Standardized artificially created stable pertrochanteric femur fractures present more homogenous results compared to osteotomies for orthopaedic implant testing

Abstract Background With regard to biomechanical testing of orthopaedic implants, there is no consensus on whether artificial creation of standardized bone fractures or their simulation by means of osteotomies result in more realistic outcomes. Therefore, the aim of this study was to artificially create and analyze in an appropriate setting the biomechanical behavior of standardized stable pertrochanteric fractures versus their simulation via osteotomizing. Methods Eight pairs of fresh-frozen human cadaveric femora aged 72.7 ± 14.9 years (range 48–89 years) were assigned in paired fashion to two study groups. In Group 1, stable pertrochanteric fractures AO/OTA 31-A1 were artificially created via constant force application on the anterior cortex of the femur through a blunt guillotine blade. The same fracture type was simulated in Group 2 by means of osteotomies. All femora were implanted with a dynamic hip screw and biomechanically tested in 20° adduction under progressively increasing physiologic cyclic axial loading at 2 Hz, starting at 500 N and increasing at a rate of 0.1 N/cycle. Femoral head fragment movements with respect to the shaft were monitored by means of optical motion tracking. Results Cycles/failure load at 15° varus deformation, 10 mm leg shortening and 15° femoral head rotation around neck axis were 11324 ± 848/1632.4 ± 584.8 N, 11052 ± 1573/1605.2 ± 657.3 N and 11849 ± 1120/1684.9 ± 612.0 N in Group 1, and 10971 ± 2019/1597.1 ± 701.9 N, 10681 ± 1868/1568.1 ± 686.8 N and 10017 ± 4081/1501.7 ± 908.1 N in Group 2, respectively, with no significant differences between the two groups, p ≥ 0.233. Conclusion From a biomechanical perspective, by resulting in more consistent outcomes under dynamic loading, standardized artificial stable pertrochanteric femur fracture creation may be more suitable for orthopaedic implant testing compared to osteotomizing the bone.

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Geriatric Proximal Femur Fractures During the Covid-19 Pandemic - Fewer Cases, But More Comorbidities

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/21514593211009657 ◽

2021 ◽

Vol 12 ◽

pp. 215145932110096

Author(s):

Christina Polan ◽

Heinz-Lothar Meyer ◽

Manuel Burggraf ◽

Monika Herten ◽

Paula Beck ◽

...

Keyword(s):

Nursing Home ◽

Elderly Patients ◽

Proximal Femur ◽

Minor Trauma ◽

Proximal Femur Fractures ◽

Femur Fractures ◽

Number Of Patients ◽

Group 2 ◽

The Impact ◽

Group 1

Background: The COVID-19 pandemic is challenging healthcare systems worldwide. This study examines geriatric patients with proximal femur fractures during the COVID-19 pandemic, shifts in secondary disease profile, the impact of the pandemic on hospitalization and further treatment. Methods: In a retrospective monocentric study, geriatric proximal femur fractures treated in the first six months of 2020 were analyzed and compared with the same period of 2019. Pre-traumatic status (living in a care home, under supervision of a legal guardian), type of trauma, accident mechanism, geriatric risk factors, associated comorbidities, time between hospitalization and surgery, inpatient time and post-operative further treatment of 2 groups of patients, aged 65-80 years (Group 1) and 80+ years (Group 2) were investigated. Results: The total number of patients decreased (70 in 2019 vs. 58 in 2020), mostly in Group 1 (25 vs. 16) while the numbers in Group 2 remained almost constant (45 vs. 42). The percentage of patients with pre-existing neurological conditions rose in 2020. This corresponded to an increase in patients under legal supervision (29.3%) and receiving pre-traumatic care in a nursing home (14.7%). Fractures were mostly caused by minor trauma in a home environment. In 2020, total number of inpatient days for Group 2 was lower compared to Group 1 (p = 0.008). Further care differed between the years: fewer Group 1 patients were discharged to geriatric therapy (69.6% vs. 25.0%), whereas in Group 2 the number of patients discharged to a nursing home increased. Conclusions: Falling by elderly patients is correlated to geriatric comorbidities, consequently there was no change in the case numbers in this age group. Strategic measures to avoid COVID-19 infection in hospital setting could include reducing the length of hospital stays by transferring elderly patients to a nursing home as soon as possible and discharging independent, mobile patients to return home.

