Aims. Joint registries classify all further arthroplasty procedures to a knee with an existing partial arthroplasty as revision surgery, regardless of the actual procedure performed. Relatively minor procedures, including bearing exchanges, are classified in the same way as major operations requiring augments and stems. A new classification system is proposed to acknowledge and describe the detail of these procedures, which has implications for risk, recovery, and health economics. Methods. Classification categories were proposed by a surgical consensus group, then ranked by patients, according to perceived invasiveness and implications for recovery. In round one, 26 revision cases were classified by the consensus group. Results were tested for inter-rater reliability. In round two, four additional cases were added for clarity. Round three repeated the survey one month later, subject to inter- and intrarater reliability testing. In round four, five additional expert partial knee arthroplasty surgeons were asked to classify the 30 cases according to the proposed revision partial knee classification (RPKC) system. Results. Four classes were proposed: PR1, where no bone-implant interfaces are affected; PR2, where surgery does not include conversion to total knee arthroplasty, for example, a second partial arthroplasty to a native compartment; PR3, when a standard primary total knee prosthesis is used; and PR4 when revision components are necessary. Round one resulted in 92% inter-rater agreement (Kendall’s W 0.97; p < 0.005), rising to 93% in round two (Kendall’s W 0.98; p < 0.001). Round three demonstrated 97% agreement (Kendall’s W 0.98; p < 0.001), with high intra-rater reliability (interclass correlation coefficient (ICC) 0.99; 95% confidence interval 0.98 to 0.99). Round four resulted in 80% agreement (Kendall’s W 0.92; p < 0.001). Conclusion. The RPKC system accounts for all procedures which may be appropriate following partial knee arthroplasty. It has been shown to be reliable, repeatable and pragmatic. The implications for patient care and health economics are discussed. Cite this article: Bone Jt Open 2021;2(8):638–645

Aim. Our collaborative study aims to demonstrate that acute partial Achilles Tendon Tears (ATTs) are not separate diagnostic entities from full ATTs. and should be thought of as a continuum rather than binary partial or full. Methods. We pooled anonymised data from four hospitals, identifying patients with acute partial ATTs on USS reports from 2019–2021. Patients were only included if they had an acute injury and no previous background Achilles tendinopathy. Results. 91 patients had acute partial ATTs reported on USS. 74/91 (81%) of patients had clinical findings in keeping with a full ATT (positive Simmonds test, palpable gap). 88/91 (97%) of patients were managed according to local full ATT protocols. 2 patients had MRIs – one showed no tear, the other showed a full rupture. 2 patients underwent surgical repair and both intra-operatively were found to have full ATTs. Conclusion. Our regional data suggests that a significant proportion (81%) of USS diagnosed partial ATTs may in fact be misdiagnosed full ATTs. All injuries clinically suspicious for an ATT should be managed according to local Achilles Protocol. USS is useful to diagnose the presence or absence of a tear but is not good at differentiating partial vs full tear. There is significant tendon end fibrillation and overlap on USS of an acute full ATT, which can give the impression of a partial ATT. More research is needed into whether any threshold exists to support the current distinction of “partial” and “full” as relates to management and outcomes

