We reviewed the clinical details and radiographs of 52 patients with ballistic fractures of the femur admitted to the International Committee of the Red Cross Hospital in Kenya (Lopiding), who had sustained injuries in neighbouring Sudan. In all cases there had been a significant delay in the initial surgery (> 24 hours), and all patients were managed without stabilisation of the fracture by internal or external fixation. Of the 52 patients, three required an amputation for persisting infection of the fracture site despite multiple debridements. A further patient was treated by an excision arthroplasty of the hip, but this was carried out at the initial operation as a part of the required debridement. All of the remaining 48 fractures healed. Four patients needed permanent shoe adaptation because of limb shortening of functional significance. Although we do not advocate delaying treatment or using traction instead of internal or external fixation, we have demonstrated that open femoral fractures can heal despite limited resources

There are 33 million people worldwide currently infected with human immunodeficiency virus (HIV). This complex disease affects many of the processes involved in wound and fracture healing, and there is little evidence available to guide the management of open fractures in these patients. Fears of acute and delayed infection often inhibit the use of fixation, which may be the most effective way of achieving union. This study compared fixation of open fractures in HIV-positive and -negative patients in South Africa, a country with very high rates of both HIV and high-energy trauma. A total of 133 patients (33 HIV-positive) with 135 open fractures fulfilled the inclusion criteria. This cohort is three times larger than in any similar previously published study. The results suggest that HIV is not a contraindication to internal or external fixation of open fractures in this population, as HIV is not a significant risk factor for acute wound/implant infection. However, subgroup analysis of grade I open fractures in patients with advanced HIV and a low CD4 count (< 350) showed an increased risk of infection; we suggest that grade I open fractures in patients with advanced HIV should be treated by early debridement followed by fixation at an appropriate time

Conservative treatment is not always possibile because it needs anatomic reduction of the fractures and to prevent the functional difficulties. There’s inherent tendency loss of reduction after non-operative treatment. According to criteria of instability of Cooney et al. as dorsal angulation > 20° degrees, loss radial length> 10 mm, intraarticular extension, etc. or if we had fractures A3, B, C of A.O. classification, open, bilateral fractures in polytrauma, will be useful to operate with internal or external fixation. We need to respect the morphology of three columns. We compare two different types of devices usually used in the last ten years in our hospital as the external fixation with Pennig and the plates and screws in internal fixation, underlining the advantages and the disadvantages. Between January 1997 and December 2006 215 patients with comminuted and unstable fractures complicated with different clinical aspects of exposure or vasculopathy or neurological acute entrapment or lesion, of severe displacement were treated by external fixator of Pennig. They were evaluated according to Gartland e Werley system, Sarmiento modified. Pain, disability and functional disease of articulation, radiological criteria of instability. To follow up average 12,4 months (range 5 to 24 months) the patients were distinguished as excellent, good, in 76% and fair good and bad in 24%. Complications of treatment were 3 osteitis and trombosis. In the same period we applied 142 plates the most in the volar side as DCP, LCP in association when it needs with graft, pinning and platelet gel after centrifugation of blood of the patient useful to bone healing. These patients were evaluated regarding to anatomy and function after reduction as strength of punch by Jamar dynamometer, pain, range of motion. After three months the patients operated with plates showed a ROM and a strength of punch better than those operated by external fixator. On the contrary after six months, more and more after twelve months the clinical and radiological results that is anatomical and functional outcomes were the same. At one year the Dash score was the same in the both of groups and there was not a difference between them. So we are authorized to use the external fixator of Pennig in unstable fracture A3 of wrist after failure of closed reduction, higher energy fractures and dislocations, unstable articular methaepiphiseal and comminuted fractures, exposed fractures, bilateral and complicated in politrauma. We applied volar plate and screws when there are extraarticular displaced fractures (A3.3), articular displaced fracture (B, C), corrected osteotomies, particularly in fracture type B (internal osteosintesis with plate + eventual volar graft), type C (internal osteosintesis volar plate associated with dorsal approach and pinning) + possible graft

