mir
- Florida Orthopaedic Institute, Tampa, FL, United States of America
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Roy D, Ramski D, Malige A, Beck M, Jeffers K, Brogle P. Injury patterns and outcomes associated with fractures of the native distal femur in adults. Eur J Trauma Emerg Surg 2019; 47:1123-1128. [PMID: 31872341 DOI: 10.1007/s00068-019-01287-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 11/05/2019] [Accepted: 12/11/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE Previous studies on distal femur fractures had a high degree of inclusion criteria in their sample populations, some even including pre-existing implants. The authors look to define an injury pattern unique to fractures of the distal femur by detailing demographics, associated injuries, and outcomes. METHODS This retrospective chart review identified 171 patients who presented to our Level 1 academic trauma center with a distal femur fracture, of which 91 injuries met inclusion for final analysis. For each patient, demographics, fracture classification, associated injuries, hospital outcomes, union rate, and complication rate were recorded. These characteristics were compared in high-energy injury versus low-energy injuries. RESULTS Additional orthopedic injuries, most commonly an ipsilateral patella or tibia fracture (p = 0.02), were more likely to occur in patients who sustained high-energy injuries (86%, p = 0.0001). High-energy injuries resulted in more severe distal femur fracture types and significantly greater rate of open fractures (19.8% of all fractures, p = 0.0001). High-energy injuries were also associated with long operating room times during fixation (p < 0.001), estimated blood loss during surgery (p = 0.03), and hospital length of stay (p = 0.04). Finally, high-energy injuries were also associated with lower union rates (p = 0.036) and a higher rate of additional surgeries (p = 0.011). CONCLUSION Patients who sustain a distal femur fracture have a greater risk for additional fractures (particularly ipsilateral tibia and patella fractures), open injuries, and non-orthopedic traumatic injuries. These high-energy injuries are also associated with a more complicated clinical course and lower rate of union compared to low-energy injuries. LEVEL OF EVIDENCE Prognostic level III.
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Affiliation(s)
- David Roy
- Department of Orthopaedic Surgery, St. Luke's University Health Network, 801 Ostrum St, PPHP 2nd Floor, Bethlehem, PA, 18015, USA
| | - David Ramski
- Department of Orthopaedic Surgery, St. Luke's University Health Network, 801 Ostrum St, PPHP 2nd Floor, Bethlehem, PA, 18015, USA
| | - Ajith Malige
- Department of Orthopaedic Surgery, St. Luke's University Health Network, 801 Ostrum St, PPHP 2nd Floor, Bethlehem, PA, 18015, USA.
| | - Matthew Beck
- Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
| | - Kirk Jeffers
- Department of Orthopaedics, Louisiana State University, New Orleans, LA, USA
| | - Patrick Brogle
- Department of Orthopaedic Surgery, St. Luke's University Health Network, 801 Ostrum St, PPHP 2nd Floor, Bethlehem, PA, 18015, USA
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Oliver WM, Smith TJ, Nicholson JA, Molyneux SG, White TO, Clement ND, Duckworth AD. The Radiographic Union Score for HUmeral fractures (RUSHU) predicts humeral shaft nonunion. Bone Joint J 2019; 101-B:1300-1306. [PMID: 31564159 DOI: 10.1302/0301-620x.101b10.bjj-2019-0304.r1] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [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] [Indexed: 11/05/2022]
Abstract
AIMS The primary aim of this study was to develop a reliable, effective radiological score to assess the healing of humeral shaft fractures, the Radiographic Union Score for HUmeral fractures (RUSHU). The secondary aim was to assess whether the six-week RUSHU was predictive of nonunion at six months after the injury. PATIENTS AND METHODS Initially, 20 patients with radiographs six weeks following a humeral shaft fracture were selected at random from a trauma database and scored by three observers, based on the Radiographic Union Scale for Tibial fractures system. After refinement of the RUSHU criteria, a second group of 60 patients with radiographs six weeks after injury, 40 with fractures that united and 20 with fractures that developed nonunion, were scored by two blinded observers. RESULTS After refinement, the interobserver intraclass correlation coefficient (ICC) was 0.79 (95% confidence interval (CI) 0.67 to 0.87), indicating substantial agreement. At six weeks after injury, patients whose fractures united had a significantly higher median score than those who developed nonunion (10 vs 7; p < 0.001). A