Introduction: Osteochondral lesions of the talus (OCL III–IV°) need both extensive debridement for revitalisation and osteochondral reconstruction of the joint surface. This can be achieved by autologous cancellous
In revision total hip arthroplasty (THA), it is essential to cope with the bone stock loss. The acetabular bone loss is reconstructed by bulk bone grafts, bone chips, bone cement or jumbo cup. The impaction
Introduction: Revitalizing of the necrotic subchondral bone is the therapeutic paradigm in OCL/OD of the talus. Bone-marrow stimulation includes K-wire drilling or open debridement and cancellous bone grafting. Our results presented here are based on retrograde core-drilling and autologous cancellous
Abstract. Background. Scaphoid non-union can result in pain, altered wrist kinematics leading to a Scaphoid Non-union Advance Collapse, ultimately to symptomatic radio-carpal arthritis. Open techniques have their limitations. We describe the rationale, surgical technique and outcomes of our series of arthroscopic
Severe glenoid bone loss in patients with osteoarthritis with intact rotator cuff is associated with posterior glenoid bone loss and posterior humeral subluxation. Management of severe glenoid bone loss during shoulder arthroplasty is controversial and technically challenging and options range from humeral hemiarthroplasty, anatomic shoulder replacement with glenoid bone grafting or augmented glenoid component implantation, to reverse replacement with reaming to correct version or structural bone grafting or metallic augmentation of the bone deficiency. Shoulder replacement with severe glenoid bone loss is technically challenging and characterised by higher rates of complications and revisions. Hemiarthroplasty has limited benefit for pain relief and function especially if eccentric glenoid wear exists. Bone loss with >15 degrees of retroversion likely requires version correction include
Acetabular revision in patients with bone deficiency is often difficult because of the poor quality and quantity of the acetabular bone stock. The purpose of this study was to evaluate the midterm clinical and radiographic outcomes of acetabular revision with use of an impaction
It is still unclear whether it is best, when revision surgery is required for replacement of an acetabular component, to treat femoral focal osteolysis with
Aim. Post traumatic distal tibia osteomyelitis (DTOM) with an upper ankle joint involvement is a serious complication after primary osteosynthesis and can be a nightmare for the patient and the surgeon as well. Our aim was to identify mayor complications during treatment and to find the way to prevent or treat them. Method. It is a retrospective analysis of eight patients with DTOM and an upper ankle joint involvement treated in our institution from 2012 to 2018. The average size of a bone defect after a debridement was 9 centimeters (4–15). Patients were treated in two stages. First stage was segmental bone resection, external fixation and soft tissue envelope reconstruction if necessary. At second stage a distraction frame was applied and proximal corticotomy performed. In all but one case a circular frame was used. Results. We have had one major intra-operative complication, an injury of arteria tibialis posterior during the corticotomy procedure. Except in one patient we did not observe major problems with pin-track infections. Despite
Osteonecrosis of the femoral head (ONFH) is a debilitating, painful, progressive, and refractory disease that has multiple etiologic risk factors. It is caused by bone cell death, which itself has various causes, leading to femoral head collapse and subsequent osteoarthritis. ONFH primarily influences patients aged from 20 to 50 years; in addition, bilateral hip joints are involved in 75% of patients. Causes include use of corticosteroids, alcohol abuse, previous trauma, hemoglobinopathy, Gaucher disease, coagulopathies, and other diseases. No pharmacologic treatment has been shown to be effective for early ONFH. Outcomes of total hip arthroplasty (THA) for these young and active patients have some drawbacks, primarily due to the young age of these patients, limited lifetime and durability of the implants and their fixation, and the skeletal manifestations of osteonecrosis. As a result of these concerns, there has been an increased focus on early interventions for ONFH aimed at preservation of the native articulation. Core decompression is currently the most widely accepted surgical treatment at the early stage of avascular osteonecrosis (AVN); however, due to limited efficacy, its use has been debated. There is currently no standardised protocol for evaluating and treating osteonecrosis of the femoral head in adults in the United States. Although total hip replacement is the most frequent intervention for treatment of post-collapse (Steinberg stage-IIIB, IVB, V, and VI) osteonecrosis; core decompression is the most commonly offered intervention for symptomatic, pre-collapse (Steinberg stage-IB and IIB) osteonecrosis. Less frequently offered treatments include non-operative, pharmacologic or modality management, osteotomy, vascularised and non-vascularised
Massive bone loss on both the femur and tibia during revision total knee arthroplasty (TKA) remains a challenging problem. Multiple solutions have been proposed for small osseous defects, including morselised cancellous bone grafting, small-fragment structural allograft, thicker polyethylene inserts, and the use of modular augments attached to revision prosthetic designs. Large osseous defects can be treated with structural allografts, impaction