This study aims to ascertain the value of CT in assessing union of complex tibial fractures in patients treated with internal or external fixation. Twenty patients who fit the above criteria were selected from a list of those sent for CT lower leg by the department of Orthopaedics and Trauma at the Royal Infirmary of Edinburgh from 2007–2012. The x-rays chronologically closest to the CTs were assessed by two observers, and the results evaluated for inter-observer agreement. The observers recorded their general impression of whether there was adequate union for fixation removal, and scored the x-rays using the Radiographic Union Scale for Tibial fractures (RUST). There was fair agreement on “general impression” (kappa 0.36, 95% CI 0.08 to 0.64), but there was good agreement using the RUST score (ICC 0.81 95CI 0.12 to 0.96). However, only 45% of the x-rays could be rated by both observers due to obstruction from metalwork. The CT scans were assessed by two orthopaedic surgeons, first giving a general impression of whether there was adequate union for fixation removal, then using a modified RUST score. The inter-observer agreement was moderate in the former (kappa 0.55, 95% CI 0.18 to 0.89) and substantial in the latter (ICC 0.78 95% CI 0.40 to 0.92); only one image was unable to be assessed due to artefact. The author concludes that CT was useful in these patients due to the high number of x-rays in which cortices were obstructed by metalwork. Use of the RUST score improved inter-observer agreement, and would therefore be useful in both future studies and inter-departmental clinical communication. Further research is needed to relate use of the modified RUST score to clinical outcome

Aims. Lower limb fractures are common in low- and middle-income countries (LMICs) and represent a significant burden to the existing orthopaedic surgical infrastructure. In high income country (HIC) settings, internal fixation is the standard of care due to its superior outcomes. In LMICs, external fixation is often the surgical treatment of choice due to limited supplies, cost considerations, and its perceived lower complication rate. The aim of this systematic review protocol is identifying differences in rates of infection, nonunion, and malunion of extra-articular femoral and tibial shaft fractures in LMICs treated with either internal or external fixation. Methods. This systematic review protocol describes a broad search of multiple databases to identify eligible papers. Studies must be published after 2000, include at least five patients, patients must be aged > 16 years or treated as skeletally mature, and the paper must describe a fracture of interest and at least one of our primary outcomes of interest. We did not place restrictions on language or journal. All abstracts and full texts will be screened and extracted by two independent reviewers. Risk of bias and quality of evidence will be analyzed using standardized appraisal tools. A random-effects meta-analysis followed by a subgroup analysis will be performed, given the anticipated heterogeneity among studies, if sufficient data are available. Conclusion. The lack of easily accessible LMIC outcome data, combined with international clinical guidelines that are often developed by HIC surgeons for use in HIC environments, makes the clinical decision-making process infinitely more difficult for surgeons in LMICs. This protocol will guide research on surgical management, outcomes, and complications of lower limb shaft fractures in LMICs, and can help guide policy development for better surgical intervention delivery and improve global surgical care. Cite this article: Bone Jt Open 2024;5(11):1020–1026

