Nontraditional Methods of Fibula Fixation.

This article explores different nontraditional methods that could be adopted in clinical settings as alternatives to the traditional fibular fixation. Less invasive methods, such as intramedullary nail and screw fixation, might be viable alternatives for managing ankle fractures. These methods might especially benefit patients with poor soft tissue envelopes, low immunity, and poor bone quality. There is minimal soft tissue coverage for most orthopedic implants around the ankle. Various authors have highlighted the importance of minimally invasive surgery as an effective modality for ensuring superior prognosis for ankle fracture surgery or those fractures involving both the distal tibia and fibula.

"Locked-Lateral" Calcaneal Fracture-Dislocation Treated with Primary Subtalar Fusion: A Case Report.

CASE REPORT: A 65-year-old man presented with pain in his left ankle. After a delay, he presented to the orthopaedic clinic where computed tomography scan revealed an intra-articular, locked-lateral calcaneal fracture with dislocation of the peroneal tendons. CONCLUSIONS: This combination of injuries can produce subtle signs, such as an atypical double-density sign and varus talar tilt, on plain radiographs; however, the consequences of delayed treatment can be catastrophic. Early recognition and treatment are essential to avoid chronic pain and limited function.

Early Tibiotalocalcaneal Arthrodesis Intramedullary Nail for Treatment of a Complex Tibial Pilon Fracture (AO/OTA 43-C).

UNLABELLED: Management of severely comminuted, complete articular tibial pilon fractures (AO/OTA 43-C) remains a challenge, with few treatment options providing good clinical outcomes. Open reduction and internal fixation of the tibial plafond, tibiotalar arthrodesis, and salvage hindfoot reconstruction procedures are all associated with surgical complications and functional limitations. In this report, we present a case of a complex pilon fracture in a patient with multiple medical comorbidities and socioeconomic disadvantages that was successfully and acutely treated with a retrograde tibiotalocalcaneal hindfoot arthrodesis nail. At final follow-up examination, the patient had decreased pain, a stable plantigrade foot, and could ambulate with normal shoes without any assistive devices. LEVELS OF EVIDENCE: Therapeutic, Level IV: Case series.

A rare case of an Essex-Lopresti injury secondary to a gunshot wound.

BACKGROUND: Radial head fractures are one of the more common fractures of the body, and the most common fractures around the elbow. CASE REPORT: While these can present in isolation, concomitant injuries to the ulna, elbow joint and surrounding ligaments, interosseous membrane, proximal radioulnar joint, and distal radioulnar joint can also occur. It is imperative that the treating surgeon rules out any concomitant injuries when evaluating a patient with a radial head fracture as the treatment options vary greatly depending on the structures which are damaged. CONCLUSIONS: Radial head resection, a viable treatment option for isolated radial head fractures, can lead to long-term sequelae if performed for a radial head fracture accompanied by interosseous membrane and distal radioulnar joint injury; this combination is termed an Essex-Lopresti injury. We will review the topic of Essex-Lopresti injuries, and discuss proper treatment options for these injuries.

Tongue-type calcaneus fractures: a threat to skin.

Calcaneal fractures account for 60% of all tarsal bone fractures. Tongue-type calcaneus fractures are longitudinal fractures that exit the calcaneal tuberosity posteriorly and involve a portion of the articular surface. They are often superiorly displaced because of the insertion of the Achilles tendon and pull of the gastroc-soleus complex. Skin compromise complicates a large percentage of these injuries because of the thin layer of soft tissue and superficial nature of the fracture. Early recognition by the emergency physician and prompt operative repair prevent further injury and obviate the need for surgical soft tissue coverage or potential amputation.

Pathologic correlation of posterior ligamentous injury with MRI.