receiver operating characteristic curve determined that a RUSHU cut-off of < 8 was predictive of nonunion (area under the curve = 0.84, 95% CI 0.74 to 0.94). The sensitivity was 75% and specificity 80% with a positive predictive value (PPV) of 65% and a negative predictive value of 86%. Patients with a RUSHU < 8 (n = 23) were more likely to develop nonunion than those with a RUSHU ≥ 8 (n = 37, odds ratio 12.0, 95% CI 3.4 to 42.9). Based on a PPV of 65%, if all patients with a RUSHU < 8 underwent fixation, the number of procedures needed to avoid one nonunion would be 1.5. CONCLUSION The RUSHU is reliable and effective in identifying patients at risk of nonunion of a humeral shaft fracture at six weeks after injury. This tool requires external validation but could potentially reduce the morbidity associated with delayed treatment of an established nonunion. Cite this article: Bone Joint J 2019;101-B:1300-1306.
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Affiliation(s)
- William M Oliver
- Edinburgh Orthopaedic Trauma, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Thomas J Smith
- Edinburgh Orthopaedic Trauma, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Jamie A Nicholson
- Edinburgh Orthopaedic Trauma, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Sam G Molyneux
- Edinburgh Orthopaedic Trauma, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Tim O White
- Edinburgh Orthopaedic Trauma, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Nick D Clement
- Edinburgh Orthopaedic Trauma, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Andrew D Duckworth
- Edinburgh Orthopaedic Trauma, Royal Infirmary of Edinburgh, Edinburgh, UK
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Bologna MG, Claudio MG, Shields KJ, Katz C, Salopek T, Westrick ER. Dual plate fixation results in improved union rates in comminuted distal femur fractures compared to single plate fixation. J Orthop 2019; 18:76-79. [PMID: 32189888 DOI: 10.1016/j.jor.2019.09.022] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [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: 08/02/2019] [Accepted: 09/14/2019] [Indexed: 11/18/2022] Open
Abstract
Purpose The treatment of distal femur fractures with extensive metaphyseal comminution is frequently complicated by high rates of nonunion and varus collapse. Dual plating with lateral and medial locking plates for these types of fractures has shown promising results in the recent literature. We hypothesize that dual plating of comminuted distal femur fractures leads to higher union rates and lower revision rates compared to an isolated lateral locking plate. Methods A retrospective medical chart review between January 2015 and December 2017 was conducted. Inclusion criteria included patients 18 years of age and older who sustained a complex distal femur fracture (AO/OTA 33-C2/33-C3 or periprosthetic fracture with significant metaphyseal comminution) and at least 6 months of follow up. Patients with simple fracture patterns, alternative fixation methods, and inadequate follow up were excluded. All patients in the single plating group were treated with a lateral distal femoral locking plate using a lateral approach. In the patients treated with dual plating, an extensile parapatellar approach was utilized for fracture reduction and placement of an adjunctive medial plate. Demographic information, fracture types, injury severity score (ISS), medical comorbidities, type of surgical fixation, union rates, complications, knee range of motion, time to follow up, and need for revision surgery were extrapolated from the medical charts for analysis. Results Twenty-one patients were included in the study. Thirteen patients underwent single plate fixation and 8 underwent dual plate fixation. There were no significant differences in demographics, number of co-morbidities, fracture classification, or ISS between single and dual plate groups (p > 0.05 for all). There was a statistically significant difference in union rates between the single plate group (6 nonunions, 4 unions, and 3 delayed unions) and the dual plate group, with no nonunions or delayed unions (p = 0.0049). Although not statistically significant, 4 patients treated with single plating underwent revision ORIF, compared to none in the dual plating group (p = 0.13). There were no significant differences in time to follow up, time to full weight bearing, or infection rates (p > 0.1 for all). Conclusion Based on these results, the medial and lateral locked plating technique demonstrates a higher union rate, with possible lower rates of revision surgery, compared to a single lateral plate in highly comminuted distal femur fractures. Level of evidence Level 3. Retrospective Cohort Study.
