Is intramedullary pinning for isolated ulnar shaft fractures a surgical alternative to plate fixation?

INTRODUCTION: Unstable isolated ulnar shaft fractures are rare injuries that need to be surgically treated. The purpose of this study was to compare the functional and radiographic outcomes of two types of surgeries: closed reduction and intramedullary fixation (IMF) by pinning and open reduction and internal fixation (ORIF). HYPOTHESIS: Our hypothesis was that IMF obtained similar outcomes to ORIF. MATERIALS AND METHODS: All patients treated for an isolated distal or middle third ulnar shaft fracture between 2016 and 2019 were enrolled into two groups: ORIF and IMF. The technique performed depended on the surgeon's preference and not the type of fracture or patient. Demographic and clinical data (QuickDASH) and complications were retrospectively collected. X-rays were also examined to classify the fracture, assess postoperative reduction quality, and determine the amount of shortening and angulation. RESULTS: A total of 81 patients with a mean age of 34 years were divided into two groups: 34 in ORIF and 47 in IMF. The two groups had similar demographics, mechanisms of injury, and preoperative fracture characteristics. The only difference was smoking (p<0.001). Despite a greater mean ulnar shortening of 0.4 mm in the IMF group (p=0.048), there were no significant differences regarding the functional score (QuickDASH) and rate of pseudarthrosis. However, the operative time (p<0.001) was shorter in the IMF group. DISCUSSION: In the treatment of unstable isolated ulnar shaft fractures, IMF and ORIF had similar clinical and radiographic outcomes in terms of bone healing. The mean ulnar shortening reported in the IMF group was small and was not at risk of developing posttraumatic osteoarthritis. CONCLUSION: IMF is a feasible therapeutic alternative to ORIF for isolated fractures of the distal two-thirds of the ulnar shaft. Further studies with a higher level of evidence need to be conducted to confirm the equivalence of these two fixation techniques. LEVEL OF EVIDENCE: IV, retrospective study.

Iliocava junction to L4-L5 disc anatomical relationship in L5-S1 isthmic spondylolisthesis.

BACKGROUND: Anterior lumbar interbody fusion finds a place in L5-S1 isthmic spondylolisthesis (ISPL) treatment. Extension of this arthrodesis at L4-L5 level is sometimes required. Anterior approach of the L4L5 disc is considered difficult due to the anatomical relationship between the iliocava junction (ICJ) and the spine. HYPOTHESIS: Does the lumbosacral deformation induced by ISPL allows anterior approach of L4-L5 disc between the iliac? STUDY DESIGN: Retrospective radiographic analysis of consecutive patients. METHODS: This retrospective imaging study of a continuous series of 97 patients treated for an L5-S1 ISPL involved radiological parameters specific to ISPL and pelvic-sagittal balance. The distance between the ICJ and the L4 lower endplate was measured in millimeters. The factors influencing this distance were sought in order to identify a predictive model of high ICJ. RESULTS: The ICJ took a cranial position with respect to the L4-L5 disc with an average distance of 1.8mm±16.4. This distance was statistically higher in the case of high-grade ISPL (p<0.01). The high ICJ position was correlated with a high Taillard index (r=0.39; CI95% [0.13; 0.61]; p<.001) and a low lumbar-sacral angle (LSA) (r=-0.33; CI95% [-0.56; -0.06]; p<0.01). Among the parameters specific to spino-pelvic statics, pelvic incidence, pelvic tilt and lumbar lordosis had similar correlations (r>0.30). CONCLUSION: ISPL induces a geometric deformation of the lumbosacral hinge which modifies its anatomical relations with the ICJ. The anterior approach technique of L4-L5 disc in the presence of an L5-S1 ISPL is possible between the iliac veins for the large displacement and low LSA forms. LEVEL OF EVIDENCE: IV, retrospective analysis.

The popliteus tendon provides a safe and reliable location for all-inside meniscal repair device placement.

PURPOSE: Repairs of the posterior horn of the lateral meniscus can be technically challenging. In contrast to medial meniscus repairs, the capsule around the posterior segment attachment of the lateral meniscus is quite thin. This study evaluates the clinical results of an arthroscopic all-inside repair technique for unstable, vertical, lateral meniscus tears, using a suture repair placed directly into the popliteus tendon. METHODS: A retrospective analysis of prospectively collected data from the SANTI database was performed. All patients who had undergone combined ACL reconstruction with lateral meniscus all-inside repair, using sutures placed in the popliteus tendon, between 2011 and 2015, were included. Patients were reviewed clinically at 1 and 2 years' follow-up. At final follow-up, all patients were contacted to identify if they underwent further surgery or had knee pain, locking or effusion. Symptomatic patients were recalled for clinical evaluation by a physician and Magnetic Resonance Imaging of the knee. Operative notes for those undergoing further surgery were reviewed and rates and type of re-operation, including for failed lateral meniscal repair were recorded. RESULTS: Two hundred patients (mean age 28.6 ± 10.2 years) with a mean follow-up of 45.5 ± 12.8 months (range 24.7-75.2) were included. The mean Subjective International Knee Documentation Committee (IKDC) at final follow-up was 85.0 ± 11.3. The post-operative mean side-to-side laxity measured at 1 year was 0.6 ± 1.0 mm. Twenty-six patients underwent re-operation (13%) at a mean follow-up of 14.8 ± 7.8 months. The ACL graft rupture rate was 5.0%. Other causes for re-operation included medial meniscus tear (2.5%), cyclops lesion (1.5%) and septic arthritis (0.5%). The lateral meniscus repair failure rate was 3.5%. No specific complications relating to placement of sutures in the popliteus tendon were identified. CONCLUSION: Arthroscopic all-inside repair of unstable, vertical, lateral meniscus tears using a suture placed in the popliteus tendon is a safe technique. It is associated with a very low failure rate with no specific complications. LEVEL OF EVIDENCE: Level IV.