This article describes 2 cases of spinal trauma in which diagnostic magnetic resonance imaging (MRI) was correlated with histopathology for diagnosis of a posterior ligamentous complex injury. Spine fractures are common and represent up to 16% of traumatic fractures. Diagnostic imaging currently involves plain films and computerized tomography, but MRI is being used with increasing frequency. The definition of neurologic tissue injury has had substantial documentation in the spinal literature. Clinically, posterior ligamentous complex injury has been associated with facet disruption, gapping of the spinous processes, and significant kyphosis. Assessment of spinal stability in the spine trauma population is based significantly on the assumed disruption or integrity of the posterior ligamentous complex. High signal intensity in the area of the ligamentum flavum and interspinous ligament on fat-saturated T2 MRIs has been associated with the clinical finding of interspinous ligament disruption noted at surgical exploration. Magnetic resonance imaging in spine trauma is widely accepted despite a paucity of data addressing its histopathologic accuracy. To our knowledge, histopathologic correlation of MRI of ligamentous injuries has not been reported.

Osteoblastic and osteolytic human osteosarcomas can be studied with a new xenograft mouse model producing spontaneous metastases.

There is no animal model that reflects the histological and radiographical heterogeneity of osteosarcoma. We assessed seven osteosarcoma cell lines for their potential to develop orthotopic tumors and lung metastasis in SCID mice. Whereas radiologically, 143B developed osteolytic tumors, SaOS-LM7 developed osteoblastic primary tumors. The mineralization status was confirmed by assessing the alkaline phosphatase activity and the microarray expression profile. We herein report a xenograft orthotopic osteosarcoma mouse model to assess osteoblastic and osteolytic lesions, which may contribute in the search for new diagnostic and therapeutic approaches.

Effect of hydrogel porosity on marrow stromal cell phenotypic expression.

This study describes investigation of porous photocrosslinked oligo[(polyethylene glycol) fumarate] (OPF) hydrogels as potential matrix for osteoblastic differentiation of marrow stromal cells (MSCs). The porosity and interconnectivity of porous hydrogels were assessed using magnetic resonance microscopy (MRM) as a noninvasive investigative tool that could image the water construct inside the hydrogels at a high-spatial resolution. MSCs were cultured onto the porous hydrogels and cell number was assessed using PicoGreen DNA assay. Our results showed 10% of cells initially attached to the surface of scaffolds. However, cells did not show significant proliferation over a time period of 14 days. MSCs cultured on porous hydrogels had increased alkaline phosphatase activity as well as deposition of calcium, suggesting successful differentiation and maturation to the osteoblastic phenotype. Moreover, continued expression of type I collagen and osteonectin over 14 days confirmed osteoblastic differentiation of MSCs. MRM was also applied to monitor osteogenesis of MSCs on porous hydrogels. MRM images showed porous scaffolds became consolidated with osteogenic progression of cell differentiation. These findings indicate that porous OPF scaffolds enhanced MSC differentiation leading to development of bone-like mineralized tissue.

Characterization of photo-cross-linked oligo[poly(ethylene glycol) fumarate] hydrogels for cartilage tissue engineering.

Photo-cross-linkable oligo[poly(ethylene glycol) fumarate] (OPF) hydrogels have been developed for use in tissue engineering applications. We demonstrated that compressive modulus of these hydrogels increased with increasing polymer concentration, and hydrogels with different mechanical properties were formed by altering the ratio of cross-linker/polymer in precursor solution. Conversely, swelling of hydrogels decreased with increasing polymer concentration and cross-linker/polymer ratio. These hydrogels are degradable and degradation rates vary with the change in cross-linking level. Chondrocyte attachment was quantified as a method for evaluating adhesion of cells to the hydrogels. These data revealed that cross-linking density affects cell behavior on the hydrogel surfaces. Cell attachment was greater on the samples with increased cross-linking density. Chondrocytes on these samples exhibited spread morphology with distinct actin stress fibers, whereas they maintained their rounded morphology on the samples with lower cross-linking density. Moreover, chondrocytes were photoencapsulated within various hydrogel networks. Our results revealed that cells encapsulated within 2-mm thick OPF hydrogel disks remained viable throughout the 3-week culture period, with no difference in viability across the thickness of hydrogels. Photoencapsulated chondrocytes expressed the mRNA of type II collagen and produced cartilaginous matrix within the hydrogel constructs after three weeks. These findings suggest that photo-cross-linkable OPF hydrogels may be useful for cartilage tissue engineering and cell delivery applications.