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Affiliation(s)
| | | | - Kelly J Shields
- Allegheny General Hospital, 320 East North Avenue, Pittsburgh, PA, 15212, USA
| | - Curren Katz
- Allegheny General Hospital, 320 East North Avenue, Pittsburgh, PA, 15212, USA
| | - Traci Salopek
- Allegheny General Hospital, 320 East North Avenue, Pittsburgh, PA, 15212, USA
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Krijgh DD, Teunis T, Schellekens PPA, Mureau MAM, Luijsterburg AJM, Tempelman TMT, van der Beek ESJ, Maarse W, Coert JH. Is dangling of the lower leg after a free flap reconstruction necessary? Study protocol for a large multicenter randomized controlled study. Trials 2019; 20:558. [PMID: 31511052 PMCID: PMC6737658 DOI: 10.1186/s13063-019-3665-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 08/19/2019] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Within the field of plastic surgery, free tissue transfer is common practice for knee and lower leg defects. Usually, after such free flap reconstruction, patients undergo a dangling protocol in the postoperative phase. A dangling protocol is designed to gradually subject the free flap to increased venous pressure resulting from gravitational forces. Worldwide there are multiple variations of dangling protocols. However, there is no evidence available in the literature that supports the use of a dangling protocol. METHODS This is a multicenter randomized controlled trial that includes patients with a free flap lower leg reconstruction. The primary outcome is to assess whether a no-dangling protocol is not inferior to a dangling protocol, in terms of proportion of partial flap loss, 6 months after surgery. Secondary objectives are to identify differences in major and minor complications, length of stay, and costs, and to objectify blood gaseous changes during dangling. Furthermore, at 2 years we will assess difference in physical function, infection rates, and osseous union rates. DISCUSSION The primary outcome of this study will give a more decisive answer to the question of whether a dangling protocol is necessary after a free flap reconstruction of the lower leg. The secondary outcomes of this study will provide a better insight into the physical functions, infection rates, and union rates in these patients. TRIAL REGISTRATION Central Committee on Research Involving Human Subjects (CCMO), NL63146.041.17. Registered on 11 July 2018. Netherlands Trial Register, NTR7545 . Registered on 10 October 2018.
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Affiliation(s)
- David D. Krijgh
- Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA Utrecht, Postbus 85500, the Netherlands
| | - Teun Teunis
- Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA Utrecht, Postbus 85500, the Netherlands
| | - Pascal P. A. Schellekens
- Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA Utrecht, Postbus 85500, the Netherlands
| | - Marc A. M. Mureau
- Department of Plastic and Reconstructive Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Antonius J. M. Luijsterburg
- Department of Plastic and Reconstructive Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Tallechien M. T. Tempelman
- Department of Plastic and Reconstructive Surgery, University Medical Center Groningen, Groningen, the Netherlands
| | - Eva S. J. van der Beek
- Department of Plastic and Reconstructive Surgery, University Medical Center Groningen, Groningen, the Netherlands
| | - Wiesje Maarse
- Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA Utrecht, Postbus 85500, the Netherlands
| | - J. Henk Coert
- Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA Utrecht, Postbus 85500, the Netherlands
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Fucentese SF, Tscholl PM, Sutter R, Brucker PU, Meyer DC, Koch PP. Bone autografting in medial open wedge high tibial osteotomy results in improved osseous gap healing on computed tomography, but no functional advantage: a prospective, randomised, controlled trial. Knee Surg Sports Traumatol Arthrosc 2019; 27:2951-2957. [PMID: 30456568 DOI: 10.1007/s00167-018-5285-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [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: 12/29/2017] [Accepted: 11/07/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE Medial open wedge high tibial osteotomy (owHTO) is a valuable surgical technique used to manage medial degeneration in varus knees. Iliac crest autograft is considered the gold standard gap-filler. It was hypothesised that iliac crest autograft promotes gap healing and improves functional outcome in owHTO. METHODS Between 2005 and 2009, patients scheduled to undergo owHTO stabilised by a medial locking compression plate were randomised to undergo owHTO either with iliac crest autograft (group A) or without bone void filler (group B). Pre- and postoperative leg axes were recorded. At 3 and 12 months postoperatively, the healing of the