Introduction. Surgical reconstruction of Charcot joint deformity is increasingly being offered to patients. In our centre a hybrid type fixation technique is utilised: internal and external fixation. This combined fixation has better wound management and earlier mobilisation in this deconditioned patient group. The aim of this study was to assess clinical, radiological and patient reported outcomes for all patients who underwent this hybrid technique. Methods. This is a prospective observational case series of all patients who underwent surgical reconstruction of Charcot foot deformity in a single centre between June 2017 and June 2023. Patient demographics, smoking status, diabetic control and BMI were recorded. Outcomes were determined from case notes and included clinical outcomes (complications, return to theatre, amputation and mortality) radiological outcomes and patient reported outcomes. The follow up period was 1–7 years post operatively. Results. 42 reconstructions were included. At the time of surgery the mean age was 59.1 years (29 – 91 years), average HbA1c was 65.2 (33–103); this did not correlate with return to theatre rate. 4 procedures were internal fixation alone (9.5%), 3 external fixation alone (7.1%) and 35 were combined fixation (83.3%). At most recent follow up 7 patients were deceased (16.7%), 2 patients had ipsilateral amputations, 2 had contralateral amputations. 11 patients had issues with recurrent ulcerations. Excluding refreshing of frames and operations on the contralateral side, 17 patients (40%) returned to theatre. We aim to present a detailed analysis of the rate of post-operative complications, return to theatre, radiographic outcomes and patient reported outcomes. Conclusion. This is the largest UK based case series of hybrid type Charcot joint reconstructions and shows that hybrid fixation is a viable option for patients undergoing Charcot joint reconstruction. To best confirm findings and determine which patients have the best post-operative prognosis a larger multi-centre study is required

Introduction. Ankle fractures in the elderly have been increasing with an ageing but active population and bring with them specific challenges. Medical co-morbidities, a poor soft tissue envelope and a requirement for early mobilisation to prevent morbidity and mortality, all create potential pitfalls to successful treatment. As a result, different techniques have been employed to try and improve outcomes. Total contact casting, both standard and enhanced open reduction internal fixation, external fixation and most recently tibiotalocalcaneal (TTC) nailing have all been proposed as suitable treatment modalities. Over the past five years popular literature has begun to herald TTC nailing as an appropriate and contemporary solution to the complex problem of high-risk ankle fragility fractures. We sought to assess whether, within our patient cohort, the outcomes seen supported the statement that TTC has equal outcomes to more traditional open reduction internal fixation (ORIF) when used to treat the high-risk ankle fragility fracture. Materials & Methods. Results of ORIF versus TTC nailing without joint preparation for treatment of fragility ankle fractures were evaluated via retrospective cohort study of 64 patients with high-risk fragility ankle fractures without our trauma centre. We aimed to assess whether results within our unit were equal to those seen within other published studies. Patients were matched 1:1 based on gender, age, Charlson Comorbidity Index (CCI) and ASA score. Patient demographics, AO/OTA fracture classification, intra-operative and post-operative complications, discharge destination, union rates, FADI scores and patient mobility were recorded. Results. There were 32 patients within each arm. Mean age was 78.4 (TTC) and 78.3 (ORIF). The CCI was 5.9 in each group respectively with mean ASA 2.9 (TTC) and 2.8 (ORIF). There were two open fractures within each group. Median follow up duration was 26 months. Time to theatre from injury was 8.0 days (TTC) versus 3.3 days (ORIF). There was no statistically significant difference in 30-day, one year or overall mortality at final follow up. Kaplan-Meier survivorship analysis did however demonstrate that of those patients who died post-operatively the mean time to mortality was significantly shorter in those treated with TTC nailing versus ORIF (20.3 months versus 38.2 months, p=0.013). There was no statistical difference in the overall complication rate between the two groups (46.9% versus 25%, p=0.12). The re-operation rate was twice as high in patients treated with TTC nailing however this was not statistically significant. There was no statistical difference in the FADI scores at final follow up, 72.1±12.9 (TTC) versus 67.9±13.9 (ORIF) nor post-operative mobility status. Conclusions. Within our study TTC nailing with an unprepared joint demonstrated broadly equivalent results to ORIF in the management of high-risk ankle fragility fractures; this replicates findings of previous studies. We did however observe that mean survival was significantly shorter in the TTC group than those treated with ORIF. We believe this may have been contributed to by a delay to theatre due to TTC stabilisation being treated as a sub-specialist operation in our unit at the time. We propose that both TTC and ORIF are satisfactory techniques to stabilise the frail ankle fracture however, similarly to the other fragility fractures, the priority should be on an emergent operation in a timely fashion in order to minimise the associated morbidity and mortality. Further randomised control studies are needed within the area to establish definitive results and a working consensus

