Comparison of Monolateral External Fixation and Internal Fixation for Skeletal Stabilisation in the Management of Small Tibial Bone Defects following Successful Treatment of Chronic Osteomyelitis

Background. To compare the salvage rate and complication between internal fixation and external fixation in patients with small bone defects caused by chronic infectious osteomyelitis debridement. Methods. 125 patients with chronic infectious osteomyelitis of tibia fracture who underwent multiple irrigation, debridement procedure, and local/systemic antibiotics were enrolled. Bone defects, which were less than 4 cm, were treated with bone grafting using either internal fixation or monolateral external fixation. 12-month follow-up was conducted with an interval of 3 months to evaluate union of bone defect. Results. Patients who underwent monolateral external fixation had higher body mass index and fasting blood glucose, longer time since injury, and larger bone defect compared with internal fixation. No significant difference was observed in incidence of complications (23.5% versus 19.3%), surgery time (156±23 minutes versus 162±21 minutes), and time to union (11.1±3.0 months versus 10.9±3.1 months) between external fixation and internal fixation. Internal fixation had no significant influence on the occurrence of postoperation complications after multivariate adjustment when compared with external fixation. Furthermore, patients who underwent internal fixation experienced higher level of daily living scales and lower level of anxiety. Conclusions. It was relatively safe to use internal fixation for stabilization in osteomyelitis patients whose bone defects were less than 4 cm and infection was well controlled.

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Clinical Value of Computer-Assisted Taylor Three-dimensional External Fixation in the Treatment of Tibiofibular Fracture (Preprint)

10.2196/preprints.20711 ◽

2020 ◽

Author(s):

Hongfeng Sheng ◽

Weixing Xu ◽

Bin Xu ◽

Hongpu Song ◽

Di Lu ◽

...

Keyword(s):

Retrospective Study ◽

Internal Fixation ◽

External Fixation ◽

External Fixator ◽

Theoretical Basis ◽

New Technology ◽

Three Dimensional ◽

Computer Assisted ◽

Clinical Value

UNSTRUCTURED The retrospective study of Taylor's three-dimensional external fixator for the treatment of tibiofibular fractures provides a theoretical basis for the application of this technology. The paper collected 28 patients with tibiofibular fractures from the Department of Orthopaedics in our hospital from March 2015 to June 2018. After the treatment, the follow-up evaluation of Taylor's three-dimensional external fixator for the treatment of tibiofibular fractures and concurrency the incidence of the disease, as well as the efficacy and occurrence of the internal fixation of the treatment of tibial fractures in our hospital. The results showed that Taylor's three-dimensional external fixator was superior to orthopaedics in the treatment of tibiofibular fractures in terms of efficacy and complications. To this end, the thesis research can be concluded as follows: Taylor three-dimensional external fixation in the treatment of tibiofibular fractures is more effective, and the incidence of occurrence is low, is a new technology for the treatment of tibiofibular fractures, it is worthy of clinical promotion.

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Revision Rates After Surgical Treatment for Femoral Neck Fractures: Results of 2-Year Follow-up

Medicina ◽

10.3390/medicina49030022 ◽

2013 ◽

Vol 49 (3) ◽

pp. 22

Author(s):

Jaunius Kurtinaitis ◽

Narūnas Porvaneckas ◽

Giedrius Kvederas ◽

Tomas Butėnas ◽

Valentinas Uvarovas

Keyword(s):

