INTRODUCTION

Ligament balancing aims to equalize lateral and medial gaps or tensions for optimal functional outcomes. Balancing can now be measured as lateral and medial contact forces during flexion (Roche 2014). Several studies found improved functional outcomes with balancing (Unitt 2008; Gustke 2014a; Gustke 2014b) although another study found only weak correlations (Meneghini 2016). Questions remain on study design, optimal lateral-medial force ratio, and remodeling over time. Our goals were to determine the functional outcomes between pre-op and 6 months post-op, and determine if there was a range of balancing parameters which gave the highest scores.

Background

Although gradual bone transport may provide a large-diameter bone, complications are common with the long duration of external fixation. To reduce such complications, a new technique of bone transport with a locking plate has been done for tibial bone defect.

Abstract

By next summer the number of patients in the tranexamic acid group will be much higher, probably around 50–60.

We evaluated the outcome of hemiarthroplasty with bone block graft and low profile prosthesis (Aequalis^® fracture prosthesis) for the comminuted proximal humerus fractures. Sixteen low profile prostheses were used since July 2004, and 11 patients were followed-up for average 19.9 (12–30) months. Their mean age was 67.3 (52–78) years. Cemented stem in all cases. Two bone block graft and cancellous chip bone from resected humeral head. Ten cases for Neer type 4 fracture, one case for type 3 fracture. During 6 weeks, abduction brace with neutral rotation position was maintained. Passive and active range of motion exercise started at 6 weeks. Pain and satisfaction visual analog scale (VAS), range of motion, and modified UCLA score for hemiarthroplasty were evaluated at every visit. Radiography was also checked for stem position, loosening, and tuberosity union.

Mean pain VAS was 2.7 (0–5), and mean satisfaction VAS was 8.4 (5–10). Mean active forward flexion was 137o (90–170), external rotation at side was 45.5o (25–70), and internal rotation at back was T10 (T7-L1). Modified UCLA score was 19 (12–30) at final visit. All stems were stable, and there were no loosening at the final follow-up. All tuberosities were united except two tuberosity absorptions. One complication case was infection.

The outcome of hemiarthroplasty with bone block graft and low profile prosthesis was comparable to other implants for comminuted proximal humerus fractures. This system had unique advantages for tuberosity union. Further study with more patients and longer follow-up period are necessary to clarify the effectiveness of this prosthesis.

Aims: To evaluate the early midterm outcomes of primary total hip arthroplasty (THA) using Hydroxyapatite (HA)-coated on smooth surface acetabular component with 28 mm metal head on polyethylene liner articulation. Methods: Seventy primary THA in 63 patients with HA-coated acetabular component were performed consecutively between June 1993 and August 1996. Fifty-four cases were eligible for follow-up of average 71 months (48–104) and the mean age of index operation was 49 years (23–71). The clinical results were analyzed by modiþed Harris hip score, and the radiologic evaluation in terms of stability, polyethylene wear rate (Dorr method), osteolysis around acetabular component was done. Results: Mean Harris hip score improved from 50.9 to 82.2 at the last follow-up. Excellent or good results were found in 38 cases (70%). Eight cases (15%) were unstable radiologically. Pelvic osteolysis was found at 18 cases (33%). The mean polyethylene wear rate was 0.146 mm/year (0.01–0.45). Wear rate of hip dyaplasia was greater than osteonecrosis signiþcantly (p< 0.05). Seven cases (13%) were revised (5 mechanical failures, 2 deep infections). Any bone ongrowth was not found during revision surgery for loose components. Complications included 5 heterotrophic ossiþcations, 2 deep infections, and 1 nonrecurrent dislocation. Conclusion: Primary THA using HA-coated on smooth surface acetabular component showed unsatisfactory clinical results, accelerated polyethylene wear rate accompanying high incidence of osteolysis, and high loosening rate due to lack of bony ongrowth at early midterm.

Introduction: This study was designed to investigate the feasibility and advantages of minimally invasive plate osteosynthesis of tibia fractures.

Methods: In a prospective study, 24 cases of unstable tibial fractures were stabilized with a narrow LC-DCP (Limited Contact-Dynamic Compression Plate) inserted using minimally invasive percutaneous plate osteosyn-thesis technique. The technique consisted of 3 major steps: 1) reduction of fracture with or without distractor; 2) pre-contoured plate insertion percutaneously at the stab incision distant to fracture site; 3) plate fixation to the tibia percutaneously inserted screw. All the procedure was done under fluoroscopic guide. Between January 1998 and March 1999, we operated 16 proximal or distal periarticular fractures, 5 segmental fractures, and 3 mid-shaft fractures of adolescents that had still open physis. 18 fractures were closed, and 4 were open.

Results: 22 of 24 cases healed without second procedures such as bone graft or correction of angular deformity. There was no infection except 1 case of superficial infection that was healed with early removal of plate. There were 3 cases of screw breakage, but no procedure was required. At the follow-up, 2 patients were healed with > 5 degree varus alignment and > 10 degree internal rotation. All the patients had good knee or ankle function.

Conclusion: The authors feel confident that the minimally invasive technique for plate osteosynthesis of tibial fractures that would be inappropriate for intramedullary nailing will prove to a feasible and worthwhile method of stabilization, while avoiding the severe complications associated with the other methods.