Background. In 2011 Aird et al published their results of the effects of HIV on early wound healing in open fractures treated with internal and external fixation. The study was conducted between May 2008 and March 2009 and performed in semi-rural area of KwaZulu-Natal, South Africa. These results suggested that HIV is not a contraindication to internal or external fixation of open fractures, as HIV is not a significant risk factor for acute wound implant infection. We present a longer term follow up of this same cohort of patients from the original study. Methods. From March 2011 to January 2012 we attempted to contact all patients from Airds original study. A simple telephonic questionnaire was obtained from all the patients contacted, regarding possible late sepsis, non-union and implant removal. Patients were requested to visit the outpatient department for a clinical assessment, a repeat HIV test and new X-rays. Results. Of the initial 133 patients, 27 patients had external fixators, which were removed, leaving 106 patients with implants in situ at the time of follow up. Six patients had died, 4 of AIDS, 1 of a traffic accident and one of community assault. We were able to obtain telephonic questionnaires of 46 patients in total. Of these 46 patients, 31 were seen at a dedicated research clinic for re-assessment. In the initial study, 33 patients were HIV positive. We re-assessed 14 of these HIV positive patients and of these, 1 patient had metal removed for sepsis and 1 patient had a non-union. The remaining 12 patients had implants in situ without sepsis or non-union. Conclusion. This is the longest follow up to date of the effect of HIV on surgical implants following open fractures. Our results suggest HIV is not a contraindication for internal surgical fixation of open fractures in HIV positive patients with regards to long term sepsis and the risk of non-unions. THIS RESEARCH IS SUPPORTED BY A RESEARCH GRANT OF THE ROYAL COLLEGE OF SURGEONS

Introduction: The Staffordshire Orthopaedic Reduction Machine (STORM) was developed to assist in the reduction of tibial shaft fractures prior to the application of an external fixator. Its use has now been extended to fractures of the tibial plateau and plafond, where it has been utilised to gain and hold a good reduction prior to the application of various internal and external fixation techniques. Methods: The STORM was used sterile within the operative field on a standard radiolucent operating table. It was applied with two tensioned 2 mm wires: the distal through the calcaneum; the proximal through the proximal tibia for shaft and pilon fractures, and through the distal femur for plateau fractures. Controlled traction was applied through these two wires. Torsion was independently corrected and locked. Translation and angulation was corrected using two translation arms each applied to the tibia with a single unicortical screw. The STORM was removed at the end of each operation. Results: The STORM was used in 241 cases. Pilon (n=42): bridging hinge 23 (t [mean operation time in minutes]=102.9), percutaneous plate 10 (t=131.4), ring fixator 5 (t=140), screws and fibula plate 3 (t=77), other 2. Plateau (n=23): ring fixator 11 (t=129.7), LISS plate 8 (t=98.6 mins), monolateral Garches fixator 3 (t=64.4), screws only 1 (t=15). Shaft (n=176): monolateral fixator 138 (t=69.1), ring fixator 37 (t=131.2), nail 1 (t=65). Ilizarov rings up to 200 mm were accommodated. Discussion: The STORM is a safe device for reliable reduction of tibial plateau, shaft and pilon fractures which allows good access for internal or external fixation. No significant complications attributable to the use of the current design of the STORM were encountered