Combined Partial Knee Arthroplasty (CPKA) is a promising alternative to Total Knee Arthroplasty (TKA) for the treatment of multi-compartment arthrosis. Through the simultaneous or staged implantation of multiple Partial Knee Arthroplasties (PKAs), CPKA aims to restore near-normal function of the knee, through retention of the anterior cruciate ligament and native disease-free compartment. Whilst PKA is well established, CPKA is comparatively novel and associated biomechanics are less well understood. Clinically, PKA and CPKA have been shown to better restore knee function compared to TKA, particularly during fast walking. The biomechanical explanation for this superiority remains unclear but may be due to better preservation of the extensor mechanism. This study sought to assess and compare extensor function after PKA, CPKA, and TKA. An instrumented knee extension rig facilitated the measurement extension moment of twenty-four cadaveric knees, which were measured in the native state and then following a sequence of arthroplasty procedures. Eight knees underwent medial Unicompartmental Knee Arthroplasty (UKA-M), followed by patellofemoral arthroplasty (PFA) thereby converting to medial Bicompartmental Knee Arthroplasty (BCA-M). In the final round of testing the PKA implants were removed a posterior-cruciate retaining TKA was implanted. The second eight received lateral equivalents (UKA-L then BCA-L) then TKA. The final eight underwent simultaneous Bi-Unicondylar Arthroplasty (Bi-UKA) before TKA. Extensor efficiencies over extension ranges typical of daily tasks were also calculated and differences between arthroplasties were assessed using repeated measures analysis of variance. For both the medial and lateral groups, UKA demonstrated the same extensor function as the native knee. BCA resulted in a small reduction in extensor moment between 70–90° flexion but, in the context of daily activity, extensor efficiency was largely unaffected and no significant reductions were found. TKA, however, resulted in significantly reduced extensor moments, leading to efficiency deficits ranging from 8% to 43% in flexion ranges associated with downhill walking and the stance phase of gait, respectively. Comparing the arthroplasties: TKA was significantly less efficient than both UKA-M and BCA-M over ranges representing stair ascent and gait; TKA showed a significant 23% reduction compared to BCA-L in the same range. There were no differences in efficiency between the UKAs and BCAs over any flexion range and TKA efficiency was consistently lower than all other arthroplasties. Bi-UKA generated the same extensor moment as native knee at flexion angles typical of fast gait (0–30°). Again, TKA displayed significantly reduced extensor moments towards full extension but returned to the normal range in deep flexion. Overall, TKA was significantly less efficient following TKA than Bi-UKA. Recipients of PKA and CPKA have superior functional outcomes compared to TKA, particularly in relation to fast walking. This in vitro study found that both UKA and CPKA better preserve extensor function compared to TKA, especially when evaluated in the context of daily functional tasks. TKA reduced knee extensor efficiency by over 40% at flexion angles associated with gait, arguably the most important activity to maintain patient satisfaction. These findings go some way to explaining functional deficiencies of TKA compared to CPKA observed clinically

Aims. There is ambiguity surrounding the degree of scaphoid union required to safely allow mobilization following scaphoid waist fracture. Premature mobilization could lead to refracture, but late mobilization may cause stiffness and delay return to normal function. This study aims to explore the risk of refracture at different stages of scaphoid waist fracture union in three common fracture patterns, using a novel finite element method. Methods. The most common anatomical variant of the scaphoid was modelled from a CT scan of a healthy hand and wrist using 3D Slicer freeware. This model was uploaded into COMSOL Multiphysics software to enable the application of physiological enhancements. Three common waist fracture patterns were produced following the Russe classification. Each fracture had differing stages of healing, ranging from 10% to 90% partial union, with increments of 10% union assessed. A physiological force of 100 N acting on the distal pole was applied, with the risk of refracture assessed using the Von Mises stress. Results. Overall, 90% to 30% fracture unions demonstrated a small, gradual increase in the Von Mises stress of all fracture patterns (16.0 MPa to 240.5 MPa). All fracture patterns showed a greater increase in Von Mises stress from 30% to 10% partial union (680.8 MPa to 6,288.6 MPa). Conclusion. Previous studies have suggested 25%, 50%, and 75% partial union as sufficient for resuming hand and wrist mobilization. This study shows that 30% union is sufficient to return to normal hand and wrist function in all three fracture patterns. Both 50% and 75% union are unnecessary and increase the risk of post-fracture stiffness. This study has also demonstrated the feasibility of finite element analysis (FEA) in scaphoid waist fracture research. FEA is a sustainable method which does not require the use of finite scaphoid cadavers, hence increasing accessibility into future scaphoid waist fracture-related research. Cite this article: Bone Jt Open 2023;4(8):612–620

