Abstract. Background. Aim of this study is to determine the difference between re-operation rates after conventional Methods of fixation of patella fractures using Metallic implants and novel technique of all suture fixation using Ethibond or fiber tape. Methods. This is a retrospective comparative analysis involving 62 patients who had a transverse patellar fracture and underwent surgery between January 2013 to December 2021. Selected patients were divided, based on different fixation methods used, into four groups - TBW group, CC screw group, Encirclage group and Suture Fixation Group. Patients were followed till bone union was evident on radiographs. Number of patients in Metallic implant group undergoing repeat operation were compared with the patients who underwent patella fracture fixation using all suture technique. Mean and standard deviation (SD) were calculated for all continuous variables. Mean of the two groups was compared using unpaired t-test. Results. TBW was the most common method of fixation used in 41(66.1%) patients. 7 patients each underwent surgery using CC screw, Encirclage +/− TBW, and suture fixation respectively. Bone union was seen in about 85% of patients in all the groups suggesting all treatment modalities lead to good fracture healing. 15 patients(36.6%) of patients in TBW group and 3 patients(42.9%) in encirclage group had implant removal because of hardware-related complications (p<0.001). None of the patient who underwent All suture Fixation underwent re-operation. Conclusion. The results suggest that Suture fixation of patellar fractures is a valid treatment modality giving excellent results with similar bone union rates without any complications

The Bernese periacetabular osteotomy (PAO) is a well-established procedure in the management of symptomatic hip dysplasia. The associated Smith-Petersen exposure offers excellent visualization of the acetabulum and control of acetabular osteotomy and mobilization. The traditional exposure of the true pelvis involves osteotomy of the iliac wing in order to mobilize the sartorial and inguinal ligament insertion. However, full osteotomy of the iliac spine may necessitate screw fixation if a relatively large segment of bone is included. A known complication with screw fixation of the iliac wing osteotomy involves failure of fixation and screw back out. Moreover, the screw may be irritative to the patient even in the setting of adequate fixation. A larger osteotomy may also injure the lateral femoral cutaneous nerve as it travels near the anterior superior spine. To minimize the risk of these potential complications, a wafer osteotomy may be used to develop a sleeve of tissue involving the sartorial insertion. Markings may be made so that the curvilinear incision is centered about the anterior-superior iliac spine (ASIS). The sartorial sleeve also mobilizes the entirety of the lateral femoral cutaneous nerve medially as it runs and branches to varying degrees in a fatty tissue layer in the tensor-sartorius interval directly beneath the subcutaneous layer, thereby affording protection throughout the procedure. When the ASIS is first osteotomized as a several millimeter-thick mobile fragment and reflected, the sartorius attachment to the mobile fragment of the wafer osteotomy may be preserved. Furthermore, the wafer osteotomy may be re-fixed to the stable pelvis during closure with simple heavy suture fixation alone, avoiding screw insertion or associated removal. Because only a wafer or bone is taken during the spine osteotomy, more bone is available at the ASIS for fixation of the mobile fragment after repositioning. In this technical note, we describe the wafer osteotomy technique in further detail. For any figures or tables, please contact authors directly

We present a case series of patients who underwent 3 or 4 part proximal humerus fracture fixation using an intra-osseous suture technique. 18 patients are included in the study with follow up data obtained ranging from 1 to 4 years. Oxford Shoulder Scores (OSS) and range of movement measurements were taken for all patients. The mean OSS for the group was 50/60 with a mean forward flexion of 140°, abduction of 132°, external rotation of 48° and internal rotation to the level 10. th. thoracic vertebra. Three patients developed adhesive capsulitis, 2 requiring subsequent arthroscopic release. This data compares favourably to outcomes reported in the literature with hemiarthroplasty or locking plate fixation. An activity based costing analysis estimated that the treatment costs for proximal humerus fractures was approximately £2,055 when performing a soft tissue reconstruction, £3,114 when using a locking plate and £4,679 when performing a hemiarthroplasty. This demonstrates a significant financial saving when using intra-osseous fixation compared to other fixation techniques. We advocate the use of the intra-osseous suture fixation technique for certain 3 and 4 part fractures. It gives good functional outcomes, significant cost savings and potentially makes revision procedures easier when compared to other fixation techniques

This paper reports a series of comparative tests in-vitro that examined how lateral meniscectomy and meniscal allografting affected tibio-femoral joint contact pressures. 8 Cadaver knees (age range 81 – 98 years) were loaded in axial compression in an Instron materials testing machine up to 700N for 10 seconds and pressure maps obtained from the lateral compartment using Fuji Prescale film inserted below the meniscus. This was repeated after meniscectomy, then after meniscal allografting with fixation by a bone plug for the insertional ligaments, plus peripheral sutures. Finally, the pressure when the allograft was secured by peripheral sutures alone was measured. Meniscectomy caused a significant increase in peak contact pressures (p=0.0002). Both of the reconstructive methods reduced the peak contact pressures significantly below that of the meniscectomised knee (p=0.0029 with bone block; p=0.0199 with sutures alone). A significant difference was not found between the peak contact pressures after the reconstructions and that of the intact knee (p=0.1721 with bone block; p=0.0910 with sutures alone). The peak pressures increased slightly when the allografts were converted from bone block to suture-only fixation (p=0.0349). The principal finding was that both of the meniscal allograft insertion techniques reduced the peak contact pressure significantly below that of the meniscectomised knee, so that it did not then differ significantly from the peak contact pressure in the intact knee. When the two fixation methods were compared, the loss of the bone plug attachment caused a small increase in peak pressure. This study suggests that meniscal allografting should have a chondroprotective effect and that there is a small advantage from adding bony fixation to suture fixation

Successful ORIF of proximal humeral fractures requires a careful assessment of the patient factors (age/osteoporosis/functional expectations), accurate identification the fracture segments (head/shaft/tuberosities) and accessory factors which are of vascular and surgical relevance (length of posteromedial metaphyseal head extension, integrity of medial soft tissue hinge, head split segments, tuberosity/head segments impacted to-gether or distracted apart). Fixation of the fracture can be achieved by a number of techniques because of the multiple factors that often apply—numerous techniques are usually required of the surgeon. The principles of fixation require accurate restoration of the head and tuberosity orientation, fixation of the metaphyseal segments (tuberosities) results in a stable circular platform on which the head segment rests. Thus, the fixation of choice acts as a load sharing device not a load bearing device. This fixation is often augmented with tension band and circlage suture fixation. These concepts are especially applicable to the osteoporotic patient. The order of fixation requires that the medial hinge not be disrupted. If it is disrupted in the younger patient it requires fixation first. All tuberosity segments are tagged with ethibond sutures. The head and the largest tuberosity segment are reduced and held with k-wire or canulated scews, avoiding the central medullary canal entry point. If the head tuberosity segment is unstable in relation to the shaft, the fixation implant of choice (plate/intramedullary) is chosen and the head/tuberosity complex is reduced to the shaft. Depending on the fracture segments and the degree of comminution this may require compression of distraction. Post-op the patient is immobilised in external rotation to balance the cuff forces. If very rigid fixation is achieved then early mobilisation is undertaken to minimise the adhesions due to opening of the subdeltoid space. If fixation is tenuous movement is commenced a 3–4 weeks. AVN of the humeral head with good tuberosity head architecure can be salvaged. The diagnosis of AVN is determned at three months with a MRI and consideration given to Zolidronate therapy. Post-traumatic stiffness with good architecture can be salvaged with an arthroscopic capsular release