We present data showing predictable bone-inducing capacity of two types of tissue-bank manipulated bone allograft, which is used increasingly as biological allograft. The first type is an in-vitro tested demineralised bone matrix (DBM) composition of human long bone, which contains lyophilised cross-linked collagenous biomaterial as a delivery system. The composition is in the form of an allograft powder that is stable at room temperature and readily rehydratable into a putty-like consistency. Its superior co-adhesive properties enable it to remain at the implant site, resisting irrigation and displacement due to bleeding. We discuss a number of cases in which successful fusion of recalcitrant long bone fractures in humans followed implantation of the DBM-collagenous biomaterial composite. We also present data on a second type of manipulated human allograft, a reconstituted DBM with increased levels of osteogenic fractions derived from human cortical bone. The osteogenic fraction is rich in bone morphogenetic protein (BMP) and capable of inducing alkaline phosphatase activity in in vitro cultures of rat myoblast cells. Alkaline phosphatase is a well-known specific marker for bone forming activity. Thirty-four patients with persistent non-union (including partial or complete segmental defects) were treated with the BMP-collagen composite. All patients had previously been treated by internal or external fixation, cast immobilisation, and/or allogenic or autogenic bone grafting. Preoperative symptoms averaged 26 months (1 to 228). At surgery the hydrated implant was injected at the site of the defect, which was then stabilised by internal or external fixation. Early radiographs showed moderate bridging in all patients, indicating that h-BMP composite implants may be effective treatment of difficult nonunions

Human bone morphogenetic protein (hBMP) was prepared according to a modified method (Sampath et al). Implants were prepared with 500 μg of hBMP adsorbed onto a composite matrix (1 gm of insoluble collagenous bone matrix and 200 mg of lyophilised human gelatine). The hBMP/collagen composite was used to treat 11 women and 23 men (mean age 36 years). All patients had failed to achieve union despite previous treatment by internal or external fixation, immobilisation in a cast, and/or allogenic or autogenic bone grafting. The mean age of the nonunions was 26 months (1 to 228). At surgery a mean of 2 gm per patient of the composite was inserted at the site of the defect, which was stabilised by internal or external fixation. Supplementary allogenic cancellous bone particles and block configured spongy bone was used in 17 patients. At follow-up 1, 8, 16 and 23 weeks postoperatively, functional results were assessed according to weight-bearing. A score of 0 was given where there was no weight-bearing, a score of 1 for weight-bearing with the assistance of two crutches, 2 for light weight-bearing with one crutch, 3 for full weight-bearing with one crutch and 4 for full weight-bearing without crutches. At a mean follow-up of 17 weeks (8 to 32), the mean score was 3.25, higher than the mean preoperative score of 2.22 and mean one-week follow-up score of 0.5. Of the five patients who suffered recurrent infection, two failed to score above 2 at 17 weeks mean. Present results indicate that hBMP composite implants may represent effective treatment of difficult nonunions

The April 2012 Wrist & Hand Roundup. 360 . looks at releasing the trigger finger, function in the osteoarthritic hand, complex regional pain syndrome, arthroscopic ligamentoplasty for the injured scapholunate ligament, self-concept and upper limb deformities in children, wrist arthroscopy in children, internal or external fixation for the fractured distal radius, nerve grafting, splinting the PIPJ contracture, and finding the stalk of a dorsal wrist ganglion

Introduction. This study reviews the orthopaedic care of the thirteen patients who were admitted and treated at Royal Manchester Children's' Hospital following the Manchester Arena Bomb blast. Methods. We included all children admitted to Royal Manchester Children's Hospital injured following the bomb blast who either suffered upper limb, lower limb or pelvic fractures, or penetrating upper or lower limb wounds. The nature of each patient's bone and soft tissue injuries, initial and definitive management, and outcome were assessed and documented. Main outcome measures were time to fracture union, time to definitive soft tissue/skin healing, and functional outcome. Findings. Thirteen children were admitted with orthopaedic injuries; 12 were female and mean age was 12.69. All patients had penetrating deep wounds with at least one large nut foreign body in situ, two patients suffered significant burn injury, one patient required amputation of two digits, and two patients required local flap reconstruction. There were a total of 29 upper and lower limb fractures in nine of the patients, with the majority managed without internal or external fixation. In only half of the patients all fractures showed full radiological union at 6 months follow up. There was significant morbidity with several patients suffering long term physical and psychological disability and one patient still in hospital. Conclusion. We found that stable fractures in children secondary to blast injuries can often be appropriately managed without metalwork, and penetrating wounds can be managed without the need for skin graft/flap reconstruction. Our study documents the severe nature of the injuries suffered by paediatric survivors of the Manchester Arena bomb blast. It highlights the demands on a trauma unit following such an event

