Objectives. The purpose of this study was to compare the results and complications of tibial lengthening over an
Aims. This study aimed to compare mortality in trochanteric AO/OTA A1 and A2 fractures treated with an
The June 2024 Trauma Roundup. 360. looks at: Skin antisepsis before surgical fixation of limb fractures; Comparative analysis of
Aims. The aim of this study was to determine the immediate post-fixation stability of a distal tibial fracture fixed with an
Aims. Due to their radiolucency and favourable mechanical properties, carbon fibre nails may be a preferable alternative to titanium nails for oncology patients. We aim to compare the surgical characteristics and short-term results of patients who underwent intramedullary fixation with either a titanium or carbon fibre nail for pathological long-bone fracture. Methods. This single tertiary-institutional, retrospectively matched case-control study included 72 patients who underwent prophylactic or therapeutic fixation for pathological fracture of the humerus, femur, or tibia with either a titanium (control group, n = 36) or carbon fibre (case group, n = 36)
Introduction. IM (Intra Medullary) nail fixation is the standard treatment for diaphyseal femur fractures and also for certain types of proximal and distal femur fractures. Despite the advances in the tribology for the same, cases of failed
Aims. To report the outcomes of patients with a fracture of the distal tibia who were treated with
Freehand distal interlocking of
Aims. The primary aim of this study was to identify independent predictors associated with nonunion and delayed union of tibial diaphyseal fractures treated with
Aims. The aim of this study is to evaluate the surgical treatment with the best healing rate for patients with proximal femoral unicameral bone cysts (UBCs) after initial surgery, and to determine which procedure has the lowest adverse event burden during follow-up. Methods. This multicentre retrospective study was conducted in 20 tertiary paediatric hospitals in France, Belgium, and Switzerland, and included patients aged < 16 years admitted for UBC treatment in the proximal femur from January 1995 to December 2017. UBCs were divided into seven groups based on the index treatment, which included elastic stable
Aims. Proximal femur fractures treatment can involve anterograde nailing with a single or double cephalic screw. An undesirable failure for this fixation is screw cut-out. In a single-screw nail, a tip-apex distance (TAD) greater than 25 mm has been associated with an increased risk of cut-out. The aim of the study was to examine the role of TAD as a risk factor in a cephalic double-screw nail. Methods. A retrospective study was conducted on 112 patients treated for intertrochanteric femur fracture with a double proximal screw nail (Endovis BA2; EBA2) from January to September 2021. The analyzed variables were age, sex, BMI, comorbidities, fracture type, side, time of surgery, quality of reduction, pre-existing therapy with bisphosphonate for osteoporosis, screw placement in two different views, and TAD. The last follow-up was at 12 months. Logistic regression was used to study the potential factors of screw cut-out, and receiver operating characteristic curve to identify the threshold value. Results. A total of 98 of the 112 patients met the inclusion criteria. Overall, 65 patients were female (66.3%), the mean age was 83.23 years (SD 7.07), and the mean follow-up was 378 days (SD 36). Cut-out was observed in five patients (5.10%). The variables identified by univariate analysis with p < 0.05 were included in the multivariate logistic regression model were screw placement and TAD. The TAD was significant with an odds ratio (OR) 5.03 (p = 0.012) as the screw placement with an OR 4.35 (p = 0.043) in the anteroposterior view, and OR 10.61 (p = 0.037) in the lateral view. The TAD threshold value identified was 29.50 mm. Conclusion. Our study confirmed the risk factors for cut-out in the double-screw nail are comparable to those in the single screw. We found a TAD value of 29.50 mm to be associated with a risk of cut-out in double-screw nails, when good fracture reduction is granted. This value is higher than the one reported with single-screw nails. Therefore, we suggest the role of TAD should be reconsidered in well-reduced fractures treated with double-screw
Aim. The treatment of fracture-related infections (FRI) focuses on obtaining fracture healing and eradicating infection to prevent osteomyelitis. Treatment guidelines include removal, exchange, or retention of the implants used according to the stability of the fracture and the time from the infection. Infection of a fracture in the process of healing with a stable fixation may be treated with implant retention, debridement, and antibiotics. Nonetheless, the retention of an
Many pre-clinical models of atrophic non-union do not reflect the clinical scenario, some create a critical size defect, or involve cauterization of the tissue which is uncommonly seen in patients. Atrophic non-union is usually developed following high energy trauma leading to periosteal stripping. The most recent reliable model with these aspects involves creating a non-critical gap of 1mm with periosteal and endosteal stripping. However, this method uses an external fixator for fracture fixation, whereas
Unstable distal tibia fractures are challenging injuries requiring surgical treatment.
