Eccentric Taylor spatial frame placement for the correction of femoral fracture deformity: a novel technique.

The treatment of post-traumatic femoral deformity with circular frames can be difficult both for the patient and for the surgeon. Patients frequently suffer from residual knee stiffness, and the cumbersome location of the frame can even result in psychiatric problems such as depression and anxiety during their treatment. Here we describe a novel technique of constructing the Taylor spatial frame (TSF) eccentrically from the femur to allow the same level of comfort as a monolateral external fixator, while applying trigonometric principles to successfully retain the utility of the TSF prescription software. Deformity correction and fracture compression can therefore still be achieved in a controlled and predictable manner on an outpatient basis.

Surgical management of complex intra-articular distal femoral and bicondylar Hoffa fracture.

Bicondylar Hoffa's fractures of distal femur are rare. We report the case of an 18-year-old male who sustained a closed complex fracture of both femoral condyles of the left femur on the sagittal plane (Hoffa fracture), combined with distal metaphyseal fracture. He was treated using parallel plates and interdigitating screws, with our technique based on an extrapolation of the principles of distal humerus fixation. The fracture united clinically and radiologically at 16 weeks. Twelve months postoperatively, the range of movement in the knee was 5°-115°. In this complex case, our technique provided stable fixation of the fragments and a satisfactory final functional outcome.

Biomechanical study of different plate configurations for distal humerus osteosynthesis.

Fractures of the distal humerus are most commonly fixed by open reduction and internal fixation, using plates and screws, either in a locking or in a non-locking construct. Three different plating systems are commonly used in practice. The most important differences between them are in plate orientation, which affects both the rigidity of the osteosynthesis and invasiveness of the surgical procedure. Unfortunately, there is no common agreement between surgeons about which plate configuration brings the best clinical outcome. In this study, we investigate the theoretical rigidity of plate osteosyntheses considering two types of AO/ASIF configurations (90° angle between plates), Mayo clinic (Acumed) configuration (180° between plates) and dorsal fixation of both plates. We also compared the results for cases with and without contact between the bone fragments. In the case of no bone contact, the Mayo clinic plate configuration is found to be the most rigid, followed by both AO/ASIF plate configurations, and the least rigid system is the Korosec plate configuration. On the other hand, no significant differences between all types of fixation configurations are found in cases with contact in-between the bone fragments. Our findings show that this contact is very important and can compensate for the lack of load carrying capacity of the implants. This could therefore incite other implant fixation solutions, leading to less invasive surgical procedures and consequently improved clinical outcome.

A novel technique for the treatment of infected metalwork in orthopaedic patients using skin closure over irrigated negative pressure wound therapy dressings.

INTRODUCTION: There has been recent interest in the use of negative pressure wound therapy (NWPT) as an adjunct to parenteral antibiotics in the treatment of infection in orthopaedic patients with metalwork in situ. To address some of the limitations of standard NPWT in this situation, the senior author has developed a modified method of treatment for infected metalwork (excluding arthroplasty) in orthopaedic patients that includes irrigation and skin closure over the standard NPWT dressing. METHODS: This retrospective study examined the outcome of a case series of 16 trauma and orthopaedic patients with deep infection involving metalwork in whom this modified form of NPWT was used. In conjunction with standard parenteral antibiotic therapy and a multidisciplinary approach, this modified technique included serial debridements in theatre, irrigation and negative pressure dressings over a white polyvinyl alcohol foam (KCI, Kidlington, UK) as well as closure of the skin over the foam. RESULTS: Among the 16 patients, there was a variety of upper and lower limb as well as spinal trauma and elective cases. In all 16 patients, there was successful resolution of the infection with no early or unplanned removal of any metalwork required. CONCLUSIONS: Patients with infected metalwork are a heterogeneous group, and often suffer high morbidity and mortality. The modified NPWT technique shows potential as an adjunct in the treatment of complex orthopaedic patients with infected metalwork.

Stabilisation of the elbow in cases of severe disruption of the lateral collateral complex.

INTRODUCTION: Rupture of the lateral collateral ligamentous complex of the elbow is a serious injury. If direct repair of the ligamentous complex is not possible, then an alternative method must be found to stabilise the elbow. MATERIALS AND METHODS: We describe a novel method of maintaining stability while allowing early movement in a severe injury to the elbow. CONCLUSION: This technique is a viable alternative to hinged external fixation in patients with severe lateral instability of the elbow joint.

Polymorphisms in the promoter region of the basic fibroblast growth factor gene are not associated with myocardial infarction in a Slovene population with type 2 diabetes.

Basic fibroblast growth factor (bFGF) is a multifunctional growth factor that may play a significant role in atherosclerotic vascular complications in patients with type 2 diabetes. This study was designed to investigate the association between genetic polymorphisms (-553 T/A, -834 T/A and -921 C/G) in the promoter region of the bFGF gene and myocardial infarction (MI) in 443 patients with type 2 diabetes (149 with MI and 294 with no history of coronary artery disease). The -553 T/A, -834 T/A and -921 C/G polymorphisms of the bFGF gene were found not to be risk factors for MI in patients with type 2 diabetes. The impact of bFGF gene polymorphisms on serum bFGF levels was also investigated and significantly higher serum levels of bFGF were demonstrated in diabetes patients with the TA genotype of the -553 T/A polymorphism compared with diabetes patients with the TT wild type genotype (9.0 +/- 5.6 ng/l versus 3.0 +/- 1.9 ng/l, respectively). Thus, the tested bFGF gene polymorphisms cannot be used as genetic markers for MI in diabetic Caucasians.

Modified pre-curved patellar basket plate, reconstruction of the proper length and position of the patellar ligament--a biomechanical analysis.

Biomechanical properties of basket plate fixation for fracture dislocation in the distal part of the patella were studied on 22 fresh-frozen lower extremities (human cadaveric knees). The patella and the patellar ligament with the proximal tibia were removed. A comminuted fracture of the distal part of the patella was created with a chisel. The fractured patella, patellar ligament and tibial tuberosity of each specimen were fixed with a basket plate and mounted into the jaws of the testing machine. The measured load to failure was 421.66+/-45.90 N, which is approximately 70% higher than the results in other studies. The results of the measurements verified the results of finite element analysis. The modified precurved patellar basket plate developed in this study showed improved performance compared to the pre-existing fixation methods.

Subperiosteal elevation of the ulnar nerve during internal fixation for fractures of the distal humerus assessed by intra-operative neurophysiological monitoring.

Ulnar nerve function, during and after open reduction and internal fixation of fractures of the distal humerus with subperiosteal elevation of the nerve, was assessed by intra-operative neurophysiological monitoring. Intermittent recording of the compound muscle action potentials was taken from the hypothenar muscles in 18 neurologically asymptomatic patients. The mean amplitude of the compound muscle action potential after surgery was 98.1% (sd 17.6; -37% to +25%). The amplitude improved in six patients following surgery. Despite unremarkable recordings one patient had progressive paresis. Motor impairment is unlikely if the compound muscle action potential is continuously preserved and not reduced by more than 40% at the end of surgery. Temporary decreases in amplitude by up to 70% were tolerated without clinical consequences. However, repeated clinical examination is obligatory to recognise and treat early post-operative palsy.