The Evolution, Current State and Clinical Benefits of Far Cortical Fracture Fixation.

Treatment of distal femur fractures have reported high fracture healing complications in several studies. The development of far cortical locking (FCL) technology results in improved fracture healing outcomes. There are biomechanical and animal studies demonstrating that the locked plating incorporating FCL screws provides a more flexible form of fixation compared to traditional locking plates (LP). Clinical studies have shown that the commercially available Zimmer Motionloc system with FCL screws provide good results in distal femur fractures and periporsthetic distal femur fractures. FCL constructs may help resolve fracture healing problems in the future. However, there is not enough available clinical evidence to conclusively indicate whether clinical healing rates are improved with FCL screw constructs compared to traditional LP's. Therefore, further prospective study designs are needed to compare FCL to LP constructs and to investigate the role of interfragmentary motion on callus formation. Level of Evidence: V.

Sensitivity and specificity of modified RUST score using clinical and radiographic findings as a gold standard.

AIMS: The modified Radiological Union Scale for Tibia (mRUST) fractures score was developed in order to assess progress to union and define a numerical assessment of fracture healing of metadiaphyseal fractures. This score has been shown to be valuable in predicting radiological union; however, there is no information on the sensitivity, specificity, and accuracy of this index for various cut-off scores. The aim of this study is to evaluate sensitivity, specificity, accuracy, and cut-off points of the mRUST score for the diagnosis of metadiaphyseal fractures healing. METHODS: A cohort of 146 distal femur fractures were retrospectively identified at our institution. After excluding AO/OTA type B fractures, nonunions, follow-up less than 12 weeks, and patients aged less than 16 years, 104 sets of radiographs were included for analysis. Anteroposterior and lateral femur radiographs at six weeks, 12 weeks, 24 weeks, and final follow-up were separately scored by three surgeons using the mRUST score. The sensitivity and specificity of mean mRUST score were calculated using clinical and further radiological findings as a gold standard for ultimate fracture healing. A receiver operating characteristic curve was also performed to determine the cut-off points at each time point. RESULTS: The mean mRUST score of ten at 24 weeks revealed a 91.9% sensitivity, 100% specificity, and 92.6% accuracy of predicting ultimate fracture healing. A cut-off point of 13 points revealed 41.9% sensitivity, 100% specificity, and 46.9% accuracy at the same time point. CONCLUSION: The mRUST score of ten points at 24 weeks can be used as a viable screening method with the highest sensitivity, specificity, and accuracy for healing of metadiaphyseal femur fractures. However, the cut-off point of 13 increases the specificity to 100%, but decreases sensitivity. Furthermore, the mRUST score should not be used at six weeks, as results show an inability to accurately predict eventual fracture healing at this time point. Cite this article: Bone Jt Open 2021;2(10):796-805.

Radiographic Healing of Far Cortical Locking Constructs in Distal Femur Fractures: A Comparative Study With Standard Locking Plates.

OBJECTIVES: To investigate the radiographic healing of far cortical locking (FCL) construct fixation in distal femur fractures compared with traditional locking plate (LP) constructs. DESIGN: A retrospective cohort of 143 consecutive patients with 146 distal femur fractures. SETTING: Level I trauma center. PATIENTS/PARTICIPANTS: After excluding patients with OTA/AO type B fractures, referred nonunion cases, patients younger than 16 years, and patients with less than 24 weeks of follow-up, 69 patients with 70 total fractures were included for analysis. INTERVENTION: AP and lateral knee radiographs were blinded to type of screws and individually reviewed by 3 orthopaedic trauma surgeons. OUTCOME MEASUREMENTS: The modified RUST (mRUST) score was our primary outcome measure. mRUST scores were assigned at 6, 12, and 24 weeks and final follow-up based on AP and lateral radiographs and compared between FCL and LP groups as a tool for evaluating fracture healing. Secondary outcomes compared between FCL and LP included union rate and postoperative complications. RESULTS: Statistically significant differences in mRUST scores were noted between FCL and LP groups at 6 weeks (P = 0.040), 12 weeks (P = 0.034), 24 weeks (0.044), and final follow-up (P = 0.048). There was no significant difference in union or specific complication rates between the 2 groups. The union rate was 90.5% and 82.1% for the FCL and LP groups, respectively, at final follow-up. CONCLUSIONS: To our knowledge, this is the first comparative study between FCL and LP constructs. The FCL group was noted to have significantly higher mRUST scores at all periods indicating increased callus formation, but the differences seen were small and there were no differences in healing rates or complications between the 2 groups, thus bringing the clinical benefit of FCL into question. Further prospective study designs are needed to compare FCL with LP constructs and to investigate the role of interfragmentary motion on callus formation in distal femur fractures. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Comparison between Staheli index on Harris mat footprint and Talar-first metatarsal angle for the diagnosis of flatfeet.

BACKGROUND: Flatfoot is practically diagnosed by physical examination, radiographs, or footprint. Talar first-metatarsal angle on a weight-bearing lateral radiograph provides an accurate measurement for the diagnosis offlatfoot and is frequently used by foot and ankle specialists. Staheli Index is also considered as a reliable method. However; there is no information of the sensitivity and specificity of this index compared to the talar-first metatarsal angle for the diagnosis of flatfoot. OBJECTIVE: To evaluate the usefulness of the Staheli Index on Harris matfootprintfor the diagnosis of flatfoot. MATERIAL AND METHOD: The weight-bearing lateral radiographs were obtainedfrom 157patients (314feet). The radiographs were examined for the talar-first metatarsal angle. Harris mat footprint was also obtained from each participant for the measurement of the Staheli Index. The sensitivity and specificity of the Staheli Index was calculated using the talar-first metatarsal angle as a gold standard. ROC curve was also performed to determine the cut-off point of the Staheli Index. Interobserver and intra-observer reliability was also tested. RESULTS: The cut-off point ofthe Staheli Index at 0.77 revealed the sensitivity of 70.2% and specificity of 73%, and the accuracy value was 72%for the detection of flatfoot compare4 to the talar-first metatarsal angle. There was no significant difference of the area under the ROC curves performed by two physicians was found. The area under the ROC curves showed no difference when performed at two different times by the same physician. CONCLUSION: The Staheli Index obtained from the Harris mat footprint could be considered as the screening or diagnostic method for flatfoot.