A larger radial tuberosity, and therefore a smaller radioulnar space, may cause mechanical impingement of the DBT predisposing to tear. We sought to investigate anatomic factors associated with partial DBT tears by retrospectively reviewing 3-T MRI scans of elbows with partial DBT tears and a normal elbow comparison group. 3-T MRI scans of elbows with partial DBT tears and elbows with no known pathology were reviewed retrospectively by two independent observers. Basic demographic data were collected and measurements of radial tuberosity length, radial tuberosity thickness, radio-ulnar space, and radial tuberosity-ulnar space were made using simultaneous tracker lines and a standardised technique. The presence or absence of enthesophytes and the presence of a single or double DBT were noted. 26 3-T MRI scans of 26 elbows with partial DBT tears and 30 3-T MRI scans of 30 elbows without pathology were included. Basic demographic data was comparable between the two groups. The tear group showed statistically significant larger mean measurements for radial tuberosity length (24.3mm vs 21.3mm, p=0.002), and radial tuberosity thickness (5.5mm vs 3.7mm, p=<0.0001. The tear group also showed statistically significant smaller measurements for radio-ulnar space (8.2mm vs 10.0mm, p=0.010), and radial tuberosity-ulnar space (7.2mm vs 9.1mm, p=0.013). There was a statistically significant positive correlation between partial DBT tears and presence of enthesophytes (p=0.007) as well as between partial DBT tears and having two discrete DBTs rather than a single or interdigitating tendon (p=<0.0001). Larger radial tuberosities, and smaller radio-ulnar and radial tuberosity-ulnar spaces are associated with partial DBT tears. This may be due to chronic impingement, tendon delamination and consequent weakness which ultimately leads to tears. Enthesophytes may be associated with tears for the same reason. Having two discrete DBTs that do not interdigitate prior to insertion is also associated with partial tears

Partial thickness abductor tendon tears are a significant source of recalcitrant laterally based hip pain. For those that fail conservative treatment, the results of endoscopic repair are highly successful with minimal morbidity. The principal burden is the protracted rehabilitation that is necessary as part of the recovery process. There is a wide gap between failed conservative treatment and successful surgical repair. It is hypothesized that a non-repair surgical strategy, such as a bioinducitve patch, could significantly reduce the burden associated recovery from a formal repair. Thus, the purpose of this study is to report the preliminary results of this treatment strategy. Symptomatic partial thickness abductor tendon tears are treated conservatively, including activity modification, supervised physical therapy and ultrasound guided corticosteroid injections. Beginning in January 2022, patients undergoing hip arthroscopy for intraarticular pathology who also had persistently symptomatic partial thickness abductor tendon tears, were treated with adjunct placement of a bioinducitve (Regeneten) patch over the tendon lesion from the peritrochanteric space. The postop rehab protocol is dictated by the intraarticular procedure performed. All patients are prospectively assessed with a modified Harris Hip Score (mHHS) and iHOT and the tendon healing response examined by ultrasound. Early outcomes will be presented on nine consecutive cases. Conclusions - Will be summarized based on the preliminary outcomes to be reported

Chronic Achilles tendinopathy is characterised by sub-acute inflammation with pro-inflammatory type 1 macrophages (M1), tissue degeneration and consequent partial or total tendon injury. Control of the inflammatory response and M1-to-M2 macrophage polarisation can favour tendon healing both directly and indirectly, by allowing for the regenerative process driven by local mesenchymal stem cells. Ten patients (3 females and 7 males aged between 32 and 71 years old) with partial Achilles tendon injury were treated with injections of autologous peripheral blood mononuclear cells (PB-MNCs). The cell concentrate was obtained from 100-120 cc of each patient's blood with a selective point-of-care filtration system. PB-MNCs remained trapped in the filter and were injected immediately after sampling. Around 60% of the PB-MNC concentrate was injected directly into the injured area, while the remaining 40% was injected in smaller amounts into the surrounding parts of the Achilles tendon affected by tendinosis. All patients were evaluated both clinically with the help of the American Orthopaedic Foot & Ankle Society (AOFAS) scale, and radiologically (MRI examination) at baseline and 2 months after the PB-MNC injection. A clinical reassessment with the AOFAS scale was also performed 6 months after the intervention. The rehabilitation protocol implied full weight-bearing walking immediately after the procedure, light physical activity 3-4 days after the injection, and physiotherapist-assisted stretching exercises and eccentric training. In all patients, functional and radiological signs of tendon healing processes were detected as early as 2 months after a single treatment and the AOFAS scale rose from the initial mean value of 37.5 (baseline) to 85.4 (6 months). Our preliminary results indicate that regenerative therapies with PB-MNCs can prove useful for partial Achilles tendon injuries as a valid alternative to surgical options, especially when other conservative approaches have failed. Advantages of this therapy include rapid execution, no need for an operating theatre, easy reproducibility, quick recovery and good tolerability regardless of the patient's age (the procedure is not to be performed in subjects who are below 18 years old). Further studies on the topic are recommended to confirm these observations