Aims: Osteomyelitis after open injuries or internal fixation of forearm fractures is uncommon. Established chronic infections do not respond fully to antibiotic suppression or limited debridement. We describe a two-stage treatment of segmental chronic osteomyelitis where wide excision of the affected area was followed by spanning external fixation and supplementary local and systemic antibiotic delivery. The bony defect was subsequently filled by vascularised fibula transfer, held by internal or external fixation. Methods: Eleven male patients (mean age 41 years) with post-traumatic segmental chronic osteomyelitis were reviewed. There were 6 radii and 5 ulnas; the mean post-debridement defect was 7.7cm (range 5–11cm). The first stage involved wide excision and metalwork removal, followed by application of a spanning external fixator to restore distal radio-ulnar congruency. Gradual distraction was needed in some cases with long standing subluxation. ‘Dead-space’ management used gentamicin beads or gentamicin-loaded calcium sulphate, supplemented with systemic antibiotics according to tissue culture results. A second stage reconstruction was performed after 4–6 weeks, using a free vascularised fibular graft, fixed using internal and/or external fixation. Results: The mean follow-up period was 42.4 months. There was no recurrence of infection and union occurred at both graft-host junctions in all patients. The mean period to radiographic bone union was 4.4 months (range 4–6 months). Patients gained an average of 46° forearm rotation (range 0–105°) with wrist or elbow motion significantly improved in 3 patients. At last review, all patients had a pain-free stable forearm with unhindered hand functions of grasp, hook and pinch. SF-36 assessment showed varied results, although mean values for the physical components of the survey were lower than general population values, while mental/emotional scores were as good. Conclusions: Staged reconstruction, as described, is a suitable treatment strategy for this challenging problem and produces a good functional outcome

Aims. Although infrequent, a fracture of the cuboid can lead to significant disruption of the integrity of the midfoot and its function. The purpose of this study was to classify the pattern of fractures of the cuboid, relate them to the mechanism of injury and suggest methods of managing them. Patients and Methods. We performed a retrospective review of patients with radiologically reported cuboid fractures. Fractures were grouped according to commonly occurring patterns of injury. A total of 192 fractures in 188 patients were included. They were classified into five patterns of injury. Results. Type 1 fractures (93 fractures, 48.4%) are simple avulsion injuries involving the capsule of the calcaneo-cuboid joint. Type 2 fractures (25 fractures, 13%) are isolated extra-articular injuries involving the body of the cuboid. Type 3 injuries (13 factures, 6.8%) are intra-articular fractures solely within the body of the cuboid. Type 4 fractures (35 fractures, 18.2%) are associated with disruption of the midfoot and tarsometatarsal injuries. Type 5 fractures (26 fractures, 13.5%) occur in conjunction with disruption of the mid-tarsal joint and either crushing of the lateral column alone or of both medial and lateral columns. Fractures with significant articular disruption or with loss of length of the lateral column underwent fixation. This involved either internal fixation to restore the anatomy of the cuboid and/or restoration of the length of the columns with bridging constructs using internal or external fixation. Conclusion. A classification system for fractures of the cuboid is proposed in relation to the mechanism of injury. The treatment of these fractures is described. Cite this article: Bone Joint J 2016;98-B:1003–8