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COMPARATIVE STUDY BETWEEN MEDIALAND LATERAL DISTAL TIBIAL LOCKING COMPRESSION PLATES FOR DISTAL THIRD TIBIAL FRACTURES

10.36106/ijsr/8003003 ◽

2021 ◽

pp. 1-4

Author(s):

Rajat Saini ◽

R. K. Verma ◽

S. P. Gupta ◽

Rajat Jangir ◽

Raj Kumar Bairwa

Keyword(s):

Open Reduction ◽

Bone Fractures ◽

Locking Compression Plate ◽

Tibial Fractures ◽

Plate Group ◽

Locking Compression Plates ◽

Compression Plate ◽

Lateral Plating ◽

Group 2 ◽

Group 1

Aim and objectives:to compare both the ways of xation in randomly selected cases in distal third tibia fractures to known the best way of xation technique & implant. Material and methods: In our study we have selected 40 patients with fractures of the distal third tibia, who attended the department of orthopaedics treated by open reduction and internal xation with using Medial/Lateral distal locking compression plates, in Mahatma Gandhi Medical College & Hospital, Jaipur during the year January 2019 to June 2020. The duration of follow-up to evaluate result was six months. We divided the distal leg bone fractures into two groups. Group 1: Include the distal third tibial fractures which are simple or comminuted treated as open reduction & internal xation with lateral locking compression plate. Group 2: Includes the distal third tibial fractures which are simple or comminuted, treated as open reduction & internal xation with medial locking compression plate. Results: There was no signicant difference in duration of surgeries and suture removal.In there were 3 cases of nonunion 1 case in lateral plating group and 2 cases in medial plating group. Group 1 were show 20% excellent, 45% good, 30% fair & 5% poor result. Group 2 were show 15 % excellent, 30% good, 45% fair &10% poor result according to Tenny & Wiss criteria. Conclusion: Lateral plating was much better in as a procedure and outcome wise.

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Treatment of Phalangeal Joint Stiffness Related to Proximal Phalangeal Bone Fractures: Therapeutic Effects on the Range of Motion and Finger Pain

Archives of Hand and Microsurgery ◽

10.12790/ahm.21.0123 ◽

2021 ◽

Author(s):

Dongkeun Jun ◽

Minkyoung Jeong ◽

Donghyeok Shin ◽

Hyungon Choi ◽

Jeenam Kim ◽

...

Keyword(s):

Range Of Motion ◽

Bone Fractures ◽

Joint Stiffness ◽

Operative Procedures ◽

Metacarpophalangeal Joints ◽

Elastic Resistance ◽

Group 2 ◽

Phalangeal Bone ◽

Swan Neck Deformity ◽

Group 1

Purpose: Proximal phalangeal bone fractures with displacement are treated using operative procedures. These fractures can cause stiffness of the interphalangeal or metacarpophalangeal joints, which can be relieved using various operative and nonoperative techniques. This study analyzed the range of motion (ROM) and pain after a combination therapy to treat finger stiffness following proximal phalangeal fractures.Methods: Fifty-two patients who underwent operative procedures for proximal phalangeal fractures and showed finger stiffness from March 2015 to January 2021 were included in this retrospective study. The patients in group 1 (n=24) performed elastic resistance exercises, while those in group 2 (n=28) underwent conventional exercise. ROM and pain score were measured at 5, 8, and 12 weeks postoperatively. Furthermore, a patient with a swan-neck deformity and intractable stiffness was treated using partial translocation of the extensor apparatus, and the postoperative outcome is presented.Results: Group 1 showed a larger ROM and less pain than group 2 at 12 weeks postoperatively (p<0.05). Patients in both groups exhibited notable improvements with regard to ROM and pain during the study period (p<0.05). In addition, the swan-neck deformity accompanying hyperextension of the proximal interphalangeal joint was significantly relieved.Conclusion: Proximal phalangeal bone fractures can lead to stiffness of the interphalangeal and metacarpophalangeal joints. Joint stiffness was relieved using an elastic resistance exercise protocol in the early postoperative period. Intractable stiffness showing a fixed joint angle can be treated with thorough tenolysis and corrective surgery.

