Incidence of calcaneal apophysitis (Sever's disease) and return-to-play in adolescent athletes of a German youth soccer academy: a retrospective study of 10 years.

BACKGROUND: Calcaneal apophysitis, or Sever's disease, is the most common cause of heel pain in childhood and adolescence. It is regarded as an overuse syndrome. Studies on the incidence of calcaneal apophysitis in young athletes and their associated return-to-play time are lacking in the current literature. The aim of our current study was to identify the incidence of calcaneal apophysitis in professional youth soccer, the associated time to return-to-play, predisposing factors and their impact on time to return-to-play. METHODS: Retrospective evaluation of injury data gathered from a German youth soccer academy in the years 2009-2018. In total, 4326 injury cases in 612 players were included in the study. The diagnosis and the follow-up visits were carried out in a weekly consultation hour at the youth academy. RESULTS: During the observation period of 10 years, 22 cases of calcaneal apophysitis were detected. The incidence of calcaneal apophysitis per 100 athletes per year was found to be 0.36. The mean age of the affected athletes at the time of diagnosis was 11.8 ± 2.1 years (MW ± SD). The complaints were unilateral in 20 and bilateral in two cases. Three of the 22 detected cases of calcaneal apophysitis (13.6%) were recurrent injuries. The mean time to return-to-play of the affected athletes was 60.7 ± 64.9 days (MW ± SD). Athletes with recurrent complaints showed longer recovery time and time to return-to-play when compared to players with primary diagnosed disease. Our results could show that neither age nor body mass index at the time of diagnosis had an impact on time to return-to-play. CONCLUSIONS: This is the first study investigating the incidence of calcaneal apophysitis and the associated time to return-to-play in youth elite soccer. Calcaneal apophysitis results in substantial time loss for the athletes. Further prospective clinical studies are required to fully understand the etiology and risk factors for calcaneal apophysitis and therefore develop preventive strategies.

Quadrilateral Surface Restoration by Medial Buttressing Before Revision in Periprosthetic Acetabular Fracture: A Case Report.

CASE: We report a case of periprosthetic acetabular fracture with pelvic discontinuity (PAFPD) classified Paprosky IIIb around an infected hip resurfacing prosthesis. A 3-stage revision was performed with (1) implants removal and surgical debridement to treat the infection; (2) open reduction and internal fixation using a medial buttress plate to treat pelvic discontinuity; and (3) custom-made total hip replacement with acetabular-ring reinforcement. The patient recovered with excellent clinical and radiographic results at 4-year follow-up. CONCLUSIONS: In complex cases of PAFPD, a collaboration between pelvic trauma surgeons and orthopaedic hip surgeons allows to provide stability for revision surgeries with good outcomes.

Nailing of proximal ulna fractures: biomechanical comparison of a new locked nail with angular stable plating.

PURPOSE: Proximal ulna fractures are common injuries and frequently treated with angular stable plating. This surgical option shows good functional results. Relevant drawbacks such as large soft tissue exposure, compromised blood supply of fracture fragments and disturbing osteosynthetic material are described. The aim of this study was to compare a new locked proximal ulna nail with angular stable plating in a biomechanical testing setup for extraarticular proximal ulna fractures. METHODS: Ten pairs of sawbones with a Jupiter type IIB proximal ulna fracture (OTA 2U1A3.1) were tested after osteosynthesis with the mentioned implants in a servo-pneumatic testing machine. The testing setup simulates physiological joint motion (0°-90°) under cyclic loading (30-300 N). Primary stability and loosening of both constructs were quantified using micromotion video-analysis after 608 test cycles. RESULTS: The micromotion analysis showed significantly higher primary stability of the locked nail (0.29 ± 0.13 mm) compared to the angular stable plate (0.97 ± 0.30 mm, p < 0.001). Both implants showed a low amount of loosening after completion of the test cycles. The construct with the locked nail (0.08 ± 0.06 mm) showed significantly lower dislocation of the fragments measured at the anterior cortex (plate 0.24 ± 0.13 mm, p < 0.001). CONCLUSION: Nailing of proximal ulna fractures shows significantly higher primary stability and lower loosening compared to angular stable plating in our testing setup.