The primary aim of this study was to compare the knee specific functional outcome of partial compared with total knee replacement (TKR) for the management of patellofemoral osteoarthritis. Fifty-four consecutive Avon patellofemoral replacements were identified and propensity score matched to a group of 54 patients undergoing a TKR with patella resurfacing for patellofemoral osteoarthritis. The Oxford knee score (OKS), the Short Form (SF-) 12 and patient satisfaction were collected (mean follow up 9.2 years). Survival was defined by revision or intention to revise. There was no significant difference in the OKS (p>0.60) or SF-12 (p>0.28) between the groups. The TKR group was significantly less likely to be satisfied with their knee (95.1% versus 78.3%, OR 0.18, p=0.03). Length of stay was significantly (p=0.008) shorter for the Avon group (difference 1.8 days, 95% CI 0.4 to 3.2). The 10 year survival for the Avon group was 92.3% (95% CI 87.1 to 97.5) and for the TKR group was 100% (95% CI 93.8 to 100). There was no statistical difference in the survival rate (Log Rank p=0.10). The Avon patellofemoral replacement have a shorter length of stay with a functional outcome and satisfaction rate that is equal to that of TKR. The benefits of the Avon need to be balanced against the increased rate of revision when compared with TKR

Aims. In elderly patients with osteoarthritis and protrusio who require arthroplasty, dislocation of the hip is difficult due to migration of the femoral head. Traditionally, neck osteotomy is performed in situ, so this is not always achieved. Therefore, the purpose of this study is to describe a partial resection of the posterior wall in severe protrusio. Methods. This is a descriptive observational study, which describes the surgical technique of the partial resection of the posterior wall during hip arthroplasty in patients with severe acetabular protrusio operated on between January 2007 and February 2017. Results. In all, 49 hip arthroplasties were performed. The average age of patients was 60 years, and idiopathic was the most frequent aetiology of protrusio. All patients were treated with femoral head autograft and no intra- or postoperative complications were reported. No patients required revision surgery. Conclusion. Partial resection of the posterior wall demonstrated to be a safe surgical technique with 100% survival in a follow-up to ten years in total hip arthroplasty due to severe acetabular protrusio. Cite this article: Bone Joint Open 2020;1-7:431–437

There has been a significant increase in the demand for arthroplasty as a result of the Covid 19 pandemic and lack of beds on the green pathway. The average length of in-hospital stay following knee replacements has been successfully reduced over the years following introduction and adoption of enhanced recovery protocols. Day case arthroplasty has the potential to be efficient as well as cost-effective. We present our day case pathway for elective knee arthroplasty and early results of its adoption at a district general hospital. Our pathway was developed through a multidisciplinary input from surgeons, anaesthetists, physiotherapists, nursing staff, administrative staff, surgical care practitioners and pharmacists. Inclusion criteria were defined to identify patients suitable for cay case arthroplasty. Results of 32 patients who underwent day case partial and total knee replacement at our institution between 2018 to 2022 are presented. 31 out of 32 (97%) were discharged safely on the day of surgery. Patients were discharged at a mean of 7 hours following surgery. There were no re-admissions following discharge. There were no surgical complications at a mean follow-up of 2 years. Patient feedback revealed high levels of satisfaction and that they would recommend the pathway to others. Cost analysis revealed savings towards bed costs. Our early results demonstrate day case knee arthroplasty to be safe and cost effective. With limited resources to tackle the enormous backlog of arthroplasty, it offers the potential to make theatre utilization efficient

