Open Reduction and Internal Fixation for Dorsal Fracture-dislocation of the Proximal Interphalangeal Joint.

PURPOSE: The purpose of this study was to investigate and compare the clinical and radiological results of ORIF with inter-fragment screw or buttress plate fixation of acute PIP joint fracture dorsal dislocation. PATIENTS AND METHODS: Between January 2007 to December 2016, nineteen patients - 14 men and 5 women with an average age of 40.9 (19 to 64) years - were included in this study; 9 patients underwent small sized interfragmentary screw fixation and 10 patients underwent small buttress plating. The average follow-up period was 45.1 (13 to 78) months. Clinical assessment included measurement of range of motion (ROM) of the proximal and distal interphalangeal joint (PIP, DIP), grip and pinch strength, and pain with use of the Visual Analog Scale (VAS). At the postoperative X-ray, articular step off, gap, and degree of dorsal subluxation was measured, and maintenance of the reduction, fracture union, and the presence of degenerative changes were assessed. RESULTS: All patients achieved solid unions without instability. The overall average range of motion of PIP joint were from 9° to 85° (10-83° in the screw group, 8-87° in the plate group without significant difference). However, the screw group (average: 53°) presented more flexion in the distal interphalangeal joint than the plate group (average: 34°). Plate fixation can cause limited DIP flexion. Six of the ten patients from the plate group, underwent implant removal and two of these patients required PIP joint arthrolysis due to the PIP flexion contracture of more than 30°. Three of the nine patients in screw group underwent implant removal and two of the three patients required PIP joint arthrolysis. CONCLUSION: Mini plate and screw fixation of acute PIP joint fracture dorsal dislocation can achieve comparable favorable clinical and radiographic outcomes through stable fixation and early range of motion exercise. Screw fixation, if possible, is probably preferable to plate fixation because of better DIP joint ROM and lower incidence of hardware removal. If there is a need for plate fixation the use of a short plate is recommended to avoid joint stiffness.

Kienböck's disease with non-negative ulnar variance : Treatment with combined radial wedge and shortening osteotomy.

PURPOSE: There are only few studies that focused on Kienböck's disease with non-negative ulnar variance, even though many surgical procedures have been introduced. A combined radial wedge and shortening osteotomy was carried out for Kienböck's disease with non-negative ulnar variance. The purpose of this article is to report the results of this procedure by analyzing the clinical and radiological data. MATERIAL AND METHODS: The data for patients with Kienböck's disease who were treated by combined radial wedge and shortening osteotomy between 2007 and 2016 were retrospectively reviewed. A total of 18 patients (8 males, 10 females), average age 37 years, were included in this study and the mean follow-up period was 22.3 months. Radiological analysis included Lichtman stage, ulnar variance, radial inclination, carpal height ratio, radioscaphoid angle and Stahl's index. Clinical analysis included range of motion (ROM), visual analog scale (VAS) score, grip power, modified Mayo wrist score (MMWS), and disabilities of arm, shoulder and hand (DASH) score. RESULTS: Preoperative radiological analysis showed 16 cases of Lichtman stage IIIA and 2 cases of stage IIIB. Preoperative ulnar variance was +0.51 mm, radial inclination was 27.7o, carpal height ratio was 0.49, radioscaphoid angle was 52.8o and Stahl's index was 0.42. All patients had solid union at the osteotomy site. At the final follow-up the average ulnar variance was +1.9 mm, radial inclination was 16.5o, carpal height ratio was 0.48, radioscaphoid angle was 58.2o and Stahl's index was 0.36. Clinical analysis showed that the average dorsiflexion of the wrist was increased by 8.4o and palmar flexion of the wrist was increased by 29.6o. Grip power was increased by an average of 9.9 kg. Average VAS at the final follow-up was 1.0, DASH score was 4.3, and modified Mayo wrist score was 78.1. CONCLUSION: Radial wedge and shortening osteotomy can be recommended as an option for Kienböck's disease with non-negative ulnar variance, based on acceptable results from this study.

Modification of Titanium Implant and Titanium Dioxide for Bone Tissue Engineering.

Bone tissue engineering using titanium (Ti) implant and titanium dioxide (TiO2) with their modification is gaining increasing attention. Ti has been adopted as an implant material in dental and orthopedic fields due to its superior properties. However, it still requires modification in order to achieve robust osteointegration between the Ti implant and surrounding bone. To modify the Ti implant, numerous methods have been introduced to fabricate porous implant surfaces with a variety of coating materials. Among these, plasma spraying of hydroxyapatite (HA) has been the most commonly used with commercial success. Meanwhile, TiO2 nanotubes have been actively studied as the coating material for implants, and promising results have been reported about improving osteogenic activity around implants recently. Also porous three-dimensional constructs based on TiO2 have been proposed as scaffolding material with high biocompatibility and osteoconductivity in large bone defects. However, the use of the TiO2 scaffolds in load-bearing environment is somewhat limited. In order to optimize the TiO2 scaffolds, studies have tried to combine various materials with TiO2 scaffolds including drug, mesenchymal stem cells, Al2O3-SiO2 solid and HA. This article will shortly introduce the properties of Ti and Ti-based implants with their modification, and review the progress of bone tissue engineering using the TiO2 nanotubes and scaffolds.

Early rehabilitation after open repair for patients with a rupture of the Achilles tendon.

PURPOSE: As outdoor activities participation increase, Achilles tendon rupture incidence also tends to increase. There are a number of treatment and rehabilitation options for a ruptured Achilles tendon. However, the optimal rehabilitation protocols are still under debate. The purpose of this study is to determine whether early rehabilitation is more effective than conventional rehabilitation. METHODS: Medical records of 56 patients who had been treated with open repair after a ruptured Achilles tendon were retrospectively reviewed. 24 patients were treated postoperatively with below knee cast immobilization for four weeks, and they started tolerable weight-bearing rehabilitation at four weeks' follow-up. The remaining 32 patients were managed postoperatively with short leg splint immobilization for two weeks and started the tolerable weight-bearing at two weeks' follow-up. We evaluated the patients several times to identify when the single heel raise was possible and measured the American Orthopedic Foot and Ankle Society (AOFAS) scores and Achilles tendon total rupture scores (ATRS) as a functional outcome. RESULTS: The single heel raise test was positive in all patients at the last assessment. But there were no statistically significant differences between the groups (p=0.137). The patients in the Cast group took significantly more time to return to work than did the patients in the Splint group (p=0.032). And AOFAS scores and ATRS were slightly higher in the Splint group than in the Cast group. There were statistically significant differences (p=0.042, p=0.028) between the two groups. CONCLUSION: The early rehabilitation did not lead to greater endurance, but it showed better results in the return to work and the Achilles functional score. Early rehabilitation after open repair for patients with a ruptured Achilles tendon is helpful for functional recovery. Type of study / Level of evidence: Therapeutic, Level III.