Nailing vs. plating in comminuted proximal ulna fractures - a biomechanical analysis.

BACKGROUND: Comminuted proximal ulna fractures are severe injuries with a high degree of instability. These injuries require surgical treatment, usually angular stable plating or double plating is performed. Nailing of proximal ulna fracture is described but not performed regularly. The aim of this study was to compare a newly developed, locked proximal ulna nail with an angular stable plate in an unstable fracture of the proximal ulna. We hypothesize, that locked nailing of the proximal ulna will provide non-inferior stability compared to locked plating. METHODS: A defect fracture distal to the coronoid was simulated in 20 sawbones. After nailing or plate osteosynthesis the constructs were tested in a servo-pneumatic testing machine under physiological joint motion (0°-90°) and cyclic loading (30 N - 300 N). Intercyclic osteotomy gap motion and plastic deformation of the constructs were analyzed using micromotion video-analysis. RESULTS: The locked nail showed lower osteotomy gap motion (0.50 ± 0.15 mm) compared to the angular stable plate (1.57 ± 0.37 mm, p < 0.001). At the anterior cortex the plastic deformation of the constructs was significantly lower for the locked nail (0.09 ± 0.17 mm vs. 0.39 ± 0.27 mm, p = 0.003). No statistically significant differences were observed at the posterior cortex for both parameters. CONCLUSIONS: Nail osteosynthesis in comminuted proximal ulna fractures shows lower osteotomy gap motion and lower amount of plastic deformation compared to locking plate osteosynthesis under laboratory conditions.

Nailing of diaphyseal ulna fractures in adults-biomechanical evaluation of a novel implant in comparison with locked plating.

BACKGROUND: Adult forearm fractures require surgical treatment in most cases. Open reduction and internal fixation with plate osteosynthesis is the therapy of choice. Intramedullary fixation offers several advantages compared to plate fixation but is not routinely used. The aim of our study was to compare a newly designed ulna nail with angular stable plating in a biomechanical testing setup of an ulna shaft fracture with a diaphyseal defect. METHODS: Ten pairs of sawbones with a defect osteotomy of the ulna shaft (OTA 2U2C3) were fixed with an interlocked nail or locked plate osteosynthesis. The constructs were tested under four-point bending, torsional loading and axial loading in a servo-pneumatic testing machine to compare the stiffness of both stabilization methods. RESULTS: The nail constructs show lower yet sufficient bending stiffness (62.25 ± 6.64 N/mm) compared to the plate constructs (71.2 ± 5.98 N/mm, p = 0.005). The torsional loading test shows superior stiffness of the plate constructs (0.24 ± 0.03 Nm/deg vs. 0.1 ± 0.01 Nm/deg; p < 0.001), while the axial loading shows superior stiffness of the nail constructs (1028.9 ± 402.1 N/mm vs. 343.9 ± 112.6 N/mm; p < 0.001). CONCLUSIONS: Intramedullary nailing of ulna shaft fractures obtains sufficient but lower stability in bending and torsional loading when compared to rigid angular stable plating and could be an alternative technique to plate fixation. The lower stability and the closed stabilization technique allow for a rapid periosteal healing, which is not present in stiffer constructs.

Complex radial head and neck fractures treated with modern locking plate fixation.

BACKGROUND: Internal fixation of complex radial head and neck (CRHN) fractures is difficult, and postoperative complications are common. This study evaluated elbow function and patient clinical status after internal fixation of CRHN fractures with modern locking plates. METHODS: We included 40 patients with 41 fractures (1 bilateral lesion). In 25 patients (61%), a concomitant injury was found. Patients were an average age of 46 years (range, 22-70 years). The mean follow-up time was 36 months (range, 2-70 months). Postoperative assessments included evaluation of range of motion, functional scores, and radiologic findings. We assessed fracture healing, surgical complications, revision surgery, and the need for metal removal. RESULTS: Of the 34 fractures available for follow-up, 33 (97%) healed well. The mean extension deficit was 6° (range, 0°-30°). The average elbow flexion was 134° (range, 90°-160°), pronation was 70° (range, 30°-90°), and supination was 64° (range, 20°-90°). The Mayo Elbow Performance Score showed a mean of 90 points (range, 65-100 points). We observed no "poor" results. The mean Disability of Arm, Shoulder and Hand score was 16.5 (range, 2.5-58.3; n = 29). All patients continued activity without daily analgesics. There were 12 (34%) complications. In 11 (32%) patients, the plate was removed. CONCLUSIONS: CRHN fractures fixed with modern locking plates and treated as an osseoligamentous lesion exhibited promising midterm results. The new fixation devices represent an improvement in the treatment of this difficult and common fracture while reducing the need for joint replacement or radial head resection. Diagnosis and treatment of concomitant injuries should be emphasized.