Abstract. In aged trauma patients the basic prerequisite is early mobilization and full weight-bearing, as immobilization can trigger various complications such as pressure ulcers, pneumonia, urinary tract infections and others. Mortality of elderly patients increases significantly in fracture patients with partial weight-bearing compared to populations with total weight-bearing. Besides the limited physical strength in these patients, partial-weight bearing is however frequently used for the aftercare of hip fracture patients. Therefore, the present study aims to evaluate mobility of aged hip fracture patients with regards to weight-bearing and postoperative mobility. Methods. An insole mobile force sensor was used to measure the post-operative weight-bearing by assessing the compressive forces between foot and shoe. Only patients (n=15) that suffered a trochanteric fracture >75 years of age were included and compared to a study group of patients (n=18) with fractures of the lower limb <40 years of age. Patients with cognitive disorders such as delirium and other diseases limiting the realization of partial weight-bearing were excluded. Both groups were instructed to maintain partial weight bearing of the affected limb following surgery. Following five days of training by our department of physiotherapy, the patients were requested to perform a gait analysis with the insole mobile force sensor. During gait analysis the maximum load was measured (kg) and the time over which the partial load could be maintained was determined. Results. None of the aged patients in the test group could meet the partial load at all times. 73.33% of patients (11 out of 15) exceeded the specified load by more than twice (> 40 kg). In the control group, 55.56% (10 of 18) of the patients were able to meet the partial load. A further 22.22% of the young patients (4 out of 18) were able to exceed only slightly (<120%, <24 kg). It was also shown that only 11.11% (2 of 18) put more than double of the allowed weight (> 40 kg) on the affected leg in the younger group. Only one of the aged patients was able to exceed the pre-determined weight-bearing restrictions for less than 10% of the measured time. In comparison, significantly more patients in the control group (88,89%; 16 of 18; p<0,05) were able to maintain the partial load for more than 90.0% of the time of gait analysis. Conclusion. Elderly patients seem to be unable to follow partial weight-bearing restrictions as proven in the present trial. As early mobilization of geriatric trauma patients is an important element for a successful rehabilitation, the relict of postoperative partial weight-bearing in these patients should be abandoned. Thus, the surgical therapy should allow immediate full weight bearing following surgery of aged hip fracture patients

Aims. Custom-made partial pelvis replacements (PPRs) are increasingly used in the reconstruction of large acetabular defects and have mainly been designed using a triflange approach, requiring extensive soft-tissue dissection. The monoflange design, where primary intramedullary fixation within the ilium combined with a monoflange for rotational stability, was anticipated to overcome this obstacle. The aim of this study was to evaluate the design with regard to functional outcome, complications, and acetabular reconstruction. Methods. Between 2014 and 2023, 79 patients with a mean follow-up of 33 months (SD 22; 9 to 103) were included. Functional outcome was measured using the Harris Hip Score and EuroQol five-dimension questionnaire (EQ-5D). PPR revisions were defined as an endpoint, and subgroups were analyzed to determine risk factors. Results. Implantation was possible in all cases with a 2D centre of rotation deviation of 10 mm (SD 5.8; 1 to 29). PPR revision was necessary in eight (10%) patients. HHS increased significantly from 33 to 72 postoperatively, with a mean increase of 39 points (p < 0.001). Postoperative EQ-5D score was 0.7 (SD 0.3; -0.3 to 1). Risk factor analysis showed significant revision rates for septic indications (p ≤ 0.001) as well as femoral defect size (p = 0.001). Conclusion. Since large acetabular defects are being treated surgically more often, custom-made PPR should be integrated as an option in treatment algorithms. Monoflange PPR, with primary iliac fixation, offers a viable treatment option for Paprosky III defects with promising functional results, while requiring less soft-tissue exposure and allowing immediate full weightbearing. Cite this article: Bone Jt Open 2024;5(8):688–696

Pre-operative 3D glenoid planning improves component placement in terms of version, inclination, offset and orientation. Version and inclination measurements require the position of the inferior angle. As a consequence, current planning tools require a 3D model of the full scapula to accurately determine the glenoid parameters. Statistical shape models (SSMs) can be used to reconstruct the missing anatomy of bones. Therefore, the objective of this study is to develop and validate an SSM for the reconstruction of the inferior scapula, hereby reducing the irradiation exposure for patients. The training dataset for the statistical shape consisted of 110 CT images from patients without observable scapulae pathologies as judged by an experienced shoulder surgeon. 3D scapulae models were constructed from the segmented images. An open-source non-rigid B-spline-based registration algorithm was used to obtain point-to-point correspondences between the models. A statistical shape model was then constructed from the dataset using principal component analysis. Leave-one-out cross-validation was performed to evaluate the accuracy of the predicted glenoid parameters from virtual partial scans. Five types of virtual partial scans were created on each of the training set models, where an increasing amount of scapular body was removed to mimic a partial CT scan. The statistical shape model was reconstructed using the leave-one-out method, so the corresponding training set model is no longer incorporated in the shape model. Reconstruction was performed using a Monte Carlo Markov chain algorithm, random walk proposals included both shape and pose parameters, the closest fitting proposal was selected for the virtual reconstruction. Automatic 3D measurements were performed on both the training and reconstructed 3D models, including glenoid version, inclination, glenoid centre point position and glenoid offset. In terms of inclination and version we found a mean absolute difference between the complete model and the different virtual partial scan models of 0.5° (SD 0.4°). The maximum difference between models was 3° for inclination and 2° for version. For offset and centre point position the mean absolute difference was 0 mm with an absolute maximum of 1 mm. The magnitude of the mean and maximum differences for all anatomic measurements between the partial scan and complete models is smaller than the current surgical accuracy. Considering these findings, we believe a SSM based reconstruction technique can be used to accurately reconstruct the glenoid parameters from partial CT scans