Total Hip Arthroplasty ◽

Femoral Neck ◽

Internal Fixation ◽

Hip Arthroplasty ◽

Revision Surgery ◽

Femoral Neck Fractures ◽

Total Hip ◽

Significant Difference ◽

Surgery Rates

Background and Objective. Intracapsular fractures of the femoral neck account for a major share of fractures in the elderly. Open reduction and internal fixation has been shown to have a higher rate of revision surgery than arthroplasty. The aim of this study was to assess and compare the rates of revision surgery performed after internal fixation and primary total hip arthroplasty. Material and Methods. Between 2004 and 2006, 681 intracapsular femoral neck fractures in 679 consecutive patients were treated with internal fixation or total hip arthroplasty at our institution. Revision surgery rates were evaluated at 1-, 3-, 6-, 12-, and 24-month follow-up. Results. There was no significant difference in the ratio of internal fixation to total hip arthroplasty during 2004–2006 (P=0.31). The mean rate of total hip arthroplasty was 19.1% with a lower rate being among patients younger than 60 years. Revision surgery rates at the 2-year followup were higher in the internal fixation group compared with total hip arthroplasty group (28.9% vs. 7.0%, P<0.001). Patients who underwent internal fixation were at a 4-fold greater risk of having revision surgery at the 2-year follow-up than those who underwent total hip arthroplasty (odds ratio, 4.11; 95% CI, 1.95–8.65; P<0.001). Age was a significant risk factor for revision surgery after total hip arthroplasty (hazard ratio, 0.93; 95% CI, 0.87–0.98; P=0.02), but not significant after the internal fixation (P=0.86). Conclusions. Higher revision surgery rates after internal fixation favors arthroplasty as a primary choice of treatment for the femoral neck fractures.

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3D Printing Individualized Assisted Repair and Reconstruction of Irregular Bone Neoplastic Bone Defects: Exploration and Practice in Scapular Aneurysmal Cystic Bone Defects

10.21203/rs.3.rs-477108/v1 ◽

2021 ◽

Author(s):

Guochen Luo ◽

yao Zhang ◽

Xiahua Wang ◽

Shuaishuai Chen ◽

Dongyi Li ◽

...

Keyword(s):

3D Printing ◽

Bone Defect ◽

Bone Tumor ◽

Surgical Approach ◽

Treatment Plan ◽

Operation Time ◽

Bone Defects ◽

Anatomical Structure ◽

Medical Software

Abstract Objective: To explore the clinical efficacy of using 3D printing individualized treatment plan in the auxiliary repair and reconstruction of irregular bone tumor bone defect.Methods：Seven patients with aneurysmal bone cyst of scapula were selected. Based on the CT data of the patient, the scapula (including defect) and pelvis were reconstructed by computer Mimics Medical software. Print out the reconstructed scapula model with a 3D printer. Before operation, the model was used to design the surgical approach and simulate the operation process, to determine the length and Radian of the plate and the number and direction of screws, and to determine the bone mass of the ilium and make reasonable segmentation and distribution. The operation time, the amount of bleeding, the length and Radian of the plate, and the direction and number of screws were recorded.Results : The average follow-up time was 25.6 months, and none of the 7 patients had recurrence during the follow-up period; The surgical approach, the length and Radian of the internal fixation, the number and direction of screws were consistent with the designed operation plan. The anatomical structure of scapula and the function of shoulder joint gradually recovered.Conclusions: Compared with traditional methods, the use of 3D printing technology in the treatment of irregular bone tumor bone defect has less trauma, shorter operation time and less bleeding, which can reduce the waste of bone graft and reconstruct the anatomical structure of bone defect more completely.

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Comparison of the efficacy of MIS-TLIF combined with unilateral or bilateral internal fixation on single-segment lumbar degenerative diseases

European Journal of Inflammation ◽

10.1177/2058739219844393 ◽

2019 ◽

Vol 17 ◽

pp. 205873921984439

Author(s):

Lisheng Zhao ◽

Huijin Yu ◽

Yan Zhang ◽

Wenjun Zhen

Keyword(s):

