scholarly journals Cement-augmented screw fixation for calcaneal fracture treatment: a biomechanical study comparing two injectable bone substitutes

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Konrad F. Fuchs ◽  
Philipp Heilig ◽  
Miriam McDonogh ◽  
Sebastian Boelch ◽  
Uwe Gbureck ◽  
...  
Keyword(s):  
Bone Cement ◽  
Screw Fixation ◽  
Weight Bearing ◽  
Calcaneal Fracture ◽  
Fracture Treatment ◽  
Peak Displacement ◽  
Early Weight Bearing ◽  
Screw Osteosynthesis ◽  
Total Displacement ◽  
With Screws

Abstract Background The role of cement-augmented screw fixation for calcaneal fracture treatment remains unclear. Therefore, this study was performed to biomechanically analyze screw osteosynthesis by reinforcement with either a calcium phosphate (CP)-based or polymethylmethacrylate (PMMA)-based injectable bone cement. Methods A calcaneal fracture (Sanders type IIA) including a central cancellous bone defect was generated in 27 synthetic bones, and the specimens were assigned to 3 groups. The first group was fixed with four screws (3.5 mm and 6.5 mm), the second group with screws and CP-based cement (Graftys® QuickSet; Graftys, Aix-en-Provence, France), and the third group with screws and PMMA-based cement (Traumacem™ V+; DePuy Synthes, Warsaw, IN, USA). Biomechanical testing was conducted to analyze peak-to-peak displacement, total displacement, and stiffness in following a standardized protocol. Results The peak-to-peak displacement under a 200-N load was not significantly different among the groups; however, peak-to-peak displacement under a 600- and 1000-N load as well as total displacement exhibited better stability in PMMA-augmented screw osteosynthesis compared to screw fixation without augmentation. The stiffness of the construct was increased by both CP- and PMMA-based cements. Conclusion Addition of an injectable bone cement to screw osteosynthesis is able to increase fixation strength in a biomechanical calcaneal fracture model with synthetic bones. In such cases, PMMA-based cements are more effective than CP-based cements because of their inherently higher compressive strength. However, whether this high strength is required in the clinical setting for early weight-bearing remains controversial, and the non-degradable properties of PMMA might cause difficulties during subsequent interventions in younger patients.

scholarly journals A Novel Minimally Invasive Reduction Technique by Balloon and Distractor for Intra-Articular Calcaneal Fractures: A Report of 2 Cases

2018 ◽  
Vol 2018 ◽  
pp. 1-8
Author(s):  
M. Prod’homme ◽  
S. Pour Jafar ◽  
P. Zogakis ◽  
P. Stutz
Keyword(s):  
Soft Tissue ◽  
Minimally Invasive ◽  
Soft Tissues ◽  
Weight Bearing ◽  
Calcaneal Fracture ◽  
Invasive Technique ◽  
Calcaneal Fractures ◽  
Early Weight Bearing ◽  
Articular Fractures ◽  
Minimally Invasive Reduction

Treatment of displaced intra-articular fractures of the calcaneus remains a challenge for the orthopaedic surgeon. Conservative therapy is known to produce functional impairment. Surgical approach is plagued by soft-tissue complications and insufficient fracture reduction. We describe a minimally invasive technique that will hopefully improve these issues. We want to present our first experience through two cases. The first was a 46-year-old man who presented with a Sanders type IIBC calcaneal fracture, and the second was a 86-year-old woman with a type IIIBC calcaneal fracture. We introduced 2 Schanz screws in the talus and the calcaneus. After distraction, we introduced an inflatable balloon inside the calcaneus. By inflating the balloon, the articular surface was reduced by lifting it up. Then bone cement was injected in order to maintain the reduction. Additional screw fixation was used in the young patient. Postoperative imaging showed good congruence of the subtalar joint without leakage of cement, for the two cases. After 2 months, the patients had no pain and were without soft-tissue complications. We advocate this technique to perform a minimally invasive reduction and fixation of intra-articular calcaneal fractures because it preserves soft-tissues and provides good clinical results with early weight-bearing.

scholarly journals Early Weight Bearing on Weber C Fractures with Retained Syndesmotic Screws

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0000
Author(s):  
Cristian Ortiz ◽  
Andres Keller Díaz ◽  
Pablo Mococain ◽  
Pablo Wagner ◽  
Ruben Radkievich ◽  
...  
Keyword(s):  
Screw Fixation ◽  
Weight Bearing ◽  
Ankle Fractures ◽  
X Rays ◽  
Aofas Score ◽  
Early Weight Bearing ◽  
Clear Space ◽  
Screw Breakage ◽  
The Mean

