Arthroscopy Assisted Balloon Osteoplasty of a Tibia Plateau Depression Fracture: A Case Report.

CONTEXT: A clinical case of a tibia plateau fracture is presented which was treated with balloon osteoplasty and arthroscopy guidance. Balloon Tibioplasty has been shown to be a very useful method for the management of tibial plateau fractures. The use of calcium phosphate has been described in the literature for management and restoration of bone defects in tibial plateau fractures. CASE REPORT: A 45-years-old Caucasian woman was presented after a fall from a ladder. The patient sustained a lateral tibia plateau fracture which was classified as Shatzker type III (AO 41-B2) with posterolateral depression of the joint surface. Surgical treatment was applied using a minimal approach which included percutaneous reduction of the fracture under arthroscopy and fluoroscopy guidance. The bone defect was filled with calcium phosphate via injection. The clinical outcome at the 6, 12 and 24 weeks was excellent with full-range of motion of the knee joint. CONCLUSION: Arthroscopy assisted balloon osteoplasty seems to be a safe and effective method for the treatment of depressed tibia plateau fractures. Further study is needed for the proper evidence based use and application of this method.

Sliding screw implants for extracapsular hip fractures.

Hip fractures are associated with significant mortality and morbidity for the patients, more dependent residual status, and increased socio-economic cost. Many hip-fracture patients experience severe functional impairment, and most never recover their pre-fracture level of function. Current research has sought to identify the most effective treatments to reduce the incidence of hip fractures, improve survival and quality of life, and minimize complications and disability. The treatment of these fractures in the elderly aims to return these people to their pre-fracture mobility and functional level. This article reviews the surgical treatment options for extracapsular hip fractures and discusses their associated advantages, disadvantages, and complications. Two types of implants are currently available: the dynamic hip screw (DHS), and the intramedullary hip nail with one or two sliding screws. In this review, no clear advantage of one implant over another for the treatment of extracapsular hip fractures was evident. Both the DHS and hip nails can be used successfully for the treatment of stable hip fractures; for unstable fractures and low subtrochanteric fractures, hip nails are preferred. Although hip nails are associated with limited exposure, lower blood loss and transfusion requirements, and shorter operative time, complications are more common with hip nails. Long-term survival and function are similar in the two approaches. Hip nails with two sliding screws do not seem to make the difference in clinical practice that is reported in biomechanical studies.

Comparison of migration behavior between single and dual lag screw implants for intertrochanteric fracture fixation.

BACKGROUND: Lag screw cut-out failure following fixation of unstable intertrochanteric fractures in osteoporotic bone remains an unsolved challenge. This study tested if resistance to cut-out failure can be improved by using a dual lag screw implant in place of a single lag screw implant. Migration behavior and cut-out resistance of a single and a dual lag screw implant were comparatively evaluated in surrogate specimens using an established laboratory model of hip screw cut-out failure. METHODS: Five dual lag screw implants (Endovis, Citieffe) and five single lag screw implants (DHS, Synthes) were tested in the Hip Implant Performance Simulator (HIPS) of the Legacy Biomechanics Laboratory. This model simulated osteoporotic bone, an unstable fracture, and biaxial rocking motion representative of hip loading during normal gait. All constructs were loaded up to 20,000 cycles of 1.45 kN peak magnitude under biaxial rocking motion. The migration kinematics was continuously monitored with 6-degrees of freedom motion tracking system and the number of cycles to implant cut-out was recorded. RESULTS: The dual lag screw implant exhibited significantly less migration and sustained more loading cycles in comparison to the DHS single lag screw. All DHS constructs failed before 20,000 cycles, on average at 6,638 +/- 2,837 cycles either by cut-out or permanent screw bending. At failure, DHS constructs exhibited 10.8 +/- 2.3 degrees varus collapse and 15.5 +/- 9.5 degrees rotation around the lag screw axis. Four out of five dual screws constructs sustained 20,000 loading cycles. One dual screw specimens sustained cut-out by medial migration of the distal screw after 10,054 cycles. At test end, varus collapse and neck rotation in dual screws implants advanced to 3.7 +/- 1.7 degrees and 1.6 +/- 1.0 degrees , respectively. CONCLUSION: The single and double lag screw implants demonstrated a significantly different migration resistance in surrogate specimens under gait loading simulation with the HIPS model. In this model, the double screw construct provided significantly greater resistance against varus collapse and neck rotation in comparison to a standard DHS lag screw implant.

The role of plating in the operative treatment of severe open tibial fractures: a systematic review.

Open fractures of the tibial diaphysis are the result of high-energy trauma. They are usually associated with extensive soft tissue loss and represent serious clinical problems. Surgical treatment of these injuries has been associated with substantial complications such as osteomyelitis, delayed bone healing, poor functional outcome, soft-tissue failure, or even amputations. More recently a staged treatment, with initial application of spanning external fixators followed by definitive fixation at secondary phase, has been advocated. Plating of these fractures in the acute setting remains a topic of heated discussion. A systematic review of the literature was carried out in order to investigate the existing evidence concerning the efficacy and safety of this method of osteosynthesis. Eleven papers met the inclusion criteria, accumulating 492 open tibial fractures treated with plating. The overall union rate ranged from 62-95% across all studies, with time to union ranging from 13-42 weeks. The reoperation rate ranged from 8-69% and a pooled estimate of deep infection rate was calculated at 11%. Plate fixation for the treatment of open tibial fractures can be considered under specific conditions which need to be elicited and clarified with future well-designed and conducted clinical trials.

Reconstruction of a severe open distal humerus fracture with complete loss of medial column by using a free fibular osteocutaneous graft.

OBJECTIVE: Open intra-articular fractures of the distal humerus can be associated with considerable bone loss and extensive soft tissue damage. The management of these injuries is quite challenging, and the restoration of elbow anatomy may require multiple bone and soft tissue surgical procedures. The purpose of this case report is to present the option of addressing at the same time a complex skin, muscular, and bone distal humerus defect by using a composite vascularized graft. METHODS: We present a case of a high-energy open fracture of the distal humerus in a polytrauma young patient. Apart from the significant damage of all skin layers and underlying muscle units at the posterolateral side of the elbow, the medial column of the distal humerus (6 cm in length) was completely absent. After patient resuscitation and wound debridement, a free vascularized osteocutaneous fibular graft was used for the reconstruction of the bone defect and the restoration of elbow anatomy. RESULTS: No complications were encountered during the postoperative period, and both bone and soft tissues progressed to sound healing. At 26 months follow-up, the patient had a functional and stable elbow and the Mayo Elbow Performance Score was 85 points, which is equivalent to a good result. CONCLUSIONS: Vascularized osteocutaneous fibular graft could effectively address complex traumatic defects of the elbow joint and enhance the potential for bone healing and early functional recovery.