Introduction. The optimal management of severe tibial and/or femoral bone loss in a revision total knee arthroplasty (TKA) has not been established. Reconstructive methods include structural or bulk allografts, impaction
Aims: In the present study we evaluated short-term outcome of complex proximal tibial fractures treated with hybrid external þxation. Methods: A retrospective evaluation of 33 tibiae in 31 patients treated with hybrid external þxation; 9 (27.2%) AO type A metaphyseal and 24 (72.8%) type C bicondylar intraarticular proximal tibial fractures. Majority of the fractures (58.1%) were due to high-energy trauma and open fractures constituted 18.2% of all fractures. Percutaneous pinning combined with indirect reduction techniques was used in 14 (42.4%) cases. Mini-open clamp reduction and screw þxation was applied in 12 (36.4%) operations. Open reduction, reconstruction of articular surface,
Introduction There are 1 million cases of major skeletal defects :that occur worldwide each year that lead to significant morbidity and disability and currently require bone grafting as the main mode of treatment. Limitations of
The intra-articular supracondylar fractures of the femur are difficult fractures that occur with increasing frequency in the last years. Their complex management is a source of controversy, since surgical outcome is not acceptable in all instances. In the last 6 years we treated 30 comminuted intra-articular supracondylar fractures of the femur (type-C). The mean age was 28 years (17– 65 years). We made any effort to apply a method which could guarantee reduction and articular reconstruction, rigid fixation and bridging of metaphysic-epiphysis, in order to achieve early mobilization and to avoid post-traumatic osteoarthritic lesions. The extra-articular portion of the fractures was fixed using DCS, condylar plates, Ô plates and in some cases the whole construct was protected by an external fixation device. In some other cases, stability was enhanced using a second bridging plate in the medial side or applying a massive cortical graft properly adapted and fixed to the plate. The articular surface was reconstructed using cancellous lag-screws. Intra-articular epiphyseal portions were regularly bone grafted when there was comminution and bone loss, Bone grafting was also carried out in cases of meta-diaphyseal severe comminution and major bone defects. Clinical and radiological outcome was evaluated. Radiological parameters (axial valgus deformity, shortening, development of post-traumatic osteoarthritis etc.) were correlated to the method of surgical treatment. There were major complications (such as infection, especially in open fractures, delayed healing, hardware failure, refracture etc.). In some instances re-operation was necessary. In problematic C3 supracondylar fractures of the knee, poor surgical results are associated to early complications and development of degenerative lesions. This handicap is particularly is particularly important since it occurs in a major weight bearing joint of young patients. Using meticulous surgical technique (including
Background: Impaction
Hybrid fixation is now an established modality of treatment for articular fractures of the proximal and distal tibia. However, there is a lack of consensus over the management of non-articular metaphyseal fractures extending into the diaphysis. Despite sophisticated techniques, intramedullary nailing remains difficult and has relatively high rates of malunion and nonunion. Plate fixation may produce satisfactory results, but its use is limited where there is major extension into the diaphysis or where the soft tissues are compromised. Since 1995, we have used hybrid external fixation in the treatment of such fractures in 24 male and 16 female patients of mean age 54 years (15 to 92). Mostly sustained in road traffic accidents, there were 26 closed and 14 open fractures, seven of which were Gustillo type IIIB. There were 26 distal tibial, seven proximal and seven tibial shaft fractures. Metaphyseal fixation consisted of two rings with tension wires, diaphyseal fixation of screws. We used additional rings in segmental diaphyseal fractures or used olive compression wires across the fracture when additional stability was required. Hybrid fixation was the primary procedure in 25 patients and a secondary procedure, performed within eight weeks of injury, in 15. All patients went on to union in a mean of 45 weeks, but 10 required additional procedures such as
Uncontained peripheral bone defect in posteromedial tibial plateau is not an infrequent problem even in primary total knee arthroplasty, especially in Korean patients some of those have large angular deformities preoperatively. We reviewed the clinical and radiological results of primary total knee replacements of 33 osteoarthritic knees in 28 patients with the use of metal block augmentation for uncontained peripheral tibial bone defects more than 5 millimeters in depth and more than a quarter of medial tibial plateau in width. Those defects were encountered in 75 knees (9.6%) during 779 primary total knee arthroplasties performed by single surgeon between January 2002 and December 2004 at our institution. Modular metal block augmentation was reserved for 42 knees, while the other knees were managed with