High Percentage of Complications and Re-Operations Following Dynamic Locking Plate Fixation with the Targon® FN for Intracapsular Proximal Femoral Fractures: An Analysis of Risk Factors.

The ideal surgical treatment of femoral neck fractures remains controversial. When treating these fractures with internal fixation, many fixation constructs exist. The primary aim of this study was to evaluate the incidence and specific risk factors associated with complication and re-operation following fixation of intracapsular proximal femoral fractures using the Targon-FN system (B.Braun Melsungen AG). A secondary aim was to identify if lateral prominence of the implant relative to the lateral border of the vastus ridge was a specific risk factor for elective plate removal. Methodically, a retrospective case series was conducted of all consecutive adult patients treated at a single level 1 trauma center in Switzerland for an intracapsular proximal femoral fracture with the Targon-FN. Demographic data were collected. Patients with a follow-up of less than three months were excluded. Complications as well as plate position were recorded. Statistical analysis to identify specific risk factors for re-operation and complications was performed. In result, a total of 72 cases with intracapsular femoral neck fractures were treated with the Targon-FN locking plate system between 2010 and 2017. Thirty-four patients (47.2%) experienced one or more complications. The most common complication was mechanical irritation of the iliotibial band (ITB) (23.6%, n = 17). Complications included intraarticular screw perforation (6.9%, n = 5), avascular necrosis (5.6%, n = 4), non-union (5.6%, n = 4) among others. In total, 46 re-operations were required. Younger age, fracture displacement and time to postoperative weight bearing were identified as risk factors for re-operation. In conclusion, intracapsular femoral neck fractures treated with the Targon-FN system resulted in a high rate of post-operative complication and re-operation. Statistical analysis revealed patient age, fracture displacement, time to postoperative full weight bearing were risk factors for re-operation. The main limitation is the limited number of cases and a short follow-up of less than 12 months in a subgroup of our patients.

[Reduction and fixation of tibia plateau fractures : Tips and tactics based on the 3-column concept]. / Reposition und Stabilisation von Tibiaplateaufrakturen : Tipps und Taktik auf Grundlage des 3-Pfeiler-Konzepts.

OBJECTIVE: The surgical management of tibial plateau fractures remains a challenge. The aim of surgery is the anatomical reconstruction of the joint surface with correct length, axis and rotation. The goal of osteosynthesis is to maintain a stable reduction to allow bone healing and functional aftercare. The continued advancements in 3D computed tomography has changed, the classification systems and, in parallel, the treatment strategies significantly changed. The 3­column concept of Luo et al. has proven to be advantageous for planning of access, reduction and stabilisation. INDICATIONS: Taking into consideration patient-specific factors. most displaced tibia plateau fractures are treated by surgery. However, no clear treatment recommendations exist in literature. In our clinical practice, joint displacement of more than 2 mm is generally not tolerated and surgical therapy is advised. OPERATION TECHNIQUE: The surgical technique is preceded by the surgical strategy, which is based on the soft tissue situation and imaging results. The gold standard in imaging is computed tomography. Timing of surgery, patient positioning, surgical approaches as well as the implants are individually adapted to the fracture pattern. RESULTS: The postoperative results are strongly influenced by fracture type, soft tissue condition, patient-specific factors, treatment method, and successful joint reconstruction. The functional postoperative results are often satisfactory even after complex tibia plateau fractures. In the literature, development of posttraumatic arthritis is reported to be 23-44%. In a study by Mehin et al. joint replacement of the knee was performed in 4.5% of cases following the surgical treatment of tibia plateau fractures.

Periprosthetic knee infection by Mycobacterium bovis and Candida guilliermondii in the context of a zoonosis: a case report and review of the literature.