Management of bone defects is a common surgical challenge encountered following any high energy trauma. Femur fractures with bone loss account for 22% of all the fractures with bone loss/defect, and 5% to 10% of distal femur fractures are open injuries. It was estimated in 2008, that, more than 4.5 million open fractures occur annually in India. In this retrospective study, patients who received bone allograft from our tissue bank between May 2012 and September 2015 were analysed. Of the 553 allografts issued, at that point in time, 26 were used in patients who underwent reconstruction for distal Femur fractures primarily. Fractures with defect or bone loss from 12 cc (1cm) to 144 cc (12cm) were treated with either Internal or External fixation and bone allograft. Morcellised cancellous, or a cortical strut, were used to fill or reconstruct the defect or void. The radiological outcome in terms of fracture union was assessed and Knee society score was used to assess the functional outcome. Complications such as non- union, infection, stiffness and need of revision or additional procedures were also assessed. Osseous consolidation was achieved in all the 26 patients with a Median time of 24 weeks (16 to 60). The Median Functional Knee Society Score was 80, indicating satisfactory functional outcome. Infection was noted in one patient, but it was not attributed to the allograft. Additional minor procedures like bone marrow infiltration, corticotomy for bone lengthening were required in 10 patients. Our studycomprises the largest group of patients treated primarily with Allograft to reconstruct or fill the void of bone loss encountered with distal Femur fracture. Reconstruction of massive bone defects, in patients of distal Femur fractures, with bone allograft, shows encouraging results. The surgeon can achieve the goal of restoring form and function of these difficult injuries in a single stage and the technique will provide the freedom to reconstruct the bony defect up to 150 cc (12 cm length) and recreate the anatomy to near normal. This allows for early mobilisation of patients and restoration of their daily routine at the earliest

Currently the debate continues in definitive fixation method for complex tibial plateau fractures. The aim of surgical management remains prevention of further damage to the articular cartilage, whilst avoiding iatrogenic risks - Low Risk Surgery (LRS). The purpose of this study was to determine the functional impact, clinical radiological outcome following tibial plateau fractures treated with either external fixation or internal fixation. 124 Schatzker IV-VI tibial plateau fractures were reviewed following surgical fixation. Fractures analysed included 24 type IV, 20 type V and 80 type VI tibial plateau fractures. The majority of Schatzker IV fractures were treated with internal fixation, but 67 of 80 Schatzker VI fractures were treated with the Ilizarov method. The average IOWA knee score, was 86 (16 to 100) and the average range of motion was 133 degrees (60 to 150). There were no differences between the circular fixator group and the internal fixation group in terms of range of motion or IOWA scores. There were comparable functional outcomes and complication rates between both groups. In summary patients with high energy tibial plateau fracture treated with internal or external fixation, have a good chance of achieving satisfactory long term knee function

Introduction. Metatarsocuneiform (MTC) fusion is a standard treatment for arthritis, instability, and deformity of these joint. The MTC fusion achieves a good clinical outcome, but nonunion rates up to 12% have been reported. There are different methods for fixation of first MTC joint arthrodesis. Our aim was to compare the biomechanical characteristic of internal and external fixation constructs. Hypothesis. Plantar plate fixation provides higher construct stiffness and endurance stability than intraosseous fixation. Materials & Methods. Seven pairs of fresh-frozen human specimens were used in a matched pair test. In one foot the MTC joint was supplied with a plantar plate. On the other foot intraosseous-screw fixation was perfomed. The specimen constructs were loaded in a 4 point bending test. Parameters obtained were initial stiffness and number of cycles to failure. Failure was defined as displacement of more than 3 mm plantar gapping. Results. The intraosseous-screw fixation group showed significantly (p=0.002) less cycles to failure (n=2946) than the plantare plate (n=7517). The initial stiffness was 131 N/mm for the plantare plate and 43 N/mm for the intraosseous implant (p=0.005). Discussion & Conclusion. Plantar plate fixation of the first MTC fusion created a stronger and stiffer construct than intraosseous fixation. This was likely due to the plantar and dorsal implant position. A stiffer construct can reduce the risk of non-union and shorten the period of nonweight-bearing