Exposure to radial extracorporeal shock waves modulates viability and gene expression of human skeletal muscle cells: a controlled in vitro study.

BACKGROUND: Recent clinical and animal studies have shown that extracorporeal shock wave therapy has a promoting influence on the healing process of musculoskeletal disorders. However, the underlying biological effects of extracorporeal shock wave therapy on human skeletal muscle cells have not yet been investigated. METHODS: In this study, we investigated human skeletal muscle cells after exposure to radial extracorporeal shock waves in a standardized in vitro setup. Cells were isolated from muscle specimens taken from adult patients undergoing spine surgery. Primary muscle cells were exposed once or twice to radial extracorporeal shock waves in vitro with different energy flux densities. Cell viability and gene expression of the paired box protein 7 (Pax7), neural cell adhesion molecule (NCAM), and myogenic factor 5 (Myf5) and MyoD as muscle cell markers were compared to non-treated muscle cells that served as controls. RESULTS: Isolated muscle cells were positive for the hallmark protein of satellite cells, Pax7, as well as for the muscle cell markers NCAM, MyoD, and Myf5. Exposure to radial extracorporeal shock waves at low energy flux densities enhanced cell viability, whereas higher energy flux densities had no further significant impact. Gene expression analyses of muscle specific genes (Pax7, NCAM, Myf5, and MyoD) demonstrated a significant increase after single exposure to the highest EFD (4 bar, 0.19 mJ/mm2) and after double exposure with the medium EFDs (2 and 3 bar; 0.09 and 0.14 mJ/mm2, respectively). Double exposure of the highest EFD, however, results in a significant down-regulation when compared to single exposure with this EFD. CONCLUSIONS: This is the first study demonstrating that radial extracorporal shock wave therapy has the potential to modulate the biological function of human skeletal muscle cells. Based on our experimental findings, we hypothesize that radial extracorporal shock wave therapy could be a promising therapeutic modality to improve the healing process of sports-related structural muscle injuries.

Is the novel olecranon tension plate a valid alternative to tension band wiring of olecranon fractures? A biomechanical study on cadaver bones.

INTRODUCTION: Tension band wiring (TBW) used for olecranon fractures is afflicted with a high rate of complications. The aim of this study was to compare the stability of the TBW versus an alternative, novel low-profile olecranon tension plate (OTP) with angular stable screws in a simulated complex fracture model. MATERIALS AND METHODS: Nine fresh-frozen pairs of cadaver proximal ulnae with an oblique osteotomy and an additional wedge fragment simulating an unstable fracture were tested. The TBW and OTP were implanted pairwise. The elbow motion was simulated in a single-muscle model and ranged from full extension to 90° of flexion. The pulling force of the triceps tendon ranged from 50 to 200 N. The displacement of the fracture fragments was measured with a video motion analysis system over 304 cycles. Data were assessed statistically using the Wilcoxon signed-rank test. RESULTS: The cyclic loading tests showed mean loosening of the fracture fragments at the articular surface of 0.56 mm using TBW (SD 0.65) and 0.15 mm for OTP (SD 0.39). There was no statistical significance in loosening between the two constructs (p = 0.31). No plate breakage or screw loosening occurred. CONCLUSIONS: The low-profile OTP, using the principles of pre-tensioning, lag, cortical, and angular stable screws together, demonstrated similar stability after olecranon fracture fixation when compared with the TBW technique and a lag screw in the olecranon fracture model with a third wedge fragment.

Olecranon tension plating or olecranon tension band wiring? A comparative biomechanical study.