INTRODUCTION: Periprosthetic joint infections are a major challenge for treating physicians. Musculoskeletal infections with Mycobacterium bovis are extremely rare, with an assumed incidence of 0.08-0.1%. Consequently, periprosthetic joint infections with Mycobacterium bovis are even less frequent. Fungal periprosthetic joint infections are very rare. No cases of Candida guilliermondii infection of implanted prostheses are described in the literature. CASE PRESENTATION: An 87-year-old Swiss man with German ethnic origin suffered from symptoms of osteoarthritis of the knee. We present the first described case of periprosthetic joint infection after total knee arthroplasty by both Mycobacterium bovis and Candida guilliermondii in the context of a zoonosis with 14 months of follow-up. The infection was presumed to originate more than 55 years earlier, when these infectious agents were still present in cattle in Switzerland. After diagnosis of the pathogens, our patient was successfully treated with tuberculostatic and mycocide medication, and a two-stage revision knee arthroplasty was performed. The medication was given for 1 year. The postoperative course was normal and he achieved ambulant musculoskeletal rehabilitation. After 14 months of follow-up no further complication emerged. At all routine consultations, there were no indications for joint inflammation, wound healing was normal, and the range of motion was flexion/extension 110/0/0°. CONCLUSIONS: We found no comparable cases in our literature search. Only a few joint infections by Mycobacterium bovis after intravesical instillation of Bacillus Calmette-Guérin are described. Primary infections without previous Bacillus Calmette-Guérin injection appear to be even less frequent. In cases where mycobacterial infection cannot be ruled out, we recommend cultivating mycobacteria cultures for weeks. In addition, a histological examination of the tissue should be carried out. After diagnosis, the concept of a two-stage reimplantation of total knee arthroplasty with mycostatic therapy for 1 year and antimycotic therapy appears to be effective.

Which lateral clavicle fractures can be treated by an arthroscopic-assisted endobutton procedure? An analysis of risk factors.

INTRODUCTION: Arthroscopy-assisted treatment of lateral clavicle fractures with coracoclavicular stabilization and an endobutton device have gained popularity over recent years. There is little evidence to support which types of lateral clavicle fractures are suitable for this treatment. The primary aim of this study was to evaluate the clinical und radiological outcomes of this treatment and to identify which fracture types are suitable. The secondary outcome was to evaluate potential risk factors for complications MATERIAL/METHODS: A retrospective single center review of 20 unstable lateral clavicle fractures treated with an arthroscopy-assisted CC stabilization technique and Endobutton device between September 2012 and August 2016. The functional outcome was evaluated using Constant and DASH Scores, VAS and SSV. RESULTS: Between September 2012 and August 2016, 20 patients were treated using this method (average age 45 years; male: female ratio 14:6). The DASH Score was on average 2.0 (0-9.82) and the Constant Score on average 81.8 points (range 68-93) with an average difference between the affected and the unaffected side of 4.1 points (range 0-15). Six patients had nonunion fractures of which two needed revision. CONCLUSIONS: Our study shows that arthroscopy-assisted CC stabilization using an endobutton technique delivers good functional results. Highly lateral unstable clavicle fractures seem to be especially suitable for this surgical technique. There was a high number of delayed unions. Analysis of risk factors showed that early mechanical stress, a lateral clavicular fragment larger than 3 cm and a time delay to surgery could be risk factors for nonunions.

Stem- and progenitor cell proliferation in the dentate gyrus of the reeler mouse.

Adult hippocampal neurogenesis has been implicated in hippocampus-dependent learning and memory. Furthermore, the decline of neurogenesis accompanying aging could be involved in age-related cognitive deficits. It is believed that the neural stem cell niche comprises a specialized microenvironment regulating stem cell activation and maintenance. However, little is known about the significance of the extracellular matrix in controlling adult stem cells. Reelin is a large glycoprotein of the extracelluar matrix known to be of crucial importance for neuronal migration. Here, we examined the local interrelation between Reelin expressing interneurons and putative hippocampal stem cells and investigated the effects of Reelin deficiency on stem cell and progenitor cell proliferation. Reelin-positive cells are found in close vicinity to putative stem cell processes, which would allow for stem cell regulation by Reelin. We investigated the proliferation of stem cells in the Reelin-deficient reeler hippocampus by Ki67 labeling and found a strong reduction of mitotic cells. A detailed analysis of dividing Type 1, type 2 and type 3 cells indicated that once a stem cell is recruited for proliferation, the progression to the next progenitor stage as well as the number of mitotic cycles is not altered in reeler. Our data point to a role for Reelin in either regulating stem cell quiescence or maintenance.