Internal Fixation ◽

Lumbar Lordosis ◽

Clinical Effects ◽

Degenerative Diseases ◽

Single Segment ◽

Tnf Α ◽

Significant Difference ◽

Lumbar Degenerative Diseases ◽

Serum Crp

In this study, to compare the efficacy of minimally invasive surgery transforaminal lumbar interbody fusion (MIS-TLIF) combined with unilateral or bilateral internal fixation for the treatment of single-segment lumbar degenerative diseases, patients with single-segment lumbar degenerative diseases treated with MIS-TLIF combined with unilateral or bilateral internal fixation in Rehabilitation Center, Gansu Province Hospital from January 2014 to November 2015 were retrospectively enrolled, and the related data of 85 patients with 2-year follow-up were obtained. The patients were divided into unilateral group (40 cases) and bilateral group (45 cases) according to the method of internal fixation, and the Oswestry dysfunction index (ODI), visual analogue scale (VAS), lumbar lordosis angle, surgical segmental lordosis angle, lumbar scoliosis angle, surgical segmental scoliosis angle, lumbar lordosis index (LI), intervertebral height index (IHI), fusion rates, and serum inflammatory factors, including C-reactive protein (CRP), interleukin (IL)-6, and tumor necrosis factor alpha (TNF-α), were calculated to evaluate the efficacy of these two surgical methods. The results showed that the VAS and ODI of the two groups at 1 month, 6 months after surgery, and the last follow-up were significantly improved when compared with those before surgery ( P < 0.05). However, there were no significant differences in VAS and ODI between the two groups at preoperative, 1 month, 6 months after surgery, and the last follow-up ( P > 0.05). The lumbar lordosis and LI decreased at 1 month, 6 months, and the last follow-up ( P < 0.05), while the IHI increased when compared with that before surgery ( P < 0.05). Besides, no significant differences were observed in lumbar lordosis, LI, and IHI between the two groups at preoperative, 1 month, 6 months after surgery, and final follow-up ( P > 0.05). In addition, the fusion rates between these two groups had no significant difference ( P > 0.05). The levels of serum CRP, IL-6, and TNF-α at 12 and 24 h after operation in the two groups were higher than those before operation ( P < 0.05), but there was no significant difference in the levels of serum CRP, IL-6, and TNF-α between the two groups at 12 and 24 h after operation ( P < 0.05). In addition, none of the patients of both groups had permanent nerve injury, incision infection, and other complications. These results showed that MIS-TLIF combined with unilateral or bilateral percutaneous internal fixation technique causes less damage to the body tissues of patients with single-segment lumbar degenerative diseases, and they were considered to have similar clinical effects and imaging.

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Arthroscopic fixation of humeral greater tuberosity fracture using a W-shaped suture

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-020-02077-8 ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Xiaocong Lin ◽

Xiuxi Huang ◽

Kaibin Fang ◽

Zhangsheng Dai

Keyword(s):

Internal Fixation ◽

Range Of Motion ◽

Shoulder Arthroscopy ◽

Healing Time ◽

Fixation Failure ◽

Greater Tuberosity ◽

Vas Score ◽

Constant Murley Score ◽

Significant Difference

Abstract Background Patients with greater tuberosity fractures of the humerus often require surgery. Therefore, there is a need to find a minimally invasive and effective surgical procedure with great patient outcomes. Aim To evaluate the clinical outcomes of the W-shaped suture technique under shoulder arthroscopy in the treatment of greater tuberosity fractures of the humerus. Methods In this retrospective study, a total of 17 patients were included. The fractures were closed, and there was no neurovascular injury. These patients underwent arthroscopically assisted reduction and internal fixation of the greater tuberosity fractures. Fixation was performed using sighting nails combined with a W-shaped suture. The imaging data of the patients were collected, and the ASES score, Constant-Murley score, and VAS score were used to evaluate the patient’s outcome. At the last follow-up (at least 1 year), the range of motion in the affected shoulder was compared with that of the contralateral side. Results The operation was successful in all the patients. The average follow-up time was 13 months. There were no reported complications such as fracture displacement, nonunion, and internal fixation failure during the follow-up period. Post-operative X-ray examinations revealed good function recovery, with a healing time of between 10 and 12 weeks, and an average healing time of 11.5 weeks. Following the operation, patients reported reduced shoulder joint pain that no longer influenced their activity or caused discomfort in their daily life. The patient’s VAS score ranged from 0 to 3, with an average of 0.52 ± 0.73, while at the last follow-up, the Constant-Murley score ranged from 83 to 97, with an average of 92.33 ± 7.55. The ASES score ranged from 81 to 98, with an average of 93.15 ± 6.93. At the last follow-up, there was no significant difference in the overall range of motion with the unaffected limb. Conclusion This study demonstrates that the W-shaped suture can be used to effectively fix the fractures of the greater tuberosity of the humerus, by increasing the fixed area to promote healing.