Abstract. Aim. Excessive glenoid retroversion and posterior wear leads to technical challenges when performing anatomic shoulder replacement. Various techniques have been described to correct glenoid version, including eccentric reaming, bone graft, posterior augmentation and custom prosthesis. Clinical outcomes and survivorship of a Stemless humeral component with cemented pegged polyethylene glenoid with eccentric reaming to partially correct retroversion are presented. Patients and Methods. Between 2010– 2019, 115 Mathys Affinis Stemless Shoulder Replacements were performed. 50 patients with significant posterior wear and retroversion (Walch type B1, B2, B3 and C) were identified. Measurement of Pre-operative glenoid retroversion and Glenoid component version on a post op axillary view was performed by method as described by Matsen FA. Relative correction was correlated with clinical and radiological outcome. Results. 4 were lost to follow up. 46 patients were therefore reviewed. The mean follow up was 4 years (2–8.9 years). Walch B1, Pre op Retroversion: 12 (8–20), post op retroversion :11.8 (−4 to 19), correction= 0.2. Walch B2, Pre op Retroversion :18.4 (10–32), post op retroversion: 13.2 (1 −22), correction= 5.2. Walch B3, Pre op Retroversion: 19.1 (13–32)post op retroversion : 16.1 (9–25), correction= 3.0. Walch C, Pre op Retroversion: 33.3 (28–42) post op retroversion: 16.0 (6–27), correction= 17.3. 3 patients required revision surgery for rotator cuff failure. Conclusion. Partial correction of glenoid retroversion with eccentric reaming and implantation of cemented pegged polyethylene component leads to satisfactory clinical outcomes at midterm follow up. No revisions for aseptic loosening of the glenoid were required

Rotator cuff disease encompasses a spectrum from partial to full thickness tears. Despite being 2–3 times more common than full–thickness tears, effective non-operative treatment for partial thickness tears has remained elusive. Platelet enriched plasma (PRP) has been proposed to enhance rotator cuff healing by enhancing the natural healing cascade. However, its utility in rotator cuff disease remains controversial. The purpose of this study was to compare the patient reported outcomes between PRP and corticosteroid injection in patients with symptomatic partial thickness tears. This double blind randomized controlled trial enrolled patients with symptomatic, partial thickness rotator cuff tears or rotator cuff tendinopathy proven on ultrasound or MRI. Patients were randomized to either corticosteroid or PRP ultrasound-guided injection of the affected shoulder. Patients completed patient reported outcomes at 6 weeks and 12 weeks. The primary outcome was Visual Analog Scale (VAS) pain scores. Secondary outcomes included the Western Ontario Rotator Cuff (WORC) index, American Shoulder and Elbow Surgeons (ASES) score, and failure of non-operative management as determined by consent for surgery or progression to operative intervention. Ninety-nine patients were enrolled in the study with equal demographics between the two groups. Taking into account pre-injection scores, patients with PRP injections demonstrated a statistically significant improvement in VAS scores compared to patients receiving corticosteroid injections at 12 weeks (p=0.045) but not at 6 weeks (p=0.704). There was no difference in other outcome measures or progression of the two groups to surgical intervention. The use of PRP in the management of partial thickness rotator cuff tears demonstrates significant improvement of pain scores at 12 week follow up compared to corticosteroid injections. However, this did not affect the rate of progression to surgical intervention. Continued study is required to determine the utility of PRP in this patient population