osteotomy gap was measured as a percentage on CT images, and functional scores were recorded. RESULTS There were 15 patients in group A, and 25 in group B. The groups were similar in age, sex ratio, knee varus deformity, body mass index, and smoking status. Group A and B had similar preoperative varus (6.9° vs. 7.6°) and postoperative valgus (2.2° vs. 3.0°). Compared with the control group, group A had a significantly greater degree of osseous gap healing after 3 months (40.1% vs. 10.8%, p = 0.045) and 12 months (91.5% vs. 59.1%, p ≤ 0.001). Multiple linear regression analysis found that bone grafting was an independent promoting factor for gap healing, while increased preoperative varus was an independent retardant factor at 3 months (p = 0.004 and p = 0.002, respectively) and 12 months (p ≤ 0.001 and p = 0.003, respectively). Younger age was a promoting factor for gap healing on CT at 3 months (p ≤ 0.001), but not at 12 months. No correlations were found between bone healing and functional outcome, body mass index, or smoking status. CONCLUSIONS Iliac crest autograft significantly increases healing of the osteotomy gap after owHTO. Increased preoperative varus and older patient age are independent factors that delay early healing of the osteotomy. However, no functional advantage was found at 3 or 12 months postoperatively. Therefore, routine use of iliac crest autograft cannot be recommended. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Sandro F Fucentese
- Department of Orthopaedic Surgery, Balgrist University Hospital, University of Zurich, Forchstr. 340, 8008, Zurich, Switzerland.
| | - Philippe M Tscholl
- Department of Orthopaedic Surgery, Balgrist University Hospital, University of Zurich, Forchstr. 340, 8008, Zurich, Switzerland
| | - Reto Sutter
- Department of Radiology, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Peter U Brucker
- Department of Orthopaedic Surgery, Balgrist University Hospital, University of Zurich, Forchstr. 340, 8008, Zurich, Switzerland
| | - Dominik C Meyer
- Department of Orthopaedic Surgery, Balgrist University Hospital, University of Zurich, Forchstr. 340, 8008, Zurich, Switzerland
| | - Peter P Koch
- Department of Orthopaedic Surgery, Balgrist University Hospital, University of Zurich, Forchstr. 340, 8008, Zurich, Switzerland
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Jennison T, Yarlagadda R. Outcome of surgical treatment of inter prosthetic fractures: A case series. Orthop Traumatol Surg Res 2019; 105:587-589. [PMID: 30745036 DOI: 10.1016/j.otsr.2018.08.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 06/06/2018] [Revised: 08/20/2018] [Accepted: 08/31/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Interprosthetic fractures occur between a total knee replacement and a femoral stem of either a hemiarthroplasty or total hip replacement. The number of interprosthetic fractures will increase as the number of joint replacements rises. There is currently a paucity of literature looking at the outcomes of interprosthetic fractures. Therefore, we performed a retrospective study to: (1) determine fracture union in patients following surgical treatment of a femoral interprosthetic fracture, (2) measure outcomes included mortality and complications. HYPOTHESIS Favoring bone fixation instead of prosthetic revision gives an acceptable rate of reoperation. MATERIALS AND METHODS A retrospective case note review of all interprosthetic femoral fractures admitted to a tertiary trauma centre over a 7-year period. There were 24 patients (4 males and 20 females) with a mean age of 82.3 (65-98). The initial operative procedure was a total hip replacement (THR) and a total knee replacement (TKR) in 19 patients, one THR and revision TKR, four hip hemiarthroplasty and TKR. There were 23 cemented femoral stems, and 1 uncemented femoral stem. The median time to surgery was 84hours. The median length of hospital stay was 16 days. Nineteen patients underwent open reduction internal fixation and 1 of these used a strut graft. Two patients underwent revision knee replacements and 3 underwent a revision hip replacement. All patients had at least 2 years clinical follow-up. RESULTS One patient died within 30 days of fracture, leaving 23 patients to assess bone union. Another patient died within 1 year of fracture. Three out of 24 patients (12.5%) suffered a complication that required further surgery. The fracture united in 19/23 (82.6%) of patients and the 2-year mortality rate was 5/24 (20.8%). DISCUSSION Interprosthetic fractures are complex fractures occurring in elderly patients with multiple medical comorbidities. Whenever possible bone fixation instead of prostehtic revision give a low rate of complication and reoperation. The surgical treatments are complex, but with a well-performed surgical technique and an adequate rehabilitation program can result in satisfactory outcomes. LEVEL OF EVIDENCE IV, retrospective case series.