Category: Ankle, Sports, Trauma Introduction/Purpose: There is no consensus about when to allow weight bearing in ankle fractures treated with syndesmotic screw fixation. There has been no evaluation of the radiographic fate of the syndesmosis when syndesmotic screws are retained and early weight bearing is encouraged, or the clinical result depending on the screw status, which can be intact, broken or loose. Our objective was to evaluate the radiographic and clinical parameters of patients who had a screw fixation of the syndesmosis and early weight bearing was allowed. Our hypothesis was that no difference would be observed on syndesmotic reduction or clinical function depending on the screw status. Methods: We analyzed 42 patients with ankle fractures treated with syndesmotic screws in which early weight bearing was allowed (3 weeks postoperatively). Weight bearing radiographs were obtained at 2 weeks, 2 months and at final follow up (41.2 months). Radiologically we measured medial clear space (MCS), tibiofibular overlap (OL), tibiofibular clear space (CS), talar shift (TS) and screw condition (intact, broken, loose). Clinical function was measured with the AOFAS score and stratified by the screw condition. Statistical analysis was performed with the SPSS software and a non-inferiority confidence interval for the mean was calculated. Results: At final follow up, 66,6% of the screws were broken, 30,9% showed significant loosening and only 1 patient (4,7%) had a screw that remained solid with no signs of osteolysis. MCS at 2 weeks, 2 months and at final follow up was 2,94 mm; 3,03 mm; 3,02, respectively. OL was 6,76 mm; 6,78 mm; 6,83 and CS was 4,26 mm; 4,66 mm; 4,6 mm. No TS was detected. There was no difference in measurements along time (p>0,05). Relative to clinical function, the mean AOFAS score was 95 points. No difference was found between the clinical scores of patients stratified by the screw condition (p>0,05). Conclusion: Early weight bearing on a fixed syndesmosis appears to be safe, with no measurable radiographic or clinical consequences regarding ankle joint function. Despite screw breakage or loosening on x-rays, loss of reduction is seldom observed. We suggest that routine removal of syndesmotic screws is not necessary in these group of patients.

scholarly journals Early Weight-Bearing Does Not Compromise Postoperative Healing in Jones Fracture ORIF

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0031
Author(s):  
Leonardo V. M. Moraes ◽  
Stéfani C. Kelly ◽  
James R. Jones ◽  
Haley McKissack ◽  
Aaradhana J. Jha ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Weight Bearing ◽  
Case Series ◽  
Wound Dehiscence ◽  
Fracture Treatment ◽  
Retrospective Case ◽  
Early Weight Bearing ◽  
Non Union ◽  
Jones Fracture ◽  
Radiographic Union

Category: Midfoot/Forefoot, Trauma Introduction/Purpose: Several controversies persist regarding fracture treatment of the fifth metatarsal base. Due to its low blood supply, Jones fracture has an inherent difficulty of consolidation, and may devolop complications such as delayed union, non- union and refracture. Usually the Jones fracture treatment is done with extended period of non-weightbearing with either nonoperative or operative treatment. The surgery is indicated particularly in athletes or in the setting of nonunion or fracture displacement. The purpose of the present retrospective case series is to assess postoperative outcomes among patients who weight bear earlier than standard practice. Methods: We performed a retrospective analysis of the medical and radiographic records from patients who had undergone operative IM fixation of an acute isolated Jones fracture from May 2013 and August 2018. Patients were permitted to weight- bear as tolerated. Demographic information, such as age, gender, body mass index, the use of tobacco, presence of medical comorbidities, and the time of radiographic union were evaluated. Standardized radiographs at 2 weeks, 6 weeks, 3 months and 6 months after surgeries were chosen for evaluation. Radiographic union was defined as bridging in 2 of 3 (medial, lateral, plantar) cortices. Results: Twenty one patients were included for analysis. Of these, 14 had at least one comorbidity present at time of operation. Average BMI was 37.6, and average age was 44.8. One patient (4.8%) was lost to follow up, and therefore did not have radiographic results available for review at any appointment. At 6 weeks, 16 of 21 patients showed signs of radiographic healing; 8 were completely healed, and 8 were incomplete. One patient (4.8%) had nonunion, which was documented at 6 week, 3 month, and 6 month readings. None of the 21 patients experienced any other postoperative complications, including infection, wound dehiscence, sepsis, DVT, implant failure, or need for revision surgery. Conclusion: Patients who were subjected to early weight-bearing after fifth metatarsal Jones fracture surgery had satisfactory fusion rates with no additional postoperative complications, even despite having high average BMI and multiple comorbidities. We believe that patients can be treated with early weightbearing as tolerated after operative fixation of an acute Jones fracture, and achieve satisfactory outcomes comparable those associated with traditional postoperative protocols.