Aims. The aim of this study was to investigate if there are differences in outcome between sliding hip screws (SHSs) and
Freehand distal interlocking of
Aims. Using tibial shaft fracture participants from a large, multicentre randomized controlled trial, we investigated if patient and surgical factors were associated with health-related quality of life (HRQoL) at one year post-surgery. Methods. The Study to Prospectively Evaluate Reamed Intramedullary Nails in Patients with Tibial Fractures (SPRINT) trial examined adults with an open or closed tibial shaft fracture who were treated with either reamed or unreamed
Aims. The purpose of the study was to investigate whether closed intramedullary
(IM) nailing with percutaneous cement augmentation is better than
conventional closed nailing at relieving pain and suppressing tumours
in patients with metastases of the femur and humerus. Patients and Methods. A total of 43 patients (27 men, 16 women, mean age 63.7 years,
standard deviation (. sd. ) 12.2; 21 to 84) underwent closed
IM nailing with cement augmentation for long bone metastases. A
further 27 patients, who underwent conventional closed
Aims. A lack of supporting clinical studies have been published to determine the ideal length of
Aims. The aim of this study was to investigate the association between the type of operation used to treat a trochanteric fracture of the hip and 30-day mortality. Patients and Methods. Data on 82 990 patients from the National Hip Fracture Database were analyzed using generalized linear models with incremental case-mix adjustment for patient, non-surgical and surgical characteristics, and socioeconomic factors. Results. The use of short and long
Introduction. Femoral-shortening osteotomy for the treatment of leg length discrepancy is demanding technique. Many surgical technique and orthopaedic devises have been suggested to perform this procedure. Herein, we describe modified femoral shortening osteotomy over a nail, using a percutaneous multiple drill-hole osteotomy technique. Materials and Methods. We operated on six patients with LLD. Mean femoral shortening was 4.2 cm. Osteotomy was performed using a multiple drill-hole technique, and bone was stabilized using an
We report the results of using a combination of fixator-assisted nailing with lengthening over an
The fixation of comminuted femoral fractures with
We compared the outcome of closed
We present the results of 90 consecutive children with displaced fractures of the forearm treated by elastic stable
The ideal form of fixation for displaced, extra-articular
fractures of the distal tibia remains controversial. In the UK, open
reduction and internal fixation with locking-plates and intramedullary
nailing are the two most common forms of treatment. Both techniques
provide reliable fixation but both are associated with specific
complications. There is little information regarding the functional
recovery following either procedure. We performed a randomised pilot trial to determine the functional
outcome of 24 adult patients treated with either a locking-plate
(n = 12) or an
There is a growing trend towards using pre-clinical models of atrophic non-union. This study investigated different fixation devices, by comparing the mechanical stability at the fracture site of tibia bone fixed by either
We reviewed 27 diabetic patients who sustained a tibial fracture treated with a reamed
Distraction osteogenesis (callotasis) has been widely used in patients with limb-length inequality or massive bone defects. This procedure, however, may be associated with a high incidence of physical and psychosocial complications. Callotasis telescoping on a locked
Background. Currently about 4–6% of all femur fractures consist of distal femoral fractures. Different methods and implants have been used for the surgical treatment of distal femoral fractures, including
Malpositioning of the trochanteric entry point
during the introduction of an
Recent concerns regarding the prospective growth disruption of the olecranon apophysis in skeletally immature patients with
Humeral diaphysis fractures consist a rather frequent injury. The aim of our study is to evaluate the results of the treatment of humeral diaphysis fractures with the use of an interlocking
The humerus is a common site for skeletal metastases in the adult. Surgical stabilisation of such lesions is often necessary to relieve pain and restore function. These procedures are essentially palliative and should therefore provide effective relief from pain for the remainder of the patient’s life without the need for further surgical intervention. We report a retrospective analysis of 35 patients (37 nails) with symptomatic metastases in the shaft of the humerus which were treated by locked, antegrade nailing. There were 27 true fractures (73.0%) and ten painful deposits (27.0%). Relief from pain was excellent in four (11.4%), good in 29 (82.9%) and fair in two (5.7%) on discharge. Function was improved in all but one patient. One case of palsy of the radial nerve was noted. The mean postoperative survival was 7.1 months (0.2 to 45.5) which emphasises the poor prognosis in this group of patients. There were no failures of fixation and no case in which further surgery was required. Antegrade
