Long-term results of treatment of Gustilo-Anderson type 3A-B tibia fractures due to combat-related high-energy ballistic injuries treated with external circular fixator: Experience of the Military Medical Academy.

OBJECTIVES: The aim of this study was to evaluate the longterm outcomes of open tibia fractures treated using the Ilizarov external circular fixation (ECF) technique in the Military Medical Academy. PATIENTS AND METHODS: Between January 1992 and December 2011, a total of 134 male military personnel (median age: 22.5 years; range, 18 to 36 years) with Gustilo-Anderson type 3 open tibia fractures treated with ECF were retrospectively analyzed. All patients underwent multiple surgeries and eventually Ilizarov fixation surgery. The radiological and functional outcomes were evaluated using the Association for the Study and Application of Methods of Ilizarov (ASAMI) criteria, and complications were noted. RESULTS: The median follow-up was 17.7 (range, 10 to 29) years. The median time to union was 4.7 (range, 3 to 8) months. All frames were removed from the limb, when union was observed. No re-fracture, limb length discrepancy more than 2.5 cm, or below-knee amputation after Ilizarov treatment was seen in any patient. Chronic osteomyelitis was observed at in 40% (n=54) of the patients at a median time ranging from 17 to 148 months. The overall ASAMI bone scores were excellent in 40 (30%), good in 20 (15%), fair in 20 (15%), and poor in 54 (40%) patients with osteomyelitis. The ASAMI functional scores were excellent in 40 (30%), good in 40 (30%), and fair in 54 patients (40%). No poor score was observed. Minor pin site infections were observed in 63 patients (47%). CONCLUSION: Our long-term study results showed that all patients returned to their social life and were mobilized without support after treatment with the use of Ilizarov ECF method of open tibia fractures caused by high-energy ballistic injuries. However, complications such as pin tract infections and osteomyelitis after several years must be kept in mind in the treatment of comminuted bone fractures caused by firearms and ballistic missiles injuries.

A New Concept of Mosaicplasty: Autologous Osteoperiosteal Cylinder Graft Covered With Cellularized Scaffold.

A concern regarding osteochondral autograft transfer for chondral defects is donor-site morbidity of the knee, the most common source of the autograft. To avoid the drawbacks of osteochondral autograft transfer, a cylindrical osteoperiosteal graft harvested from the iliac crest covered by a same-sized cylinder of hyaluronic acid-based polymer scaffold pretreated with bone marrow aspirate concentrate and transferred to the chondral defect recipient site in the exact size for restoration of the subchondral bone and the articular cartilage.

Which design tolerates rotational mismatch better in unicompartmental knee arthroplasty: fixed or mobile bearing?

Unicompartmental knee arthroplasty is an effective method for the treatment of medial compartment osteoarthritis. However, appropriate surgical tech- nique and optimum implant positioning are crucial for a satisfactory outcome. This study aimed to demonstrate the relation between the clinical scores and the alignment of the components in UKA. A total of 182 patients with medial compartment osteoarthritis and treated by UKA between January 2012 and January 2017 were enrolled in this study. Computed tomography (CT) was used to measure the rotation of components. Patients were divided into two groups according to the insert design. These groups were divided into three subgroups according to the angle of the tibia relative to the femur (TFRA) (A): TFRA 0° to 5° either internal or external rotation; (B): TFRA >5° internal rotation, and (C): TFRA >5° external rotation. There was no significant difference between the groups in terms of age, body mass index (BMI) and follow-up period. KSS scores increased as the tibial component rotation (TCR) external rotation increased, but there was no correlation for WOMAC score. (P: 0,039 r: 0,207; P:0,347 r:0,095, respectively) Post-operative KSS and WOMAC scores decreased as TFRA external rotation was increased. (p: 0,001; p:0,001, respectively) No correlation has been observed between femoral component rotation (FCR) internal rotation and post-operative KSS and WOMAC scores. (p: 0,261; p: 0,502, respectively) Any mismatch between the components is better tolerated by mobile-bearing designs compared to fixed-bearing designs. Orthopedic surgeons should take care of rotational mismatch of components, not only the axial alignment of the components.

Effects of hypothermia on skeletal ischemia reperfusion injury in rats.

OBJECTIVE: The aim of this study was to investigate the effect of hypothermia (H) on skeletal ischemia-reperfusion (IR) injury in rats by measuring malondialdehyde (MDA), superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), nitric oxide (NO), and interleukin-1 beta (IL-1ß) in muscle, and measureing immunohistochemical-inducible nitric oxide synthase (iNOS) staining of skeletal muscle. MATERIALS AND METHODS: Eighteen Wistar Albino rats were divided randomly into three groups (sham, IR, hypothermia) (n=6). The sham group had all procedures without the IR period. The lower right extremity of rats in the IR and hypothermia groups was subjected to 2 hours of ischemia and 22 hours of reperfusion by applying a clamp on the common iliac artery and a rubber-band at the level of the lesser trochanter under general anesthesia. Rats in the hypothermia group underwent 4 hours of hypothermia during the first four hours of reperfusion in addition to a 2-hour ischemia and 22-hour reperfusion period. All rats were sacrificed at end of the IR period using a high dose of anesthesia. The tibialis anterior muscles were preserved. Immunohistochemical iNOS staining was performed, and MDA, SOD, GSH-Px, NO, and IL-1ß were measured in the muscle. RESULTS: The level of MDA, NO, and IL-1ß in muscle was increased in the IR group compared with that in the sham group, but these parameters were decreased in the hypothermia group compared with the IR group. The activities of SOD and GSH-Px in muscle were decreased in the IR group; however, these parameters were increased in the hypothermia group. The score and intensity of iNOS staining of skeletal muscle was dens in IR group, mild in hypothermia group, and weak in sham group. CONCLUSION: The present study has shown that hypothermia reduced IR injury in the skeletal muscle by decreasing the levels of MDA, NO, and IL-1ß, and increasing the activities of SOD and GSH-Px. In addition, hypothermia attenuated the score and intensity of iNOS staining.

Scapulothoracic arthrodesis in facioscapulohumeral dystrophy with multifilament cable.

UNLABELLED: Patients with facioscapulohumeral dystrophy (FSHD) are affected mostly by impaired shoulder function. Scapulothoracic arthrodesis was introduced to improve shoulder function. We evaluated the outcomes of scapulothoracic arthrodesis using multifilament cables, performed on 13 patients with FSHD (18 shoulders). There were eight males and five females (mean age, 29 years; range, 20-50 years). Outcome criteria were active shoulder forward flexion and abduction, the Disabilities of the Arm, Shoulder, and Hand (DASH) score, respiratory function tests, and a new shoulder function score. Patients were followed for a minimum of 24 months (average, 35.5 months; range, 24-87 months). Solid fusion was obtained in all shoulders (two after revision); active abduction range increased from 47.2 degrees +/- 11.6 degrees to 102.2 degrees +/- 10.0 degrees (mean +/- standard deviation) and anterior flexion range from 55.6 degrees +/- 16.1 degrees to 126.1 degrees +/- 20.9 degrees . The DASH score decreased from 33.6 +/- 8.9 points preoperatively to 11.6 +/- 8.0 points postoperatively. Shoulder function score increased from 15.9 +/- 2.4 points to 22.2 +/- 1.3 points. Scapulothoracic arthrodesis provides satisfactory function in patients with FSHD. Our data suggest use of multifilament cables for fixation is a reasonable option with an acceptable complication rate. LEVEL OF EVIDENCE: Level IV, case series. See the Guidelines for Authors for a complete description of levels of evidence.