PURPOSE: The complication rate of a tension band wiring (TBW) used for the internal fixation of olecranon fractures remains high. The aim of this study was to compare the stability of a novel olecranon tension plate (OTP) with TBW in a simulated fracture model. METHODS: We tested 12 fresh frozen-pairs of cadaver proximal ulnae treated with OTP and TBW under cyclic loading. The elbow motion ranged from full extension to 90° of flexion, and the pulling force of the triceps tendon ranged from 50 to 350 N. The displacement of the fracture fragments was measured continuously. Data were assessed statistically using the Wilcoxon test with significance level of p < 0.05. RESULTS: The cyclic loading tests showed median displacements of the fracture fragments of 0.25 mm using OTP and 1.12 mm for TBW. Statistical analysis showed the difference to be substantial (p = 0.086) but not statistically significant. No plate breakage or screw loosening occurred. CONCLUSIONS: The concept of replacing prominent K-wires at the proximal end of the ulna using an low-profile plate with classical lag and multidirectional angle-stable screws demonstrated biomechanical advantages over TBW.

Tension band wiring in olecranon fractures: the myth of technical simplicity and osteosynthetical perfection.

PURPOSE: The tension band wiring (TBW) technique is a common treatment for the fixation of olecranon fractures with up to three fragments. The literature and surgeons describe TBW as an uncomplicated, always available and convenient operation producing excellent results. The purpose of this study was to determine whether TBW is more ambitious than believed or the procedure provides an increased level of tolerance concerning the surgical technique. METHODS: This study reviewed 239 TBW cases in patients with olecranon fractures or osteotomies. We reviewed a total of 2,252 X-rays for ten operative imperfections: (1) nonparallel K-wires, (2) long K-wires, (3) K-wires extending radially outwards, (4) insufficient fixation of the proximal ends of the K-wires, (5) intramedullary K-wires, (6) perforation of the joint surface, (7) single wire knot, (8) jutting wire knot(s), (9) loose figure-of-eight configuration, and (10) incorrect repositioning. RESULTS: On average, there were 4.24 imperfections per intervention in the cases reviewed. A total of 1,014 of 2,390 possible imperfections were detected. The most frequent imperfections were insufficient fixation of the proximal ends of the K-wires (91% of all cases), the use of a single wire knot (78%) and nonparallel K-wires (72%). Mayo IIa (n = 188) was the most common fracture type. CONCLUSIONS: Our results and the number of complications described by the literature together support the conclusion that TBW is not as easy as surgeons and the literature suggest. Although bone healing and the functional results of TBW are excellent in most cases, the challenges associated with this operation are underestimated. LEVEL OF EVIDENCE: IV, treatment study.

Locking-plate osteosynthesis versus intramedullary nailing for fixation of olecranon fractures: a biomechanical study.

PURPOSE: Intramedullary nailing and locked plating for fixation of olecranon fractures has recently gained popularity. However, these two new technologies have not been compared for their biomechanical efficacy. The aim of this study was to evaluate the biomechanical stability of two newly designed fracture fixation devices for treating olecranon fractures during dynamic continuous loading: the ION intramedullary locking nail and the LCP precontoured locking compression plate. METHODS: Simulated oblique olecranon fractures were created in eight pairs of fresh-frozen cadaver ulnae and stabilised using either the LCP or ION. Specimens were then subjected to continuous dynamic loading (from 25 to 200 N), with a continuous angle alteration between 0° and 90° of flexion, to perform a matched-pairs comparison. Significant differences in the distance between markers surrounding the fracture gap was determined using the Wilcoxon test after four and 300 loading cycles. RESULTS: The ION resulted in significantly less displacement in the fracture gap at 0° extension (P = 0.036), 45° flexion (P = 0.035) and 90° flexion (P = 0.017) after 300 cycles of continuous loading. The measured displacements were small and were probably not of clinical significance. No mechanical failure or hardware migration was seen with either fixation technique. CONCLUSION: This study shows significantly less micromotion for the ION than for the LCP in treating oblique olecranon fractures after 300 cycles of dynamic loading. Both implant types could be appropriate surgical techniques for fixation of selected olecranon fractures and osteotomies.