Early Weight-Bearing After Percutaneous Reduction and Screw Fixation for Low-Energy Lisfranc Injury

2013 ◽  
Vol 34 (7) ◽  
pp. 978-983 ◽  
Author(s):  
Emilio Wagner ◽  
Cristian Ortiz ◽  
Ignacio E. Villalón ◽  
Andrés Keller ◽  
Pablo Wagner
Keyword(s):  
Screw Fixation ◽  
Weight Bearing ◽  
Low Energy ◽  
Early Weight Bearing ◽  
Lisfranc Injury ◽  
Percutaneous Reduction

scholarly journals Mid-term outcomes of minimally invasive plate osteosynthesis for fresh and old calcaneal fractures with locked plate

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0022
Author(s):  
Tatsuji Fujiwara
Keyword(s):  
Minimally Invasive ◽  
Plate Osteosynthesis ◽  
Weight Bearing ◽  
Calcaneal Fracture ◽  
Minimally Invasive Plate Osteosynthesis ◽  
Calcaneal Fractures ◽  
Locked Plate ◽  
Early Weight Bearing ◽  
The Mean

Category: Trauma Introduction/Purpose: Since the mid-1990s, open reduction and internal fixation via an extended L-shaped lateral approach has been considered the gold standard for surgical treatment of displaced intraarticular calcaneal fractures. However, postoperative wound healing complications, including wound infection, skin edge necrosis, wound breakdown, and hematoma, remain a major concern. To minimize the incidence of and offer rigid stabilization of the calcaneal fracture fragments, we have performed minimally invasive plate osteosynthesis (MIPO) with locked plate for fresh and old calcaneal fractures. This study aims to assess the clinical and radiological mid-term outcomes in surgical treatment of the fresh and old calcaneal fractures using a minimally invasive technique and a locking plate to permit early weight bearing. Methods: A total of 29 fractures in 24 patients were found that met our inclusion criteria. 23 foots were fresh calcaneal fractures with an average age of 53.9 years (range, 17-80 years). We defined calcaneal fractures more than 6 weeks old as old calcaneal fracture. 6 foots were old calcaneal fractures with an average age of 43 years (range,35-52 years). Patients with fresh calcaneal fracture had been followed up for an average of 25.8 months (range, from 18-65 months). Patients with old calcaneal fracture had been followed up for an average of 29.4 months (range, from 24-48 months). The mean interval between injury and operation was 8.9 days (3-19 days) in fresh calcaneal fractures and 97 days (43-154 days) in old calcaneal fractures. There were 19 foots Sanders type II fractures, 9 foots Sanders type III and one Sanders type IV. Results: For fresh calcaneal fractures, the mean change in Böhler’s angle and width of the calcaneus from immediately after surgery to final follow-up were 0.5° and 0.7 mm, respectively. For old calcaneal fractures, the mean change in Böhler’s angle and width of the calcaneus from immediately after surgery to final follow-up were 3.4° and 1.7 mm, respectively. The reduction was graded as nearly anatomical (less than 2 mm residual articular displacement) in all fractures. One of the 22 foots had a blister. There were no events of osteomyelitis or infection or nonunion. Eight foots had revision surgery for symptomatic hardware removal. At final follow up the average American Foot and Ankle Society Score (AOFAS) were 82.8 for fresh calcaneal fractures and 83.2 for old calcaneal fractures. Conclusion: This study is first report to show that MIPO with locked plate and early weight bearing can be effectively treated for displaced intra-articular calcaneal fractures. Surgical preparation, reduction maneuvers, and fixation techniques can take time to master; however, with experience, all types of calcaneus fractures can be treated with this technique.

scholarly journals Trans-obturator cable fixation of open book pelvic injuries

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Martin C. Jordan ◽  
Veronika Jäckle ◽  
Sebastian Scheidt ◽  
Fabian Gilbert ◽  
Stefanie Hölscher-Doht ◽  
...  
Keyword(s):  
Pelvic Ring ◽  
Testing Machine ◽  
Biomechanical Testing ◽  
Pubic Symphysis ◽  
Cadaver Study ◽  
Steel Cable ◽  
Reliable Technique ◽  
Peak Displacement ◽  
Total Displacement ◽  
Cable Fixation

AbstractOperative treatment of ruptured pubic symphysis by plating is often accompanied by complications. Trans-obturator cable fixation might be a more reliable technique; however, have not yet been tested for stabilization of ruptured pubic symphysis. This study compares symphyseal trans-obturator cable fixation versus plating through biomechanical testing and evaluates safety in a cadaver experiment. APC type II injuries were generated in synthetic pelvic models and subsequently separated into three different groups. The anterior pelvic ring was fixed using a four-hole steel plate in Group A, a stainless steel cable in Group B, and a titan band in Group C. Biomechanical testing was conducted by a single-leg-stance model using a material testing machine under physiological load levels. A cadaver study was carried out to analyze the trans-obturator surgical approach. Peak-to-peak displacement, total displacement, plastic deformation and stiffness revealed a tendency for higher stability for trans-obturator cable/band fixation but no statistical difference to plating was detected. The cadaver study revealed a safe zone for cable passage with sufficient distance to the obturator canal. Trans-obturator cable fixation has the potential to become an alternative for symphyseal fixation with less complications.

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