Aim. Chronic osteomyelitis of the calcaneus is a frequent problem in a population of diabetic patients, patients with neurologic disorders or bedridden patients with ulcers. Partial calcanectomy is an alternative option which avoid major amputation. The aim of this retrospective study was to determine the effectiveness of partial calcanectomy for treating chronic osteomyelitis of the calcaneux. Method. We conducted a retrospective review of patients who underwent in our department a partial calcanectomy between 2006 and 2015. All patients with a complete set of radiographs and adequate follow-up (minimum 2 years) were included. We reviewed these cases to determine healing rate, microbiological analysis, risk factors of failure (comorbidities), limb salvage rate and survival rate. We analyzed specifically the footwear and the functional subjective evaluation according to the LEFS score (Lower Extremity Functional Scale). Results. Twenty-four patients were included (24 foot). There were 17 men and the mean age was 65.2 years. The control of the infection and the healing was obtained in 15 cases. An additional surgery was required in 46% of the cases. A transtibial amputation has been realized in 9 cases because of uncontrolled infection. The existence of a preoperative vascular disease increased 5,9 times the risk of amputation after a partial calcanectomy (p=0,033). The type of germ was not related to the risk of recurrence. Soles were necessary for 60% of the patients with a successful partial calcanectomy (n=15). The average LEFS score was 51/80. Conclusion. The treatment of the chronic osteomyelitis of the calcaneus was a therapeutic challenge for these patients. The partial calcanectomy is a useful procedure for limb salvage, but the selection of patients must be rigorous. In our study, arteriopathic patients had a high risk of amputation after partial calcanectomy. When the healing is acquired, the patients were satisfied and presented a good function

Radial head fractures are relatively common, representing approximately one-third of all elbow fractures. Outcomes are generally inversely proportional to the amount of force involved in the mechanism of injury, with simple fractures doing better than more comminuted ones. However, the prognosis for these fractures may also be influenced by associated injuries and patient-related factors (age, body index mass, gender, tobacco habit, etc.) The purpose of this study is to evaluate which factors will affect range of motion and function in partial radial head fractures. The hypothesis is that conservative treatment yields better outcomes. This retrospective comparative cohort study included 43 adult volunteers with partial radial head fracture, a minimum one-year follow up, separated into a surgical and non-surgical group. Risk factors were: associated injury, heterotopic ossification, worker's compensation, and proximal radio-ulnar joint implication. Outcomes included radiographic range of motion measurement, demographic data, and quality of life questionnaires (PREE, Q-DASH, MEPS). Mean follow up was 3.5 years (1–7 years). Thirty patients (70%) had associated injuries with decreased elbow extension (−11°, p=0.004) and total range of motion (−14°, p=0.002) compared to the other group. Heterotopic ossification was associated with decreased elbow flexion (−9°, p=0.001) and fractures involved the proximal radio-ulnar joint in 88% of patients. Only worker's compensation was associated with worse scores. There was no difference in terms of function and outcome between patients treated nonsurgically or surgically. We found that associated injuries, worker's compensation and the presence of heterotopic ossification were the only factors correlated with a worse prognosis in this cohort of patients. Given these results, the authors reiterate the importance of being vigilant to associated injuries

Osteosynthesis of high-energy metaphyseal proximal tibia fractures is still challenging, especially in patients with severe soft tissue injuries and/or short stature. Although the use of external fixators is the traditional treatment of choice for open comminuted fractures, patients' acceptance is low due to the high profile and therefore the physical burden of the devices. Recently, clinical case reports have shown that supercutaneous locked plating used as definite external fixation could be an efficient alternative. Therefore, the aim of this study was to evaluate the effect of implant configuration on stability and interfragmentary motions of unstable proximal tibia fractures fixed by means of externalized locked plating. Based on a right tibia CT scan of a 48 years-old male donor, a finite element model of an unstable proximal tibia fracture was developed to compare the stability of one internal and two different externalized plate fixations. A 2-cm osteotomy gap, located 5 cm distally to the articular surface and replicating an AO/OTA 41-C2.2 fracture, was virtually fixed with a medial stainless steel LISS-DF plate. Three implant configurations (IC) with different plate elevations were modelled and virtually tested biomechanically: IC-1 with 2-mm elevation (internal locked plate fixation), IC-2 with 22-mm elevation (externalized locked plate fixation with thin soft tissue simulation) and IC-3 with 32-mm elevation (externalized locked plate fixation with thick soft tissue simulation). Axial loads of 25 kg (partial weightbearing) and 80 kg (full weightbearing) were applied to the proximal tibia end and distributed at a ratio of 80%/20% on the medial/lateral condyles. A hinge joint was simulated at the distal end of the tibia. Parameters of interest were construct stiffness, as well as interfragmentary motion and longitudinal strain at the most lateral aspect of the fracture. Construct stiffness was 655 N/mm (IC-1), 197 N/mm (IC-2) and 128 N/mm (IC-3). Interfragmentary motions under partial weightbearing were 0.31 mm (IC-1), 1.09 mm (IC-2) and 1.74 mm (IC-3), whereas under full weightbearing they were 0.97 mm (IC-1), 3.50 mm (IC-2) and 5.56 mm (IC-3). The corresponding longitudinal strains at the fracture site under partial weightbearing were 1.55% (IC-1), 5.45% (IC-2) and 8.70% (IC-3). From virtual biomechanics point of view, externalized locked plating of unstable proximal tibia fractures with simulated thin and thick soft tissue environment seems to ensure favorable conditions for callus formation with longitudinal strains at the fracture site not exceeding 10%, thus providing appropriate relative stability for secondary bone healing under partial weightbearing during the early postoperative phase

