Transosseous Suturing for the Correction of Juvenile Hallux Valgus: A Preliminary Case Series Study.

Background and Objectives: Many treatment modalities are available for juvenile hallux valgus. However, all of them have some disadvantages. Therefore, we developed a transosseous suturing procedure. Materials and Methods: Six patients (seven feet) with juvenile hallux valgus received transosseous suturing procedure. Clinical and radiological examinations were performed preoperatively and postoperatively. All patients underwent the soft tissue release procedure, followed by transosseous suturing with Fiberwire (in which sutures are anchored with mini plates). Results: The mean IMA and HVA decreased from 15.6° ± 2.6° to 7.3° ± 1.1° and 39.2° ± 3.3° to 12.5° ± 3.1°, respectively. Corrections achieved in the IMA and HVA of all patients were maintained through the last follow-up. The mean American Orthopedic Foot & Ankle Society score improved from 53.3 ± 3.5 to 86.9 ± 4.7 points. Conclusions: Based on these preliminary data, the transosseous suturing technique demonstrated satisfactory results and apparent improvements in the IMA and HVA without early complications.

Loop Anchor Tension Band Fixation for Olecranon Fractures and Chevron Olecranon Osteotomy.

Although tension band wiring is effective for treating olecranon fractures, it is associated with a high reoperation rate because of hardware-related problems. The loop anchor tension band technique is a novel modification of the Arbeitsgemeinschaft für Osteosynthesefragen (AO)-modified tension band wiring technique. This technique is suitable for treating olecranon fractures without severe comminution and olecranon osteotomy. In the current case series, 2 intramedullary 1.25-mm Kirschner wires (K wires) were inserted as temporary fixation into the ulnar shaft from the olecranon after anatomical reduction. The proximal end of each K-wire was bent into a loop shape and advanced deep into the triceps tendon. A transverse hole was drilled distal to the fracture site, and a 1.0-mm metal wire was passed through the bone tunnel and the loops. The wire was tightened to form a figure-of-eight tension band construct. In total, 10 patients with a mean age of 49 (range: 19 to 85) years were included in this pilot series. The mean and minimum follow-up periods were 13.9 and 12 months, respectively. All fractures achieved favorable union, both radiographically and clinically. The mean QuickDASH score was 15.4 (range: 13.6 to 18.2) and the mean Mayo elbow performance score was 94 (range: 85 to 100). None of the patients experienced K-wire migration. The loop anchor tension band technique is a simple, cost effective modification of conventional tension band wiring and exhibited no implant migration in a pilot series.

Loop Anchor Tension Band Technique for Patella Fractures Lowers the Rate of Kirschner Migration.

OBJECTIVE: To compare the complications of patella fracture after open reduction and internal fixation using our innovative, loop-based modification of the tension band wiring technique and the traditional tension band wiring technique. METHODS: Fifty-eight patients with patella fracture (AO/OTA: 34-C) were enrolled in this retrospective case-control study during the study period. We treated 36 patients with the traditional tension band wiring and 22 patients with our loop anchor tension band technique. Lysholm knee scoring scale, sex, numbers of wire dislodge, number of implants removal between two groups were compared. RESULTS: The number of cases of wire dislodgement was zero in the loop anchor tension band group and seven in the traditional tension band group. There was statistically significant difference (P = 0.037). Lysholm knee score (P = 0.685) and operation time (P = 0.395) were not significantly different between the two groups CONCLUSIONS: The loop anchor tension band technique is safe and effective for treating patella fractures. The rates of implant loosening and wire pull-out were significantly lower in the loop anchor tension band group than those in the traditional technique group.

Vascularized bone graft and scapholunate fixation for proximal scaphoid nonunion: a case report.

We report a 38-year-old woman with a proximal scaphoid fracture nonunion from an injury 1 year ago. She was successfully treated with 2,3 intercompartmental supraretinacular artery pedicled vascularized bone graft and scapholunate fixation. It highlights the possible combination of scapholunate fixation and vascularized bone grafting in treating proximal scaphoid nonunion.

A biomechanical comparison of two screw fixation methods in a Letenneur type I Hoffa fracture.

BACKGROUND: The treatment of Hoffa fractures is challenging, for which the ideal fixation and approach are still controversial. Osteosynthesis with plate or screws fixation in different trajectories have been described in previous literature. The purpose of this study was to compare the biomechanical strength and stability of two types of screw trajectories used to stabilize displaced coronal fractures of the lateral femoral condyle. METHODS: Sixteen synthetic femurs (Sawbones Pacific Research Laboratories, Vashon, WA) were divided into two groups. A vertical osteotomy was performed to mimic a Letenneur type I Hoffa fracture. Group A (n = 8) was fixed with screw in anteroposterior direction (A-P) screws. Group B (n = 8) was fixed with crossed screws. Both groups were tested with a nondestructive axial compression aligned with the femur axis. After that, 10,000 cyclic loading tests were applied to the specimen with a force ranging between 200 to 600 N, and the interfragmental displacement was recorded, respectively, after 10, 100, 1000 and 10,000 cycles. Finally, a destructive axial compression test was applied until catastrophic failure. RESULTS: There were no statistical between-group differences in regard to the average axial stiffness, interfragmental displacement, and ultimate failure load. The average axial stiffness of the A-P screw was comparable to that of the crossed screw (361 ± 113 N/mm vs. 379 ± 65 N/mm, p = 0.753). All specimens completed the entire cyclic loading test without catastrophic failure, and the interfragmental displacement after loading for 10,000 cycles was 1.36 ± 0.40 mm for the A-P screw and 1.29 ± 0.61 mm for the crossed screw, there were no statistical differences between the groups (p = 0.823). The average ultimate failure loads for the A-P and crossed screws were 1214 ± 127 N and 1109 ± 156 N, respectively (p = 0.172). CONCLUSIONS: Based on our in vitro study, the crossed screws can provide comparable mechanical performance as traditional A-P screws in Hoffa fracture fixation. Considering the screws trajectories are commonly determined by the choice of surgical approach, the current study provides support from a biomechanical perspective for the application of crossed screws in direct lateral approach.