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Bone remodeling features in elderly and senile patients with the proximal femur fractures after hip replacement

Wiadomości Lekarskie ◽

10.36740/wlek202002110 ◽

2020 ◽

Vol 73 (2) ◽

pp. 259-265

Author(s):

Oleksandr M. Khvysyuk ◽

Volodymyr O. Babalian ◽

Serge B. Pavlov ◽

Galina B. Pavlova

Keyword(s):

Treatment Outcome ◽

Proximal Femur ◽

Enzyme Linked Immunosorbent Assay ◽

Regulatory Pathways ◽

Proximal Femur Fractures ◽

Femur Fractures ◽

Results Of Treatment ◽

Group 2 ◽

Tgf Β1 ◽

Group 1

The aim of this study is to identify the dependence of the result of surgical treatment of patients of elderly and senile age with fractures of the proximal femur on the characteristics of the response cytokine-mediated regulatory response to trauma and surgery. Materials and methods: In 74 patients after hip arthroplasty, serum levels of bone metabolism markers were determined using enzyme-linked immunosorbent assay. Patients were divided into 2 groups depending on the results of treatment. Results: It was found that compared with group 2 (treatment outcome is worse) in group 1 (treatment outcome is better) there was a greater number of correlations. In group 1, correlations were found between OPG and RANKL (r = 0.88; p = 0.000), OPG and OPG/RANKL (r = 0.44; p = 0.006), TGF-β1 and OPG/RANKL (r = 0.66; p = 0.000) , IL-6 and OPG (r = 0.67; p = 0.000), IL-6 and RANKL (r = 0.53; p = 0.001), IL-6 and OPG/RANKL (r = 0.39; p = 0.016). In group 2, only between OPG and OPG/RANKL (r = 0.72; p = 0.000), RANKL and OPG/RANKL (r = −0.53; p = 0.0007). In patients of group 2, there was a decrease in the level of OPG relative to the control and a less significant increase in TGF-β1 and IL-6 relative to group 1. Conclusion: The prognosis of the results of treatment of patients with proximal femur fractures is largely determined by the nature of the adaptive response to injury and the implant, the synchronism of the mechanism of stress remodeling of the bone. A less favorable prognosis after arthroplasty is associated with exacerbation of the initial metabolic disorders in the bone tissue due to severe cytokine-mediated dysfunction of the regulatory pathways.

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Iliac Fascia Compartment Block and Analgesic Consumption in Patients Operated on for Hip Fracture

Ortopedia Traumatologia Rehabilitacja ◽

10.5604/01.3001.0010.5825 ◽

2017 ◽

Vol 19 (5) ◽

pp. 0-0 ◽

Cited By ~ 3

Author(s):

Mateusz Klukowski ◽

Rafał Kowalczyk ◽

Grzegorz Górniewski ◽

Paweł Łęgosz ◽

Marek Janiak ◽

...

Keyword(s):

Proximal Femur ◽

Medical Records ◽

Ultrasound Guidance ◽

Postoperative Mortality ◽

Early Mobilization ◽

Femur Fractures ◽

Study Results ◽

Group 2 ◽

Fascia Iliaca Compartment Block ◽

Group 1

Background. Fractures of the proximal femur in elderly patients are a challenge for orthopedics, anesthesiology and geriatrics. Early mobilization reduces postoperative mortality among these patients. Effective analgesia is necessary to achieve this goal. Material and methods. A retrospective analysis of perioperative medical records of 78. patients undergoing surgical treatment of proximal femur fractures was performed. Group 1 (n=35)consisted of patients who were treated with pharmacologic analgesia only (systemic analgesics) and Group 2 (n=43) involved patients who received a preoperative fascia iliaca compartment block (FICB) and pharmacologic analgesia. FICB was performed under ultrasound guidance, and systemic analgesics were administered according to a standardized protocol. Demographics, anesthesia and operation data as well as the dosage of analgesics used on postoperative day 0 were collected for the study. Results. Patients with antecedent iliac fascia blockade required fewer analgesic interventions (3 vs. 11, p <0.0001) and showed significantly less need for analgesics than non-block patients. No complications were observed after performing FICB. Conclusion. The iliac fascia compartment block produces effective postoperative analgesia and reduces postoperative opioid consumption.

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Comparison of Titanium Elastic Nailing and End-threaded Intramedullary Pinning for Distal Femoral Fractures in Young Dogs

Indian Journal of Animal Research ◽

10.18805/ijar.b-4454 ◽

2021 ◽

Author(s):

Harmanpreet Singh Sodhi ◽

Ashwani Kumar ◽

Arun Anand ◽

Vandana Sangwan ◽

Opinder Singh

Keyword(s):