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Preliminary Results on the Effectiveness of a Nutrition Intervention in Lowering Diabetes Risk in Prediabetic People Living with HIV (PLWH) in MASH Cohort (OR36-06-19)

Current Developments in Nutrition ◽

10.1093/cdn/nzz035.or36-06-19 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

Author(s):

Alicia Sneij Perez ◽

Adriana Campa ◽

Leslie Seminario ◽

Sabrina Martinez ◽

Fatma Huffman ◽

...

Keyword(s):

Blood Glucose ◽

Fasting Blood Glucose ◽

Intervention Group ◽

Nutrition Intervention ◽

Control Group ◽

Reactive Protein ◽

Research Initiative ◽

Significant Difference ◽

Hs Crp

Abstract Objectives The objective of this study is to assess the effectiveness of a 6-month nutrition intervention to improve glycemic parameters and inflammation in prediabetic PLWH on stable ART with undetectable HIV viral load. Methods A 6-month randomized, controlled nutrition intervention was conducted in prediabetic PLWH. The study participants for the intervention were recruited from the Miami Adult Studies for HIV (MASH) cohort at the FIU-Borinquen Research Clinic. Upon their consent, the participants were randomized into the intervention group or the control group. Participants randomized in the intervention group met once a month for approximately 1 hour where they received medical nutrition therapy, nutrition counseling and nutrition education; participants randomized into the control group received educational material at baseline. Blood was drawn at baseline and at 6-month to measure fasting blood glucose (FBG) and high sensitivity C-reactive protein (hs-CRP). Results A total of 38 participants were recruited and randomized into either the intervention group (n = 20) or the control group (n = 18). We found that the FBG for the 6-month follow-up for the intervention group was significantly lower than the baseline FBG values of the same study group (paired t-test; P = 0.031). No significant difference was found in the control group between the baseline and 6-month fasting blood glucose values (P = 0.068). Moreover, no significant difference was found in pre/post C-reactive protein (CRP) levels in the intervention or control group (paired t-test; P = 0.404 and P = 0.117 respectively). There was a significant difference in CRP levels at baseline (P = 0.028) between the study groups but no difference at the 6-month follow up (Mann Whitney U test: P = 0.430). Conclusions The results from this intervention support the notion that a nutrition intervention is effective in prediabetic PLWH to lower diabetes risk by significantly lowering fasting blood glucose and may be implemented into larger scale interventions; however, no significant changes was seen in hs-CRP values between the 2 groups. Funding Sources National Institute of General Medical Sciences (NIGMS): Research Initiative for Scientific Enhancement (RISE), Biomedical Research Initiative (BRI) Grant, National Institute on Drug Abuse 5U01DA040381-03 and FIU-Dissertation Funding.

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Outcomes of Hindfoot and Ankle Arthrodesis in Neuropathic Patients

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00284 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0028

Author(s):

David Macknet ◽

Andrew Wohler ◽

Carroll P. Jones ◽

J. Kent Ellington ◽

Bruce E. Cohen ◽

...

Keyword(s):