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Affiliation(s)
- Toby Jennison
- Plymouth Hospitals NHS Trust, Derriford Road, Crownhill, Plymouth, Devon PL6 8DH, United Kingdom.
| | - Rathan Yarlagadda
- Plymouth Hospitals NHS Trust, Derriford Road, Crownhill, Plymouth, Devon PL6 8DH, United Kingdom
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Dilogo IH, Phedy P, Kholinne E, Djaja YP, Fiolin J, Kusnadi Y, Yulisa ND. Autologous mesenchymal stem cell implantation, hydroxyapatite, bone morphogenetic protein-2, and internal fixation for treating critical-sized defects: a translational study. Int Orthop 2019; 43:1509-1519. [PMID: 30747273 PMCID: PMC6525135 DOI: 10.1007/s00264-019-04307-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 01/27/2019] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Critical-sized defect (CSD) is one of the most challenging cases for orthopaedic surgeons. We aim to explore the therapeutic potential of the combination of bone marrow-derived mesenchymal stem cells (BM-MSCs), hydroxyapatite (HA) granules, bone morphogenetic protein-2 (BMP-2), and internal fixation for treating CSDs. METHODS This was a translational study performed during the period of January 2012 to 2016. Subjects were patients diagnosed with CSDs who had previously failed surgical attempts. They were treated with the combination of autologous BM-MSCs, HA granules, BMP-2, and mechanical stabilization. Post-operative pain level, functional outcome, defect volume, and radiological healing were evaluated after a minimum follow-up of 12 months. RESULTS A total of six subjects were recruited in this study. The pain was significantly reduced in all cases; with the decrease of mean preoperative visual analog scale (VAS) from 4 ± 2.2 to 0 after six month follow-up. Clinical functional outcome percentage increased significantly from 25 ± 13.7 to 70.79 ± 19.5. Radiological healing assessment using Tiedemann score also showed an increase from 0.16 ± 0.4 to 8 ± 3 at one year follow-up. No immunologic nor neoplastic side effects were found. CONCLUSIONS The combination of autologous BM-MSCs, HA granules, and BMP-2 is safe and remains to be a good option for the definitive treatment for CSD with previous failed surgical attempts. Further studies with a larger sample size are required to be done.
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Affiliation(s)
- Ismail Hadisoebroto Dilogo
- Department of Orthopaedics and Traumatology, Cipto Mangunkusumo Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia.
- Stem Cells Medical Technology Integrated Service Unit, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.
- Stem Cells and Tissue Engineering Research Cluster, Indonesian Medical Education and Research Institute (IMERI), Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia.