Stainless Steel ◽

Functional Outcome ◽

Weight Bearing ◽

Femoral Fractures ◽

Titanium Implants ◽

Early Weight Bearing ◽

Femur Fractures ◽

Elastic Nails ◽

Group 2 ◽

Group 1

Background: Femur fractures are common in immature dogs. As compared to stainless steel, titanium implants are lighter and allow controlled micro-motion at the site of fracture that stimulates early callus formation by limiting stress shielding. Cited literature reports successful clinical use of titanium elastic nails for the stabilization of long bone fractures in young human patients; however, there is paucity of information on this technique is dogs. This study was planned with an objective to compare titanium elastic nails (TENS) and single end-threaded pin for the management of femoral fractures in young dogs. Methods: The study included 20 clinical cases (10 male and 10 female) of dogs suffering from distal femoral fracture with a mean ± SD age of 5.70 ± 5.60 month, body weight 11.09 ± 4.48 Kg since 3.05 ± 2.35 days. The cases were divided into 2 groups; using TENS (n=10; group 1) and stainless steel end-threaded intramedullary pin (n=10; group 2). Result: Group 1 dogs demonstrated better fracture reduction score, early and uniform callus and better implant stability as compared to group 2, radiographically. Early weight bearing and minimum postoperative complications with better functional outcome including joint mobility was reported in group 1. In conclusions, TENS is superior fracture fixation technique for the repair of supracondylar or distal third femur fractures in young dogs with better functional outcome, minimal stiffness of stifle joint and early weight bearing, in comparison to single end threaded intramedullary pin.

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Complications of Resection Arthroplasty in Two-Stage Revision for the Treatment of Periprosthetic Hip Joint Infection

Journal of Clinical Medicine ◽

10.3390/jcm8122224 ◽

2019 ◽

Vol 8 (12) ◽

pp. 2224 ◽

Cited By ~ 1

Author(s):

Irene K. Sigmund ◽

Tobias Winkler ◽

Nuri Önder ◽

Carsten Perka ◽

Nora Renz ◽

...

Keyword(s):

Blood Loss ◽

Bone Fractures ◽

Joint Infection ◽

Resection Arthroplasty ◽

High Rate ◽

Complication Rates ◽

Two Stage ◽

Free Survival ◽

Group 2 ◽

Group 1

Little data is available regarding complications associated with resection arthroplasty in the treatment of hip periprosthetic joint infection (PJI). We assessed complications during and after two-stage revision using resection arthroplasty. In this retrospective study, 93 patients undergoing resection arthroplasty for hip PJI were included. Patients were assigned to a prosthesis-free interval of ≤10 weeks (group 1; 49 patients) or >10 weeks (group 2; 44 patients). The complication rates between groups were compared using the chi-squared test. The revision-free and infection-free survival was estimated using a Kaplan–Meier survival analysis. Seventy-one patients (76%) experienced at least one local complication (overall 146 complications). Common complications were blood loss during reimplantation (n = 25) or during explantation (n = 23), persistent infection (n = 16), leg length discrepancy (n = 13) and reinfection (n = 9). Patients in group 1 experienced less complications after reimplantation (p = 0.012). With increasing severity of acetabular bone defects, higher incidence of complications (p = 0.008), periprosthetic bone fractures (p = 0.05) and blood loss (p = 0.039) was observed. The infection-free survival rate at 24 months was 93.9% in group 1 and 85.9% in group 2. The indication for resection arthroplasty needs to be evaluated carefully, considering the high rate of complications and reduced mobility, particularly if longer prosthesis-free intervals are used.

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Outcomes of Surgical Treatment of Fractures in Concomitant and Multiple Injuries in Children

N.N. Priorov Journal of Traumatology and Orthopedics ◽

10.17816/vto200916272-75 ◽

2009 ◽

Vol 16 (2) ◽

pp. 72-75

Author(s):

Tokhir Sidikovich Musaev ◽

N N Tolipov ◽

F A Masharipov ◽

T S Musaev ◽

N N Tolipov ◽

...

Keyword(s):

Surgical Treatment ◽

Treatment Duration ◽

Simple Technique ◽

Bone Fractures ◽

Locomotor System ◽

Surgical Interventions ◽

Fixation Devices ◽

Duration Of Hospitalization ◽

Group 2 ◽

Group 1

Outcomes of surgical treatment of 72 children with concomitant (55) and multiple (17) injuries of locomotor system were analyzed. In 53 patients (group 1) surgical interventions for bone fractures were performed in early terms (within 3 days after trauma), in 19 patients (group 2) the interventions were postponed. In group 1 good and satisfactory result was achieved in 92% of patients (63 segments), in group 2 - in 85.2% of patients (23 segments). Duration of hospitalization made up in two groups 11.5 and 14.5 days, respectively. Application of pirod external fixation devices facilitated the treatment course due to the reduction of treatment duration and traumatization, as well as use of more simple technique of long bones and pelvis osteosynthesis.