Internal Fixation ◽

External Fixation ◽

Limb Salvage ◽

Median Number ◽

Ankle Arthrodesis ◽

High Rate ◽

Hardware Failure ◽

Radiographic Outcomes ◽

Fixation Group

Category: Ankle Arthritis, Diabetes, Hindfoot Introduction/Purpose: Charcot neuropathy of the ankle and hindfoot is a progressive and destructive process that can lead to instability and ulceration resulting in significant morbidity which can end with amputation. The foot and ankle surgeon’s aim is to reconstruct the high risk foot with the creation of a stable plantigrade foot, while reducing the risk of ulceration and allowing the patient to mobilize in commercially available footwear. There are numerous techniques for the reconstruction of the neuropathic hindfoot, but the most utilized of these include multiplanar external fixation or internal fixation with a plate or intramedullary nail. It is our goal to further elucidate outcomes of Charcot patients undergoing corrective ankle and hindfoot fusion comparing internal versus external fixation. Methods: We retrospectively collected 377 patients undergoing hindfoot and ankle arthrodesis at our institution from 2006- 2017. 77 patients were identified that underwent arthrodesis for Charcot arthropathy, 56 of which met our inclusion and exclusion criteria. This included 47 who had internal fixation as their primary procedure and 9 patients who underwent external fixation with a multi-planar external fixator. Our median follow up time was 3.4 years (IQR .5 to 12.9). Preoperatively we collected basic demographic variables, reasons for neuropathy, and ulcer status. Postoperatively we collected complications including infection, hardware failure, ulceration, recurrent deformity, and radiographic outcomes including union and hardware backout. Reoperation numbers and indications were also collected. Our primary outcome was limb salvage at final follow up. Secondarily, we collected final ambulatory and footwear status. Results: The limb salvage rate was 82% with 10 patients undergoing amputation, which did not vary between groups (p=.99). The primary reasons for amputation were persistent infection (4 of 10) and nonunion (4 of 10). Thirteen (24%) patients developed an infection. The median number of reoperations per patient was 1 (IQR 0-2) with the patients who underwent amputation undergoing a median of 2 (IQR 2-4) reoperations. The rate of union was 54%, occurring at a median of 26.5 (IQR 12-47) months. 44% (4/9) of patients in the external fixation group had a preoperative ulceration versus 19% (9/47) of the patients in the internal fixation group (p=.19). Preoperative ulceration was not a risk factor for amputation. Forty-two (75%) patients were ambulatory at final follow up. Conclusion: We report on the single largest series of Charcot patients undergoing hindfoot and ankle arthrodesis. The surgical management of this population has a high rate of complications with infection and reoperation being common. Despite a high nonunion rate most patients are able to ambulate in a brace or orthotic. Limb salvage can be expected with either internal or external fixation techniques.

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Ankle spanning external fixator with limited internal fixation for distal tibial extra-articular fractures

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20174557 ◽

2017 ◽

Vol 5 (10) ◽

pp. 4355

Author(s):

Siddharth Goel ◽

Abhay Elhence

Keyword(s):

Soft Tissue ◽

Internal Fixation ◽

External Fixation ◽

External Fixator ◽

Tibial Fractures ◽

Fixation Method ◽

Ankle Pain ◽

Distal Tibial Fractures ◽

Tract Infections

Background: Fractures of the distal tibia are among the most difficult fractures to treat. The short distal segment presents difficulty in choosing the appropriate fixation method. The greatest challenge lies in the relatively tight soft tissue around the ankle. As a result, it has been a recent interest in treating these fractures with external fixation and limited internal fixation. The external stable fixation methods used are tubular or ring fixators, with or without immobilising the ankle. This minimally invasive nature of the surgery can avoid catastrophic wound complications like dehiscence, implant exposure and infection.Methods: 18 patients with extra-articular distal tibial fractures (AO Type 43A) were treated with the technique of ankle spanning external fixation. Lag screws or K-wires were supplemented for limited internal fixation when required. Fibula was stabilised in all cases. Intra- articular and Compound fractures were excluded. In addition to union at fracture site, ankle pain and motion was noted in each follow-up.Results: The mean follow-up was 25 months. Of the 18 patients included all but one fractures united with an average healing time of 16 to 18 weeks. Ankle pain and motion was graded according to Mazur modified by Teeny and Wiss clinical scoring system. 15 of them had excellent or good results, 2 had fair results. One patient had poor result. Five pin tract infections occurred. 17 patients had no evidence of osteoarthritis after completing follow up of at least 2 years.Conclusions: Distal tibial fractures are complex injuries, not only regarding the bony component, but also in terms of the management of the soft tissue problem. Ankle Spanning External Fixator with Limited Internal fixation is a relatively simple and cost-effective method for treating these fractures, achieving union and also maintaining ankle function.

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Comparison of outcomes of ORIF versus bidirectional tractor and arthroscopically assisted CRIF in the treatment of lateral tibial plateau fractures: a retrospective cohort study

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02447-w ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Xiangtian Deng ◽

Hongzhi Hu ◽

Yiran Zhang ◽

Weijian Liu ◽

Qingcheng Song ◽

...

