Anterior tibial artery and deep peroneal nerve entrapment in spiral distal third tibia fracture.

The rate of injury to arterial structures following long bone injuries is low. The rate in tibial diaphyseal fractures is similarly low. This rate increases with open fractures, likely reflective of the higher energy nature of open fractures. The possibility of iatrogenic injury to neurovascular structures during fracture fixation is more concerning. Consequently, the clinician must be aware of the location of neurovascular structures and the possible distortion of the normal anatomy when treating fractures. The anterior tibial artery is in proximity to the distal tibia. Typically, the neurovascular bundle lies directly on the anterolateral tibia between the tibialis anterior and the extensor hallucis longus in the distal third of the tibia. After fracture, this normal relationship may be disrupted.

Osteochondral shortening osteotomy for the treatment of ulnar impaction syndrome: a new technique.

A new technique for ulna shortening is described. It is a modification of the open-wafer procedure that preserves the distal ulna's articular surface. A 4- to 5-mm chondral-cortical bone block is removed at the distal ulna articular-metaphysis junction. Closing the bone gap results in the osteotomy site proximal to the sigmoid notch. The distal ulna chondral-cortical fragment is secured with 1 or 2 headless compression screws, which permit early motion and results in solid healing. Similar to Feldon's previously described open-wafer procedure, this new technique reduces the ulna carpal load by reducing the distal ulna carpal length at the distal radioulnar joint. This new technique eliminates the exposure of the radiocarpal joint to continuous bleeding from the distal ulna's trabecular bone as seen in Feldon's open-wafer procedure and avoids all the inherent problems associated with plating the ulna for a typical distal ulna osteotomy, such as delayed union and painful hardware.

rhBMP-2 (ACS and CRM formulations) overcomes pseudarthrosis in a New Zealand white rabbit posterolateral fusion model.

STUDY DESIGN: The study design consisted of a New Zealand white rabbit model of pseudarthrosis repair. Study groups consisting of no graft, autograft, or recombinant human bone morphogenetic protein-2 (rhBMP-2) with absorbable collagen sponge (ACS) or compression resistant matrix (CRM) were evaluated. OBJECTIVE: To evaluate the relative efficacy of bone graft materials (autograft, ACS, and CRM). SUMMARY OF BACKGROUND DATA: rhBMP-2 has been shown to have a 100% fusion rate in a primary rabbit fusion model, even in the presence of nicotine, which is known to inhibit fusion. METHODS: Seventy-two New Zealand white rabbits underwent posterolateral lumbar fusion with iliac crest autograft. To establish pseudarthroses, nicotine was administered to all animals. At 5 weeks, the spines were explored and all pseudarthroses were redecorticated and implanted with no graft, autograft, rhBMP-2/ACS, or rhBMP-2/CRM. At 10 weeks, fusions were assessed by manual palpation and histology. RESULTS: Eight rabbits (11%) were lost to complications. At 5 weeks, 66 (97%) had pseudarthroses. At 10 weeks, attempted pseudarthrosis repairs were fused in 1 of 16 of no graft rabbits (6%), 5 of 17 autograft rabbits (29%), and 31 of 31 rhBMP-2 rabbits (with ACS or CRM) (100%). Histologic analysis demonstrated more mature bone formation in the rhBMP-2 groups. CONCLUSIONS: The 2 rhBMP-2 formulations led to significantly higher fusion rates and histologic bone formation than no graft and autograft controls in this pseudarthrosis repair model.