| | - Phedy Phedy
- Department of Orthopaedics and Traumatology, Fatmawati General Hospital, Jakarta, Indonesia
| | - Erica Kholinne
- Department of Orthopaedics and Traumatology, St. Carolus Hospital, Jakarta, Indonesia
| | - Yoshi Pratama Djaja
- Department of Orthopaedics and Traumatology, Fatmawati General Hospital, Jakarta, Indonesia
| | - Jessica Fiolin
- Department of Orthopaedics and Traumatology, Cipto Mangunkusumo Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Yuyus Kusnadi
- Laboratory of Regenerative and Cellular Therapy (ReGeniC), Bifarma Adiluhung Ltd., Jakarta, Indonesia
| | - Nyimas Diana Yulisa
- Department of Radiology, Cipto Mangunkusumo Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
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SahraNavard B, Hudson PW, de Cesar Netto C, Wills BW, Araoye IB, Bergstresser S, Cone BM, Shah A. A comparison of union rates and complications between single screw and double screw fixation of sliding calcaneal osteotomy. Foot Ankle Surg 2019; 25:84-89. [PMID: 29409301 DOI: 10.1016/j.fas.2017.08.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 04/24/2017] [Revised: 08/03/2017] [Accepted: 08/28/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND The number of screws used for sliding calcaneal osteotomy fixation has not been examined in the literature. The purpose of this paper is to examine this topic. METHODS Retrospective chart review was performed on 190 patients who met selection criteria. We compared complication risk for single versus double screw, headed versus headless screw, and short versus longitudinal incision cases. RESULTS The mean age was 48.4 (18-83) years and average follow up was 28 (12-150) weeks. All cases achieved radiographic union. Overall complication rate was 19.5% (37/190). Risk of complication did not differ significantly between single and double screw (RR: 1.170; 95% CI: 0.66-2.09; p=0.594) or short and extended incision groups (RR: 0.868; 95% CI: 0.42-1.80; p=0.704). Risk of complication differed significantly between headed and headless screw fixation (RR: 5.558; 95% CI: 2.69-11.50; p<0.0001). CONCLUSIONS Single screw fixation of sliding calcaneal osteotomy achieves similar outcomes as double screw fixation. Headless screws are advantageous for minimizing hardware pain and subsequent hardware removal.
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Affiliation(s)
- Bahman SahraNavard
- University of Alabama at Birmingham, 1313 13th Street South, Birmingham, AL 35205, USA.
| | - Parke W Hudson
- University of Alabama at Birmingham, 1313 13th Street South, Birmingham, AL 35205, USA.
| | - Cesar de Cesar Netto
- University of Alabama at Birmingham, 1313 13th Street South, Birmingham, AL 35205, USA.
| | - Bradley W Wills
- University of Alabama at Birmingham, 1313 13th Street South, Birmingham, AL 35205, USA.
| | - Ibukunoluwa B Araoye
- University of Alabama at Birmingham, 1313 13th Street South, Birmingham, AL 35205, USA.
| | - Shelby Bergstresser
- University of Alabama at Birmingham, 1313 13th Street South, Birmingham, AL 35205, USA.
| | - Brent M Cone
- University of Alabama at Birmingham, 1313 13th Street South, Birmingham, AL 35205, USA.
| | - Ashish Shah
- University of Alabama at Birmingham, 1313 13th Street South, Birmingham, AL 35205, USA.