Clinical Outcomes of Single Anteromedial Bundle Biologic Augmentation Technique for Anterior Cruciate Ligament Reconstruction With Consideration of Tibial Remnant Size.

PURPOSE: The primary aim of this study was to evaluate the functional outcomes, knee stability, complications, and reoperations associated with anatomic anterior cruciate ligament (ACL) reconstruction using the single anteromedial bundle biological augmentation (SAMBBA) technique in a consecutive series of 128 patients with a minimum follow-up of 24 months. A secondary aim was to compare larger preserved ACL remnants with smaller preserved remnants. METHODS: Patients who underwent primary anatomic ACL reconstruction using the SAMBBA technique from July 2013 to October 2014 were analyzed. Exclusion criteria were (1) age <16 years, (2) revision cases, (3) multiple ligament injuries, (4) chondral lesions greater than grade 2 according to the Outerbridge classification, (5) additional injuries to the collateral ligaments greater than grade 2, or (6) a history of a contralateral ACL injury. Clinical assessment including evaluation of side-to-side difference and functional outcome measures with the International Knee Documentation Committee (IKDC) subjective score and the Tegner Activity Scale were used to evaluate outcomes before surgery and at the last follow-up. Any subsequent surgical procedures were systematically recorded during the study period. The patients were also divided in 2 groups according to their ACL remnant size, ≥50% or <50%, and compared. RESULTS: Of the 135 patients who underwent primary SAMBBA technique, 128 patients returned to final follow-up, with a mean follow-up of 31.7 months (range, 24-44.3). At last follow-up, the IKDC score significantly improved from 54.1 ± 15.1 to 92.5 ± 11.4 (P < .001); the Tegner activity score (6.4 ± 1.2) was similar (P = .3) to the preinjury score (6.5 ± 1.2). Side-to-side laxity significantly improved from 6.7 ± 1.2 mm to 0.7 ± 1 mm (P < .001). Twenty-four subsequent surgeries (18.7%) were performed including 10 meniscal procedures, 7 ACL revisions, 5 arthroscopies for cyclops lesions, one microfracture, and one manipulation under anaesthesia. The side-to-side laxity (P = .30) and rates of reoperation (P = .65), graft failure (P = .45), and cyclops lesions (P = .67) were not significantly different between ≥50% or <50% ACL remnant groups. CONCLUSIONS: The results of this study demonstrate that primary anatomic ACL reconstruction using the SAMBBA technique significantly improved clinical and functional outcomes between baseline and follow-up at a minimum of 24 months. A low rate of complications was observed with this technique. No significant differences between large and moderate size ACL remnants were detected for all outcome measures. LEVEL OF EVIDENCE: Level IV case series with subgroup analysis.

Noninvasive Optoelectronic Assessment of Induced Sagittal Imbalance Using the Vicon System.

OBJECTIVE: Spinal diseases often induce gait disorders with multifactorial origins such as lumbar pain, radicular pain, neurologic complications, or spinal deformities. However, radiography does not permit an analysis of spinal dynamics; therefore, sagittal balance dynamics during gait remain largely unexplored. This prospective and controlled pilot study assessed the Vicon system for detecting sagittal spinopelvic imbalance, to determine the correlations between optoelectronic and radiographic parameters. METHODS: Reversible anterior sagittal imbalance was induced in 24 healthy men using a thoracolumbar corset. Radiographic, optoelectronic, and comparative analyses were conducted. RESULTS: Corset wearing induced significant variations in radiographic parameters indicative of imbalance; the mean C7-tilt and d/D ratio increased by 15° ± 7.4° and 359%, respectively, whereas the mean spinosacral angle decreased by 16.8° ± 8° (all P < 0.001). The Vicon system detected the imbalance; the mean spinal angle increased by 15.4° ± 5.6° (P < 0.01), the mean floor projection of the C7S1 vector (C7'S1') increased by 126.3 ± 51.9 mm (P < 0.001), and the mean C7-T10-S1 angle decreased by 9.8° ± 3° (P < 0.001). Variations in C7'S1' were significantly correlated with d/D ratio (ρ = 0.58; P < 0.05) and C7-tilt (ρ = 0.636; P < 0.05) variations. CONCLUSIONS: Corset wearing induced radiographically confirmed anterior sagittal imbalance detected using the Vicon system. Optoelectronic C7'S1' correlated with radiographic C7-tilt and d/D ratio.