Stress-related femoral cortical and cancellous bone density loss after collum femoris preserving uncemented total hip arthroplasty: a prospective 7-year follow-up with quantitative computed tomography.

PURPOSE: Bone loss around uncemented femoral components is suspected to precede implant loosening and contribute to problems in revision surgery. Short-stemmed cementless femoral components are designed to preserve proximal femoral bone stock and ultimately the longevity of the prosthesis. METHODS: With quantitative computed tomography-assisted osteodensitometry, we prospectively analyzed femoral cortical and cancellous bone density (BD) and contact area changes of an uncemented collum femoris preserving stem (n = 38) 10 days, 1, 3 and 7 years post-operatively. RESULTS: Seven years post-operatively, cancellous BD (mg CaHA/mL) had decreased by as much as -66 % and cortical BD by up to -27 % at the metaphyseal portion of the femur; the decrease was progressive between the 1- and 3-year examinations and halted thereafter. Contact area (in % out of a possible 100 %) decreased proximally between the 1- and 3-year follow-up. CONCLUSION: Proximal cortical and cancellous bone density loss and decrease of contact area indicate that metaphyseal fixation cannot be achieved. The lack of cortical BD loss and increase of contact area values below the trochanter minor suggest diaphyseal fixation.

Periacetabular cortical and cancellous bone mineral density loss after press-fit cup fixation: a prospective 7-year follow-up.

The impact of total hip arthroplasty on strain adaptive bone remodeling has been extensively analyzed by dual-energy x-ray absorptiometry. In this study, we present a prospective computed tomography-assisted study of periacetabular cortical and cancellous bone mineral density (in milligrams of calcium hydroxyapatite [CaHA] per milliliter, or mgCaHA/mL) changes 10 days and 1, 3, and 7 years after press-fit cup implantation for 38 hips in vivo. Cancellous bone mineral density decreased by Ø -63% ventral and Ø -85% dorsal to the cup; cortical bone mineral density, by Ø -22% ventral and Ø -18% dorsal to the cup. The presented periacetabular strain adaptive bone mineral density data are the most extensive of the current literature. Even the measured extensive cancellous bone mineral density loss was thus far of no clinical relevance because all cups showed radiographic signs of stable ingrowth.

Volar fixed-angle plating of distal radius fractures: screws versus pegs--a biomechanical study in a cadaveric model.

OBJECTIVES: The purpose of this biomechanical study was to determine whether a multidirectional fixed-angle plate with locking screws or with locking pegs in the distal fragment would optimize fixation of Orthopaedic Trauma Association (OTA) type A3 distal radius fractures. METHODS: Eight pairs of fresh-frozen human distal radii were used. Extra-articular distal radius fractures were created and stabilized with a multidirectional volar fixed-angle plate. The radii were randomized into 2 matched-paired groups. The distal fragment in Group I was stabilized with 7 locking screws. The distal fragment in Group II was fixed with 7 locking pegs. The proximal fragment in both groups was fixed with 3 screws. The specimens were tested under torsion and axial compression during static and cyclic tests. Finally, load-to-failure tests were performed under torsion. RESULTS: After 1000 cycles, 99% of the median torsional stiffness remained in the group using screws, whereas only 76% of the median stiffness under torsion remained in the group using pegs (P = 0.018). Under axial compression, median stiffness remained at 93% in the group using screws after 1000 cycles compared with a median of 0% in the group using pegs (P = 0.018). CONCLUSIONS: This biomechanical study showed a statistically significant difference between the locking screw and locking smooth peg configuration with regard to stiffness of the constructs after 1000 cycles. The use of locking screws as opposed to smooth locking pegs for OTA type A3 extra-articular distal radius fractures optimizes construct stability.

Retrograde nailing versus locking plate osteosynthesis of proximal humeral fractures: a biomechanical study.