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Efficacy of dalbavancin against MRSA biofilms in a rat model of orthopaedic implant-associated infection

Journal of Antimicrobial Chemotherapy ◽

10.1093/jac/dkaa163 ◽

2020 ◽

Author(s):

Vanessa Silva ◽

H Sofia Antão ◽

João Guimarães ◽

Justina Prada ◽

Isabel Pires ◽

...

Keyword(s):

Biofilm Formation ◽

Proximal Tibia ◽

Severe Infection ◽

Control Group ◽

Orthopaedic Implant ◽

Treatment Groups ◽

Group 2 ◽

Established Infection ◽

Group 1

Abstract Objectives The aim of this study was to evaluate the efficacy of dalbavancin against MRSA biofilm-related infection in orthopaedic implants in vivo. Methods One MRSA strain isolated from human osteomyelitis was used to promote biofilm formation on the surface of screws. The implants were inserted in the proximal tibia under general anaesthesia. Thirty-nine Wistar rats were divided into three groups [control group (no treatment), Group 1 (7 days of treatment) and Group 2 (14 days of treatment)]; both treatment groups were administered dalbavancin intraperitoneally and euthanized after treatment. cfu of bacteria present in both the tibia and the implant were quantified. The infection severity was assessed by histopathology and scored from 0 (no infection) to 4 (severe infection). Results The high number of cfu/g and cfu/mL present in the control group indicated a well-established infection. There was a significant reduction in cfu in rats treated with dalbavancin both in the tibia (2.8 × 105 cfu/g) and the implant (1.1 × 106 cfu/mL) in Group 1 (1.8 × 103 cfu/g and 2.4 × 105 cfu/mL, respectively) and in Group 2 (8.2 cfu/g and 8.2 × 103 cfu/mL, respectively). Most animals from the control group presented an infection scored as 3 (severe). At the end of the experiment, most rats from Groups 1 and 2 presented an infection scored as 2 (moderate) and 0 (no infection), respectively. Conclusions Although there was a marked decrease in cfu number, signs of biofilm-induced infection prevailed after 14 days of treatment. Further studies should be carried out to evaluate the potential of dalbavancin in the treatment of bone and orthopaedic implant-associated MRSA infections.

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Surgical treatment of children with hip dysplasia complicated with avascular necrosis of the femoral head

Pediatric Traumatology Orthopaedics and Reconstructive Surgery ◽

10.17816/ptors7125-34 ◽

2019 ◽

Vol 7 (1) ◽

pp. 25-34

Author(s):

Mikhail P. Teplenky ◽

Evgeny V. Oleinikov ◽

Vyacheslav S. Bunov

Keyword(s):

Surgical Treatment ◽

Femoral Head ◽

Avascular Necrosis ◽

Hip Dysplasia ◽

Hip Dislocation ◽

Functional Results ◽

X Ray ◽

Group 2 ◽

Time Of Operation ◽

Group 1

Introduction. Avascular necrosis of the femoral head complicates the surgical treatment of hip dysplasia and aggravates the prognosis. Aim. We studied the immediate and medium-term results of reconstructive treatment in 18 children with hip dysplasia complicated by avascular femoral head necrosis, which developed after closed repositioning of a congenitally dislocated femur. Material and methods. Average age at the time of operation was 4.2 0.2 years. The patients were divided into two groups. Group 1 included 12 children with hip subluxation who underwent extra-articular reconstructions on articular components, spinal tunneling of the neck and head, and hardware unloading of the joint and group 2 included six patients with hip dislocation in whom an additional open reduction was performed. Functional results were estimated using DAubigne-Postel classification, whereas X-ray results were evaluated using Kruczynski classification. Results. Duration of observation was 37 years (average, 4.2 0.3 years). Functional results were good (1518 points) in nine joints in group 1, satisfactory (1214 points) in three joints in group 1 and five in group 2, and unsatisfactory (11 points) in one joint in group 2. X-ray results were good in six joints in group 1, satisfactory in six joints in group 1 and five in group 2, and unsatisfactory in one joint in group 2. Conclusions. Extra-articular reconstructive and stimulatory interventions combined with hardware decompression helps improve the shape and structure of the femoral head, and formation of congruent articular surfaces in children with subluxation of the thigh complicated by avascular necrosis.

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