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Alzahrani MM, Cota A, Alkhelaifi K, Aleidan A, Berry G, Reindl R, Harvey E. Are clinical outcomes affected by type of plate used for management of mid-shaft clavicle fractures? J Orthop Traumatol 2018; 19:8. [PMID: 30112628 PMCID: PMC6093820 DOI: 10.1186/s10195-018-0492-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 08/05/2016] [Accepted: 12/14/2017] [Indexed: 11/10/2022] Open
Abstract
Background Open reduction and internal fixation (ORIF) using plate osteosynthesis for midshaft clavicle fractures is often complicated by the prominence of the implant due to the subcutaneous position of the clavicle. Reoperation rates for symptomatic clavicle plate removal have been reported to be as high as 53%. We sought to determine to which degree do clinical outcomes (all cause reoperation rate and rate of fracture union) differ between types of clavicle plates. Materials and methods A retrospective chart review was performed using our hospital database for patients treated with ORIF for mid-shaft clavicle fractures (OTA/AO type 15-B). Implants included in this review were 2.7 mm reconstruction plates, 3.5 mm reconstruction plates, 3.5 mm precontoured clavicle plates and 3.5 mm locking compression plates. The primary outcome measure was the all cause reoperation rate. Secondary outcomes compared the rate fracture union, documented infection, hardware failures and clinical symptoms at the surgical site among the various plate types. Data was collected and descriptive statistics were analyzed. p values < 0.05 were considered statistically significant. Results A total of 102 midshaft clavicle fractures treated with ORIF were included in this study. The majority of patients were ≤ 50 years old (83.3%) and male (72.5%). The overall union rate for all plating constructs was 97.1%. We found that age, sex and smoking were not associated with the rate of re-operation. In addition, the fracture classification, type of implant used and number of screws used didn’t increase the risk of revision surgery. In addition, more than 50% of patients complaining of pain at 6 weeks post-operatively required a second surgery for removal of hardware. Moreover, there was no association between age, sex, smoking, fracture classification or plate type and the rate of union. Interestingly, clavicle fractures fixed with 3.5 mm reconstruction plates were more likely to have hardware failure due to plastic deformation, whereas 2.7 mm plates were more likely to fail by plate breakage. Conclusion Although different types of implants have different biomechanical properties, no difference in reoperation, union and plate removal rates were found between the various plate types. Future studies with a larger sample size are required to further examine these outcomes. Level of evidence Level III.
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Affiliation(s)
- Mohammad M Alzahrani
- Division of Orthopaedic Surgery, McGill University, 1650 Cedar Ave, Montreal, QC, H3G 1A4, Canada. .,Department of Orthopaedic Surgery, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
| | - Adam Cota
- Rocky Mountain Orthopaedic Associates, Grand Junction, CO, USA
| | - Khalid Alkhelaifi
- Division of Orthopaedic Surgery, McGill University, 1650 Cedar Ave, Montreal, QC, H3G 1A4, Canada.,Department of Orthopedic Surgery, ASPETAR, Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Aljarrah Aleidan
- Division of Orthopaedic Trauma, Department of Orthopaedic Surgery, Al-Razi Orthopaedic Hospital, Kuwait City, Kuwait
| | - Gregory Berry
- Division of Orthopaedic Surgery, McGill University, 1650 Cedar Ave, Montreal, QC, H3G 1A4, Canada
| | - Rudy Reindl
- Division of Orthopaedic Surgery, McGill University, 1650 Cedar Ave, Montreal, QC, H3G 1A4, Canada
| | - Edward Harvey
- Division of Orthopaedic Surgery, McGill University, 1650 Cedar Ave, Montreal, QC, H3G 1A4, Canada
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Noblet TM, Jackson PC, Foster P, Taylor DM, Harwood PJ, Wiper JD. Managing soft tissues in severe lower limb trauma in an ageing population. Injury 2018; 49:1197-1202. [PMID: 29588023 DOI: 10.1016/j.injury.2018.03.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 12/07/2017] [Revised: 02/22/2018] [Accepted: 03/07/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE With an ageing population, the incidence of trauma in those aged over 65 years is increasing. Strategies for dealing with these patients must be developed. At present the standard management of open tibial fractures in the UK is described by the BOAST4 guidelines (from the British Orthopaedic Association and British Association of Plastic & Aesthetic Surgeons). It is not clear to what extent these are appropriate for older patients. We describe our experience of managing elderly patients presenting with open tibial fractures. METHOD Patients were identified via prospectively collected national and departmental databases. These data were supplemented by review of the patient records and radiographs. Data collated included patient demographics, injury details, orthopaedic and plastic surgery operative details, and long-term outcomes. RESULTS Between January 2013 and June 2016, 74 patients aged over 65 years were admitted with open lower limb fractures. 54 of these were open tibial fractures and these patients formed the study group. 19 patients required soft-tissue reconstruction for Gustilo and Anderson IIIB tibial fractures (age range, 67-95 years). In these patients, there were 7 midshaft (AO 42), 1 proximal (AO 41), and 11 distal (AO 43) fractures. 13 patients were treated with internal fixation and 6 with circular frames. The median length of hospital stay was 27 days (range, 4-85). 14 patients received loco-regional flaps and 5 underwent free tissue transfer with one requiring preoperative femoral angioplasty. There were no flap losses. Four patients had fasciocutaneous flaps, 3 tibialis anterior transposition, 2 an extensor digitorum brevis flap, 1 a hemisoleus flap, and 4 were skin grafted. All patients went on to unite and return to their premorbid weight-bearing status (4 using walking frames, 3 using sticks, and 12 walking independently). CONCLUSION Although the literature suggests a significantly higher complication rate in elderly patients with open fractures, we have demonstrated comparable rates of flap survival and bony union to those observed in younger patients. Challenges are presented in terms of patient physiology and these must be carefully managed pre- and postoperatively. These challenges are reflected in prolonged hospital stays.
