Medial opening wedge high tibial osteotomy (MOWHTO) is the workhorse procedure for correcting varus malalignment of the knee. There have been recent developments in the synthetic options to fill the osteotomy gap. The current gold standard for filling this osteotomy gap is autologous bone graft which is associated with donor site morbidity. We would like to introduce and describe the process of utilizing the novel Osteopore® 3D printed, honeycomb structured, Polycaprolactone and β-Tricalcium Phosphate wedge for filling the gap in MOWHTO. In the advent of additive manufacturing and the quest for more biocompatible materials, the usage of the Osteopore® bone wedge in MOWHTO is a promising technique that may improve the biomechanical stability as well the healing of the osteotomy gap.

Background

Acetabular fractures occur as a result of high-velocity trauma and are often associated with other life threatening injuries. Approximately one-third of these fractures are associated with dislocation of the femoral head but there are only few studies documenting the long term outcomes of this group of acetabular fracture.

This study reports on the natural history of acetabular fracture dislocations. We retrospectively reviewed patients who sustained an acetabular fracture associated with a posterior hip dislocation from a prospective database. Patient characteristics, complications and the requirement for further surgery were recorded. Patient outcomes were measured using the Oxford Hip score and Short Form SF-12 health survey.

A total of 99 patients were treated over a 24 year period. The mean age was 41 years. Open reduction and internal fixation was performed in the majority (n=87), 10 were managed conservatively following closed reduction and two underwent primary total hip replacement (THR). At a median follow up of 12.4 years (range 4–24 years) patient outcomes were available for 53 patients. 12 patients had died. 19 patients went onto have a THR as a secondary procedure, of which 11 had confirmed avascular necrosis. Median time to THR was 2 years (range 1–17 years). The mean Oxford hip score was 35 (range 2–48), SF-12 physical component score (PCS) was 40 and a third of the patients used a walking aid. In THR group the mean Oxford score was 32 (range 3–46), SF-12 PCS was 39 and almost all required a walking aid.

This is the first study to present the long term outcomes following an acetabular fracture dislocation. Our study suggests there is considerable disability in this group of patients and the requirement for subsequent THR has inferior patient reported outcomes.

In modern orthopaedics surgery, the pneumatic tourniquet has become an essential tool that paved the way to many of the advances in trauma and orthopaedic surgery. Tourniquet slippage is one of the challenging disadvantages of it use. This study examines the possibility of reducing tourniquet slippage by comparing two different tourniquet application techniques.

Twenty two patients were included in the study. Thirteen were males and eight were females. The average age was fifty five years. The patients were randomized into two groups, a controlled, and a modified tourniquet application technique groups. There were eleven patients in the control group and ten in the modified group. A standard tourniquet application technique was used as a control by applying Softband (Orthoband) alone to skin prior to application of tourniquet; this was compared to a modified version where a drape (Steridrape) was used as an interval layer.

There was a strong statistical significant difference in tourniquet slippage between the two groups, p< 0.0001 the control group being the better performer.

We concluded that steridrape interval makes tourniquet slippage more likely to occur.