Introduction: The majority of midshaft humeral fractures will achieve a satisfactory outcome with non-operative management. However, internal fixation is occasionally required to assist with rehabilitation, particularly in multiply-injured patients. Although the clinical risks and benefits of the locking plate and humeral nail are well known, there is a paucity of data comparing their mechanical properties. The aim of this study was to determine the torsional and 4-point bending properties of a midshaft humeral osteotomy reconstructed with either an
Several techniques are available for the treatment of displaced fractures of the neck of the radius in children. We report our experience in 14 children treated by indirect reduction and fixation using an elastic stable
Aims: Present our experience with a protocol for acute Ç gradual È femoral distraction for post- traumatic femoral shotening. Methods: Six females and four men with an average age of 35 y/o with al least one year follow-up and an average shortening of 4.5 cm (range 3–6). A butterßy osteotomy was performed at the diaphysary-subtrochanteric level. A femoral distractor was applied to the lateral side of the femur. An antegrade femoral
There is a growing trend towards using pre-clinical models of atrophic non-union. This study investigated different fixation devices, by comparing the mechanical stability at the fracture site of tibia bone fixed by either
Aim: End result study of closed
Knee arthrodesis is a potencial salvage procedure for limb preservation in patients with multiple failures of Total Knee Arthroplasty (TKA) with massive bone loss and extensor mechanism deficiency. The purpose of the study is to evaluate the outcome of bridging knee arthrodesis using a modular and non cemented
Flexible
The purpose is to present our experiences with the conversion of external fixation to an
Intracompartmental pressures of 66 patients with 67 tibial fractures treated by
The stress response to trauma is the summation of the physiological response to the injury (the ‘first hit’) and by the response to any on-going physiological disturbance or subsequent trauma surgery (the ‘second hit’). Our animal model was developed in order to allow the study of each of these components of the stress response to major trauma. High-energy, comminuted fracture of the long bones and severe soft-tissue injuries in this model resulted in a significant tropotropic (depressor) cardiovascular response, transcardiac embolism of medullary contents and activation of the coagulation system. Subsequent stabilisation of the fractures using
Aims. Hindfoot arthrodesis with retrograde
Aim. The aim of this study was to compare the cost-effectiveness of
intramedullary nail fixation and ‘locking’ plate fixation in the
treatment of extra-articular fractures of the distal tibia. Patients and Methods. An economic evaluation was conducted from the perspective of
the United Kingdom National Health Service (NHS) and personal social
services (PSS), based on evidence from the Fixation of Distal Tibia
Fractures (UK FixDT) multicentre parallel trial. Data from 321 patients
were available for analysis. Costs were collected prospectively
over the 12-month follow-up period using trial case report forms
and participant-completed questionnaires. Cost-effectiveness was
reported in terms of incremental cost per quality adjusted life
year (QALY) gained, and net monetary benefit. Sensitivity analyses
were conducted to test the robustness of cost-effectiveness estimates. Results. Mean NHS and PSS costs were significantly lower for patients
treated with an
Thirty patients underwent tibio-talo-calcaneal fusion using an interlocking arthrodesis
We report a retrospective study over five years to determine the incidence of infection and nonunion after
Aims. The aim of this study was to investigate whether clinical and radiological outcomes after
Elastic stable
Aim. Open fractures with bone defects and skin lesions carry a high risk of infection potentially leading to prolonged hospitalization and complication requiring revision procedures. Treatment options for diaphyseal fractures with soft tissue lesions are one- or two-stage approaches using external fixation or
Management of open tibial fractures remains controversial. We hypothesised that unreamed
As management of open tibial fractures remains controversial, we hypothesised that unreamed
We reviewed the results of the treatment of 30 tibial fractures with minor to severe bone loss in 29 patients by early soft-tissue and bony debridement followed by primary locked
Using human cadaver specimens, we investigated
the role of supplementary fibular plating in the treatment of distal
tibial fractures using an
Purpose of study. The addition of interlocking screws to
We compared the complications and outcome of tibial lengthening using the Ilizarov method with and without the use of a supplementary