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Affiliation(s)
- Timothy M Noblet
- Limb Reconstruction Unit, Leeds General Infirmary, Leeds, West Yorkshire, United Kingdom.
| | - Philippa C Jackson
- Limb Reconstruction Unit, Leeds General Infirmary, Leeds, West Yorkshire, United Kingdom
| | - Patrick Foster
- Limb Reconstruction Unit, Leeds General Infirmary, Leeds, West Yorkshire, United Kingdom
| | - David Martin Taylor
- Limb Reconstruction Unit, Leeds General Infirmary, Leeds, West Yorkshire, United Kingdom
| | - Paul J Harwood
- Limb Reconstruction Unit, Leeds General Infirmary, Leeds, West Yorkshire, United Kingdom
| | - Jay D Wiper
- Limb Reconstruction Unit, Leeds General Infirmary, Leeds, West Yorkshire, United Kingdom
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Sharma DK, Kumar N, lal H, Sahu BK, Saikia SS. Osteochondritis dissecans-Does platelet rich plasma really help. J Clin Orthop Trauma 2018; 9:153-156. [PMID: 29896019 PMCID: PMC5995159 DOI: 10.1016/j.jcot.2017.09.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 07/04/2017] [Revised: 09/25/2017] [Accepted: 09/28/2017] [Indexed: 12/30/2022] Open
Abstract
Osteochondritis dissecans is a common disorder of knee and can be treated by various methods, depending on age of patient and stability of chondral fragment. In Osteochondritis dissecans ICRS type III lesion i.e. articular cartilage discontinuity but no dislocation, variable rate of union as well as high rate of non-union was observed in previous studies when treated with arthroscopic or open reduction and fixation. In previous study it has been also shown that platelet rich plasma help in fracture healing. In this study we are trying to extend the benefit of platelet rich plasma to Osteochondritis dissecans lesion. We took six patients with OCD, ICRS scale of OCD type III lesion. All Patients were operated Arthroscopiclly. Chondral flap of OCD lesion were fixed with stainless steel cannulated cancellous screw. To enhance union we used platelet rich plasma injections. .We access the union of chondral fragment to parent bone and knee function. Chondral fragment united to parent bone in all patients. To access knee function we used Tagner- Lysholm knee scoring system, in this study preoperatively score was 52.8 where as postoperatively it was 91.8. This study showed PRP is helpful in healing of chondral flap as all the chondral flap of osteochondral lesion united in this study.
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Affiliation(s)
- Deepak Kumar Sharma
- Corresponding author at: 49 Lucky Home Apartment, setor 13, Rohini, Delhi 110085, India.
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Abstract
There are times when clinical examinations, radiographs, and computed tomography scans do not provide sufficient information to know whether a scaphoid fracture or scaphoid bone graft has united, partially united, or not united. When this problem arises, arthroscopic examination of the scaphoid fracture or scaphoid bone graft provides additional information to solve the problem and plan further management in an evidence-based manner. The indications for the use of arthroscopy and surgical technique are described.
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Affiliation(s)
- Jeff Ecker
- Western Orthopaedic Clinic, Perth, Western Australia, Australia; Hand and Upper Limb Centre, Perth, Western Australia, Australia; Curtin University of Technology, Perth, Western Australia, Australia.
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