Keyword(s):

Cohort Study ◽

Internal Fixation ◽

Clinical Outcomes ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Tibial Plateau ◽

Clinical Score ◽

Lateral Tibial Plateau ◽

Significant Difference

Abstract Background Lateral tibial plateau fractures (TPFs) are often treated with conventional open reduction and internal fixation (ORIF) through standard anterolateral sub-meniscal arthrotomy. There has been increasing support for “bidirectional rapid redactor” device-assisted closed reduction and internal fixation (CRIF) for treating TPFs. The aim of the present study is to compare the clinical and radiological outcomes between CRIF and ORIF procedures. Methods We performed a retrospective cohort study of 55 lateral TPF patients (Schatzker types I–III) who accepted surgical treatment at our trauma level 1 center between January 2016 and January 2018. They were divided into the CRIF group (32 patients) and the ORIF group (23 patients) based upon the different surgical protocols. The patients’ clinical outcome analysis was evaluated by using the Knee Society Score (KSS) and Rasmussen’s clinical score. For radiological assessment, changes in tibial plateau width (TPW), articular depression depth (ADD), medial proximal tibial angle (MPTA), and posterior tibial slope angle (PTSA) were evaluated using radiographs and computed tomography (CT) scan. Results The CRIF group had a mean follow-up of 28.9 months, and the ORIF group had a mean follow-up of 30.7 months (p>0.05). Furthermore, there was no statistically significant difference in terms of age, gender, injury mechanism, follow-up time, time interval from injury to surgery, and Schatzker classification in the two groups. With respect to the clinical outcomes including the KSS score and Rasmussen’s clinical score, there was also no significant difference (p>0.05). Nevertheless, the CRIF group had lower intra-operative blood loss, shorter hospitalization days, and better range of movement of the knee joint than the ORIF group (p<0.05). Furthermore, CRIF had better radiological results when compared to the ORIF group using Rasmussen’s radiological score (p<0.05), although no significant difference was observed in TPW, ADD, MPTA, and PTSA between the two groups (p>0.05). Conclusion The present study showed that CRIF could achieve comparable clinical outcomes and better radiological results for treating lateral TPFs as compared with conventional ORIF.

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Outcomes of arthroscopic capsulolabral reconstruction for anterior instability with greater than 20% glenoid bone defects: are Latarjet procedures absolutely indicated for these patients?

Clinics in Shoulder and Elbow ◽

10.5397/cise.2019.00094 ◽

2020 ◽

Vol 23 (2) ◽

pp. 62-70 ◽

Cited By ~ 1

Author(s):

Sae Hoon Kim ◽

Whanik Jung ◽

Sung-Min Rhee ◽

Ji Un Kim ◽

Joo Han Oh

Keyword(s):

Bone Defect ◽

Shoulder Instability ◽

Bone Defects ◽

Defect Size ◽

Anterior Shoulder Instability ◽

Return To Sports ◽

Anterior Instability ◽

Recurrent Instability ◽

Capsulolabral Reconstruction

Background: Recent studies have reported high rates of recurrence of shoulder instability in patients with glenoid bone defects greater than 20% after capsulolabral reconstruction. The purpose of the present study was to evaluate the failure rate of arthroscopic capsulolabral reconstruction for the treatment of anterior instability in the presence of glenoid bone deficits >20%. Methods: Retrospective analyses were conducted among cases with anterior shoulder instability and glenoid bone defects of >20% that were treated by arthroscopic capsulolabral reconstruction with a minimum 2-year follow-up (30 cases). We included the following variables: age, bone defect size, instability severity index score (ISIS), on-/off-track assessment, incidence recurrent instability, and return to sports. Results: The mean glenoid bone defect size was 25.8% ± 4.2% (range, 20.4%–37.2%), and 18 cases (60%) had defects of >25%. Bony Bankart lesions were identified in 11 cases (36.7%). Eleven cases (36.7%) had ISIS scores >6 points and 21 cases (70%) had off-track lesions. No cases of recurrent instability were identified over a mean follow-up of 39.9 months (range, 24–86 months), but a sense of subluxation was reported by three patients. Return to sports at the preinjury level was possible in 24 cases (80%), and the average satisfaction rating was 92%. Conclusions: Arthroscopic soft tissue reconstruction was successful for treating anterior shoulder instability among patients with glenoid bone defects >20%, even enabling return to sports. Future studies should focus on determining the range of bone defect sizes that can be successfully managed by soft tissue repair.

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