Introduction: We have calculated the amount of antero-posterior diameter expansion by tibial
Osteogenesis imperfecta is a heterogeneous group of collagen type 1 defects. The resulting fragile bone with increased risk of fractures and deformity is the primary orthopaedic challenge. Surgical treatment is aimed at reducing the risk of fracture, correcting deformity and improving ambulatory status. Management of the growing child with extensible intramedullary device was introduced in the 1960’s by Bailey and Dubow. Since then a number of different nails have been used. The current report presents our experience with the Fassier-Duval
Callus distraction over an
Knee arthrodesis is a useful procedure in difficult cases such as failed total knee arthroplasty, bone tumors and infected knee joints. A review of 27 cases treated using a modular locked
1. Distal migration of a femoral
Introduction: For years traditional
This study evaluated variation in the surgical treatment of stable (A1) and unstable (A2) trochanteric hip fractures among an international group of orthopaedic surgeons, and determined the influence of patient, fracture, and surgeon characteristics on choice of implant (intramedullary nailing (IMN) versus sliding hip screw (SHS)). A total of 128 orthopaedic surgeons in the Science of Variation Group evaluated radiographs of 30 patients with Type A1 and A2 trochanteric hip fractures and indicated their preferred treatment: IMN or SHS. The management of Type A3 (reverse obliquity) trochanteric fractures was not evaluated. Agreement between surgeons was calculated using multirater kappa. Multivariate logistic regression models were used to assess whether patient, fracture, and surgeon characteristics were independently associated with choice of implant.Aims
Methods
The use of locking
Purpose: Little has been written about the size of bone defect that could be restored with one-stage lengthening over a reamed
Infected nonunion of the femur or tibia diaphysis requires resection of infected bone, stabilization of bone and reconstruction of bone defect. External fixation of the femur is poorly tolerated by patients. In 2004 authors introduced in therapy for infected nonunions of tibia and femur diaphysis coating of IMN with a layer of antibiotic loaded acrylic cement (ALAC) containing 5% of culture specific antibiotic. Seven patients with infected nonunion of the diaphysis of femur (2) and tibia (2) were treated, aged 20–63 years, followed for 2–9 years (average 5,5 years). All have been infected with S. aureus (MSSA: 2 and MRSA: 4) or Staph. epidermidis (1) and in one case with MRSA and Pseudomonas aeruginosa. All patients underwent 3 to 6 operations before authors IMN application. Custom-made IMN coated with acrylic cement (Palamed) loaded fabrically with gentamycin with admixture of 5% of culture-specific antibiotic: vancomycin (7 cases) and meropeneme (1 case) was used for bone stabilization. Static interlocking of IMN was applied in 4 cases and dynamic in 2 cases. In 1 case the femur was stabilized with IMN without interlocking screws. In 2 cases IMN was used for fixation of nonunion at docking site after bone transport. In 3 cases ALAC was used as temporary defect filling and dead space management. In one case after removal of IMN coated with ALAC, a new custom made Gamma nail and tubular bone allograft ranging 11 cm was used for defect reconstruction. Infection healing was achieved in all 7 cases, bone union was achieved in 4 from 7 cases. In 1 case of segmental diaphyseal defect ranging over 12 cm infection was healed, but bone defect was not reconstructed. This patient is waiting for total femoral replacement. In another case of segmental defect of 11 cm infection is healed, but allograft substitution and remodeling by host bone is poor. In the 3rd case of lacking bone healing, the 63 year old patients was noncooperative and not willing to walk in walker with weight bearing. This patient refused further treatment. Custom-made
Introduction: Antegrade intramedullary locked nailing is a reliable method for the treatment of humeral shaft fractures. There is a still debate on the functional effect due to a possible damage during surgical approach of the rotator cuff, but in the Literature few paper deal with the analysis of tendons in these patients. Ultrasonography is still considered a reliable method in evaluating rotator cuff tendons. The aim of this study is to evaluate if antegrade
In polytrauma patients invasive surgeries can potentiate the posttraumatic systemic inflammation thus increasing the risk of multi organ dysfunction. Therefore, fractures are initially treated by external fixators, which later are replaced by
Limb lengthening by callus distraction and external fixation has a high rate of complications. We describe our experience using an
We evaluate the effectiveness of external fixation exchange by
Distraction osteogenesis is widely used for leg lengthening, but often requires a long period of external fixation which carries risks of pin-track sepsis, malalignment, stiffness of the joint and late fracture of the regenerate. We present the results of 20 cases in which, in an attempt to reduce the rate of complications, a combination of external fixation and
