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.

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.

Introduction: In a new external fixation system for tibial fractures, accurate reduction was achieved with a complex temporary device, the Staffordshire Orthopaedic Reduction Machine (STORM) following which the fracture was fixed using a simple titanium bar fixator (IOS). The fixator was designed to allow controlled bending to optimise movement at the fracture site for callus growth. Ideal mechanical properties are approached: elastic return is to the reduced position; epicentric placement minimises shear and distraction on weightbearing. Integral healing assessment measures bending stiffness. The device is single-use.

Methods: Closed or grade I compound unstable tibial shaft fractures in 38 patients were externally fixed using the STORM in the operating theatre to reduce the fracture prior to application of an IOS fixator. Immediate full weight-bearing was encouraged. Bending characteristics of the fixator allowed 1 mm of axial movement for 20 kg loading. Fixator removal time was determined by fracture stiffness measurements against which the integral IOS stiffness measurement was compared.

Results: Mean healing time was 18.1 weeks, shortest time 9.5 weeks. The healing endpoint was fixator removal at a bending stiffness of 15 Nm/deg in two orthogonal axes. There was no subsequent creep or re-fracture. Good reduction, defined as less than 3 deg of maximum angulation and less than 3 mm of maximum translation, was achieved and maintained.

Discussion: The IOS/STORM system allows safe and effective treatment of tibial shaft fractures. With the fracture reduced, the external fixator screws can be placed in optimum positions. Good reductions were achieved and maintained. The IOS bending characteristics appear to approach the optimum for callus growth. The simple integral fracture stiffness measurement method has been validated against more complex devices.

Mesenchymal stem cells (MSC) are suitable candidates for the cell-based cartilage reconstruction and have been isolated from different sources such as bone marrow (BMSC), adipose tissue (ATSC) and synovium (SMSC). The aim of this study was to analyse the tendency of BMSC, ATSC and SMSC to undergo hypertrophy during chondrogenic induction in vitro and to evaluate their in vivo development after ectopic transplantation into SCID mice in order to determine which cell source is most suitable for cartilage regeneration.

Human BMSC, ATSC and SMSC were cultured under chondrogenic conditions for five weeks. Differentiation was evaluated based on histology, gene expression, and analysis of alkaline phosphatase activity (ALP). Pellets were transplanted subcutaneously into SCID mice after chondrogenic induction for 5 weeks and analysed 4 weeks later by histology. Similar COL2A1:COL10A1 mRNA ratios were found in BMSC, ATSC and SMSC. BMSC displayed the highest ALP activities, SMSC had lower and heterogenic ALP activities in vitro which correlated with calcification of spheroids in vivo. Most SMSC transplants specifically lost their collagen type II in vivo or were fully degraded. BMSC and ATSC pellets always underwent vascular invasion and calcification in vivo. Single BMSC samples had the capacity to develop into woven bone or fully developed ossicles with hematopoietic tissue surrounded by a bone capsule.

Neither BMSC nor ATSC or SMSC were able to form stable ectopic cartilage. While BMSC and ATSC underwent developmental processes related to endochondral ossification instead of stable ectopic cartilage formation, SMSC tended to undergo fibrous dedifferentiation or degradation. Besides appropriate induction of chondrogenesis, locking of cells in the desired differentiation state is, thus, a further challenge for adult stem cell-based cartilage repair.