BACKGROUND: In locking plate osteosynthesis of proximal humeral fractures, secondary varus malalignment is a specific complication. Retron nails (Tantum AG, Neumunster, Germany), among others, have been designed to improve medial support of the calcar humeri. The aim of our biomechanical study was to examine whether Retron nails provide increased stiffness for axial loads and adequate stiffness for torsional loads when compared with Philos plates (Synthes AG, Umkirch, Germany). MATERIALS AND METHODS: Twenty-two fresh-frozen paired humeri were collected. After potting the specimens, intact bones were exposed to sinusoidal axial (10-120 N) and torsional (±2.5 Nm) loading for 8 cycles to calculate the initial stiffness and exclude pairs with differences. Afterward, an unstable proximal humeral fracture (AO 11-A3) was created by means of an oscillating saw, and the respective osteosynthesis devices were implanted. After another 4 cycles, initial changes in stiffness were measured. Subsequently, all specimens were tested for 1,000 cycles of loading before final stiffness was assessed. RESULTS: We found no statistically significant differences between Retron and Philos specimens after 4 or 1,000 cycles of loading. CONCLUSION: Our study suggests that retrograde nailing provides sufficient stability for axial and torsional loading in 2-part fractures of proximal humeri.

Quantitative computed tomography-assisted osteodensitometry of the pelvis after press-fit cup fixation: a prospective ten-year follow-up.

BACKGROUND: As a follow-up of a previously reported three-year study, we analyzed the periprosthetic acetabular cortical and cancellous bone density changes at ten years after implantation of a press-fit cup. METHODS: Prospective clinical, radiographic, and quantitative computed tomography examinations were performed within ten days and at mean periods of one, three, and ten years after total hip arthroplasty with a press-fit cup, a femoral stem with a tapered design, and alumina-alumina pairing. Periacetabular cortical and cancellous bone density (mg CaHA/mL) in the cranial, ventral, and dorsal regions about the cup were measured for twenty-four hips in vivo. RESULTS: All acetabular cups showed radiographic signs of stable ingrowth, and no acetabular component had to be revised. The loss of periacetabular cancellous bone density about the cup was as much as -37% cranially, -60% ventrally, and -71% dorsally; the decrease was progressive between the one-year and three-year examinations only. In contrast, cortical bone density above the dome of the acetabular cup remained constant throughout the ten-year follow-up. A moderate change in cortical bone density of -5% to -18% was seen at the level of the cup ten years postoperatively. CONCLUSIONS: Both periacetabular cortical and cancellous bone density changes were nonprogressive between the three-year and ten-year examinations after press-fit cup fixation.

Distal humerus hemiarthroplasty of the elbow for comminuted distal humeral fractures in the elderly patient.

BACKGROUND: The purpose of our study was to evaluate the objective and subjective outcomes, as well as the radiographic results after elbow hemiarthroplasty (HA) for comminuted distal humerus fractures in elderly patients. METHODS: Ten female patients with a mean age of 75.2 years were treated with elbow HA either for osteoporotic, comminuted distal humerus fractures (n = 8) or for early failed osteosynthesis of distal humerus fractures (n = 2). The mean follow-up period was 12.1 months. All patients were examined and evaluated using the Mayo Elbow Performance Score and the Disabilities of the Arm, Shoulder, and Hand score. Radiographic postoperative outcomes were assessed performing anteroposterior and lateral radiographs of the injured elbow. RESULTS: According to the Mayo Elbow Performance Score, nine patients achieved "good" to "excellent results" and only one patient revealed a "fair" clinical outcome. The mean Disabilities of the Arm, Shoulder, and Hand score was 11.5 (range, 0-30). The flexion of the affected elbow was 124.5° (range, 95-140°), the extension deficit was 17.5° (range, 5-30°), the pronation was 80.5° (range, 60-90°), and the supination was 79.5° (range, 50-90°). The following postoperative complications were seen: one triceps weakness, one transient ulnar nerve irritation, one superficial wound infection, and two heterotopic ossifications. None of the patients required explantation of the prosthesis. There was no evidence of loosening, radiolucency, or proximal bone resorption, whereas one patient developed progressive osteoarthritis of the proximal ulnar and radial articulation. CONCLUSIONS: Elderly patients treated with elbow HA revealed good to excellent short-term clinical outcomes. A high rate of complications occurred but most complications found were minor and reoperation rate was low. Our results must be regarded as a report on our first experience with HA. As cartilage wear is just a question of time especially in active patients, we cautiously recommend HA only for elderly and multimorbid low-demand patients.