Background. Both-bone diaphyseal forearm fractures constitute up to 5.4% of all fractures in children under 16 years of age in the United Kingdom. Most can be managed with closed reduction and cast immobilisation. Surgical fixation options include flexible
The risk of articular penetration during tibial nailing is well known, but the incidence of unrecognised damage to joint cartilage has not been described. We have identified this complication in the treatment of tibial fractures, described the anatomical structures at risk and examined the most appropriate site of entry for tibial nailing in relation to the shape of the bone, the design of the nail and the surgical approach. We studied the relationship between the intra-articular structures of the knee and the entry point used for nailing in 54 tibiae from cadavers. The results showed that the safe zone in some bones is smaller than the size of standard reamers and the proximal part of some nails. The structures at risk are the anterior horns of the medial and lateral menisci, the anterior part of the medial and lateral plateaux and the ligamentum transversum. This was confirmed by observations made after nailing 12 pairs of cadaver knees. A retrospective radiological analysis of 30 patients who had undergone tibial nailing identified eight at risk according to the entry point and the size of the nail. Unrecognised articular penetration and damage during surgery were confirmed in four. Although
The traditional treatment method of pediatric femoral shaft fracture has been traction and spica casting.This method is safe but prolonged immobilization, frequent X-ray , pin tract infections are some of the disadvantages. Internal fixation has become an alternative treatment in especially children between 6-10 years. Surgical treatment has been advocated for children who have multiple injuries or severe head injury. Compression plate fixation provides rigid and stable fixation but requires extensive dissection. Fixation of the fractures with flex-ible
We report the use of Grosse-Kempf reamed
Winner of ISFR Best Paper Award. Introduction: Surgeons agree on the benefits of
Purpose To investigate the outcome of tibiotalocalcaneal (TCC) fusion using the retrograde
As there is little information on the factors that influence fracture union following
We reviewed 63 patients with fractures of the distal tibial metaphysis, with or without minimally displaced extension into the ankle joint. The fractures had been caused by two distinct mechanisms, either a direct bending force or a twisting injury. This influenced the pattern of the fracture and its time to union. All fractures were managed by statically locked
The case reports of four patients with breakage of the
The humerus is a common site for metastasis.
Purpose: Surgeons agree on the benefits of
1. A method of hip fusion with the aid of a straight
Fractures of the femur are the most incapacitating fractures in children. Conservative treatment necessitates a long stay in hospital for traction and subsequent immobilisation in an uncomfortable cast. This treatment is not well tolerated, especially in adolescents. Moreover, near the end of growth, accurate reduction is necessary, as malunion is no longer correctable by growth. Stable elastic
Aims: Outcome of the distal tibial fractures treated with interlocking nail. Method: We reviewed 108 patients with distal tibial fractures which were treated in our clinic between 1990 using interlocking
We describe a patient with fractures of both bones of the forearm in whom flexible
Four matched pairs of fresh frozen human femora were used to compare the biomechanical properties in axial and torsional loading of a Locking Condylar Plate and a retrograde
We made a prospective study of 208 patients with tibial fractures treated by reamed
There is concern about the incidence and serious nature of infection after
We report the use of elastic stable
We used 15 pairs of femora from fresh human cadavers to study the effects of the size and location of the entry hole for an
Exchange nailing for failure of union after primary
We have studied the medium- and long-term effects of femoral
Purpose: To investigate the outcome of tibiotalocalcaneal (TCC) fusion using the retrograde
Background: goal of our study was to predict the size of
Aim: This paper presents the treatment of malunited fractures of tibia with intramedullary interlocking nail with correction of malunion, in order to prevent gait abnormalities and pathological loading of the adjacent joints. Method: We treated sixteen fractures of tibia that were treated initially with P.O.P. or external þxation and led to malunion or considered leading to malunion. In most patients there was combination of deformities with severe gait abnormality. In case of solid malunion the deformity was corrected after open osteotomy at the fracture site. In case of non solid malunion the deformity was corrected closed or semi-closed. Stabilization was achieved with interlocking