Introduction. There is a challenge to detect partial tear of the ACL, the number of bundle injured and the proportion of fibers torn. The MRI was shown efficient to individualize the two anteromedial (AM) and posterolateral (PL) bundles of the ACL. The purpose of this study was to assess the ability of the MRI to detect partial tears of the ACL on axial views to display the AM and PL bundles. Materials and methods. This retrospective study included 48 patients (19 partial tears of the ACL, 16 complete rupture of the ACL and 13 normal knee) who underwent both arthroscopy and MRI examinations of the knee. The conventional MRI protocol included one sagittal T1- weighted sequence and 3 proton-density fat sat. The images from MRI were analysis by a radiologist specialized in musculoskeletal imaging who was blinding to the arthroscopic findings. The criteria for the analysis of MRI were divided into primary (those involving the ACL himself) and secondary signs (associated abnormalities). The primary signs included the horizontalisation of the ACL (ACL axis), the global ACL signal intensity and the signal intensity of each AM and PL bundle. The secondary signs included bone bruise, osteochondral impaction, popliteus muscle injury, medial collateral ligament injury and joint effusion. The ACL was classified as normal, partially or totally torn. The rupture of the AM and PL bundle was specified. Results. In our study, MRI was found to have a 75% sensitivity and a 73% specificity for the diagnosis of partial tears of the ACL. The sensitivity to detect AM bundle lesion was 88% but the specificity was 50%. The lack of horizontalisation of the ACL was a very good sign, for partial tears of the ACL, with a sensitivity of 84% and a specificity of 81% (p<0.05). Regarding the secondary signs, there was no significant difference to distinguish partial and complete tear. However, we found that there was a greater probability to find a partial tear of the ACL with the lack of joint effusion, bone bruise and medial collateral ligament injury. Quantifying the proportion of injured fibers was unsuccessful and was found as a failure of the MRI. Conclusions. MRI exhibited lower sensitivity and specificity for partial tear than for complete rupture of the ACL. However 3 important arguments can guide us: the lack of horizontalisation of the ACL, a continuous ACL signal, the display of one of two bundles on the axial view

Aim: To ascertain the accuracy of partial weight bearing. Method: 6 healthy volunteers with a below knee plaster cast, 10 patients with uncemented hip replacements and 12 patients with lower limb fractures were trained to partial weight bear. They were asked to place the affected leg on a bathroom scale and to press on it till the prescribed limit. This process was repeated till the subject formed a mental image of the amount of load they must put through the limb. The ability to partial weight bear was tested in a gait lab by making them walk on a walkway incorporating a Bertec force platform. Exact magnitude of weight bearing was calculated from the vertical ground reaction forces produced. Results: 4 out of 6 volunteers exerted mean weight of 20.3 kg above and the remaining 2 exerted 5.6 kg below that prescribed. Of the 22 patients, 19 exerted mean weight of 24.3 kg above and 3 patients exerted mean weight of 7.5 kg below that prescribed. As per Spearmanñs rank correlation test, the relationship between the prescribed weight bearing and the actual weight bearing was non-signiþcant (p=0.399) i.e., there is little relationship between the prescribed and actual weight bearing. Conclusions: Neither patients nor healthy volunteers could partial weight bear to the extent required. They were either above or below the prescribed level of partial weight bearing. Current method of teaching partial weight bearing is inaccurate and has poor reproducibility. Such methods use static loading situations whereas walking is a dynamic activity. An inexpensive, easy to use, dynamic device is required to train patients to partial weight bear