Anatomic fit of six different radial head plates: comparison of precontoured low-profile radial head plates.

PURPOSE: Bulky implants may lead to symptomatic soft tissue irritation after open reduction and internal fixation of radial head and neck fractures. The purpose of our study was to compare the anatomic fit of precontoured radial head plates. METHODS: We stripped 22 embalmed human cadaveric radiuses of soft tissues. We investigated 6 radial head plates: (1) the Medartis radial head buttress plate (MBP), (2) the Medartis radial head rim plate (MRP), (3) the Synthes radial neck plate (SNP), (4) the Synthes radial head plate (SHP), (5) the Acumed radial head plate (AHP), and (6) the Wright radial head plate (WHP). Each plate was applied to each radial head at the place of best fit within the safe zone. We tested 4 parameters of anatomic fit: (1) plate-to-bone distance, (2) plate contact judged by 3 different observers, (3) pin-subchondral zone distance, and (4) plate-to-bone contact after adjustment of the plates. RESULTS: The MBP and MRP showed the lowest profile by objective measurements, the SNP and AHP had a moderate profile, and the SHP and WHP demonstrated the bulkiest profile. The subjective assessments also demonstrated the best fit for the MBP, a good fit for the SNP, a moderate fit for the MRP and AHP, and a poor fit for the SHP and WHP. The MBP, MRP, and AHP could always provide pin-subchondral zone contact, unlike the SHP, SNP, and WHP. After bending, significant improvement of plate-to-bone distance could only be seen for the MBP, MRP, and WHP. The ranking among plates remained the same except for the WHP, which showed a significantly lower plate-to-bone distance than the SHP. CONCLUSIONS: Currently available radial head implants are heterogeneous. The MBP and MRP showed the lowest profile and best anatomic fit. Owing to the complex radial head anatomy, to date there is no one radial head plate that perfectly fits all radial heads. CLINICAL RELEVANCE: Conformance of existing plates to the radial head and neck is not perfect. Careful plate selection and modification, when necessary, may minimize interference of this hardware with the surrounding soft tissues and facilitate recovery of motion.

Prospective study of a cementless total hip arthroplasty with a collum femoris preserving stem and a trabeculae oriented pressfit cup: minimun 6-year follow-up.

AIM: Tissue sparing hip prostheses are becoming more and more popular especially for the treatment of younger patients. The objective of this study was to evaluate the clinical and radiological results after insertion of a tissue sparing hip prosthesis. METHOD: In 47 consecutive non-selected patients (50 hips), the clinical and radiographic results of cementless total hip arthroplasty using a collum femoris preserving stem, a pressfit cup and an alumina-polyethylene pairing were prospectively evaluated. The mean age at index-surgery was 58 (36-82) years, there were 38 women and 9 men. After a mean follow-up of 6.8 years (minimum 6.1 years), two patients had died and one patient underwent revision surgery due to aseptic loosening of the stem. RESULTS: The overall survival rate of the acetabular component was 100% and of the femoral component 98%. The mean Harris hip score at follow-up was 94 points. CONCLUSION: The mid-term survival with this type of total hip arthroplasty is excellent and compares equal with uncemented straight stems in this age group.

Influence of formalin fixation on the biomechanical properties of human diaphyseal bone.

Owing to the lack of fresh human bones, formalin-fixed specimens are frequently used in biomechanical testing. However, formalin fixation is assumed to affect the biomechanical properties of bone. The aim of this study was to compare axial and torsional stiffness and bone mineral density in fresh and embalmed human bones. The subtrochanteric regions of 12 pairs of fresh human femora were randomised into two groups for paired comparison. After bone mineral density measurement, one group was preserved in 4% formalin. After 6 weeks, bone mineral density was remeasured and each specimen underwent axial and torsional loading. The formalin group showed significant higher stiffness values for torsional and axial loads than the fresh group. Axial stiffness increased by 14.1%, whereas torsional stiffness increased by 14.3%. These differences were not reflected in bone mineral density values. Formalin fixation significantly influences the stiffness of human cadaveric bones. Fresh bones represent the in vivo conditions better than formalin fixed bones.