Case Report: Trans-Articular External Skeletal Fixation of the Hip for a Highly Comminuted Juxta-Articular Fracture of the Proximal Femur Caused by Gunshot Injury in a Cat

This report describes a novel surgical technique for trans-articular external skeletal fixation (TA-ESF) of the hip to stabilize a rare, highly comminuted juxta-articular fracture of the proximal femoral segment involving the metaphysis and diaphysis in a cat. A 2-year-old, castrated male, Korean shorthair cat was admitted for a left femoral fracture caused by gunshot injury. Radiographs and computed tomography (CT) scans revealed a highly comminuted proximal femoral diaphyseal fracture that involved the femoral neck and the greater trochanter. The left femoral head was intact on CT. Under fluoroscopic guidance, an intramedullary Steinmann pin was placed to align the femur, and five positive-profile, end-threaded pins were placed in the left hemipelvis and distal femur. A triangulated frame of connecting bars was constructed using Steinmann pins and epoxy resin for TA-ESF. This secured the pins placed in the pelvis and femur as well as the intramedullary pin, providing proximal femoral stabilization by trans-articular fixation of the hip. The cat began placing weight on the left pelvic limb 4 days postoperatively, and progressively obtained near-normal limb function by day 112. The TA-ESF was partially dismantled to a linear tie-in construct on day 64 and was completely removed on day 161. Final radiographs on day 161 revealed lack of bone healing in the proximal segment, especially femoral head and neck, despite functional recovery of the injured leg. At one year postoperatively, the cat had normal limb function without any noticeable complications. On follow-up 29 months after surgery, the owner reported that the cat had normal limb function without any noticeable complications. Despite insufficient bone healing in the cat, TA-ESF of the hip allowed for satisfactory functional recovery of this challenging juxta-articular fracture of the proximal femur, which was not amenable to stabilization with a traditional non-load-sharing fixation system.

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Traumatic Obturator Hip Dislocation with Marginal Femoral Head Fracture in a 15-Year-Old Adolescent: A High-Energy Trauma—A Case Report and a Review of the Literature

Case Reports in Orthopedics ◽

10.1155/2018/7268032 ◽

2018 ◽

Vol 2018 ◽

pp. 1-4

Author(s):

Yoann Durand ◽

Clémence Bruyère ◽

Marco Saglini ◽

Aurélien Michel-Traverso

Keyword(s):

Femoral Head ◽

Hip Dislocation ◽

High Energy ◽

Hip Pain ◽

X Rays ◽

Hip Function ◽

One Year ◽

High Level ◽

Joint Limitation

We report the case of a 15-year-old boy brought to the emergency department after a bike accident, complaining of an isolated left hip pain. The X-rays showed an obturator hip dislocation treated by closed reduction under general anaesthesia, followed by 6 weeks of discharge. The follow-up MRI performed 6 weeks after the trauma showed an avascular femoral head necrosis, for which we performed multiple retrograde femoral head drilling, completed by the injection of autologue stem cells from the iliaq crest. One year later, the patient has no hip pain, no joint limitation, and can practice BMX at a high level again. The purpose of this report is to make the physicians aware of this rare problem that may be damaging for hip function, especially in young people.

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Magnesium-Based Absorbable Metal Screws for Intra-Articular Fracture Fixation

Case Reports in Orthopedics ◽

10.1155/2016/9673174 ◽

2016 ◽

Vol 2016 ◽

pp. 1-4 ◽

Cited By ~ 9

Author(s):

Roland Biber ◽

Johannes Pauser ◽

Markus Geßlein ◽

Hermann Josef Bail

Keyword(s):

Case Report ◽

Magnesium Alloy ◽

Fracture Fixation ◽

Clinical Course ◽

Radial Head Prosthesis ◽

Osteochondral Fracture ◽

Articular Fracture ◽

One Year ◽

Biodegradable Magnesium

MAGNEZIX® (Syntellix AG, Hanover, Germany) is a biodegradable magnesium-based alloy (MgYREZr) which is currently used to manufacture bioabsorbable compression screws. To date, there are very few studies reporting on a limited number of elective foot surgeries using this innovative implant. This case report describes the application of this screw for osteochondral fracture fixation at the humeral capitulum next to a loose radial head prosthesis, which was revised at the same time. The clinical course was uneventful. Degradation of the magnesium alloy did not interfere with fracture healing. Showing an excellent clinical result and free range-of-motion, the contour of the implant was still visible in a one-year follow-up.

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Mechanical Evaluation of Collapse Risk for Osteonecrosis of Femoral Head Post-Medical Treatment

10.21203/rs.3.rs-138877/v1 ◽

2021 ◽

Author(s):

Yuqian Mei ◽

Qi Tang ◽

Songhao Chen ◽

Duanduan Chen

Keyword(s):

Femoral Head ◽

Medical Treatment ◽

Early Stage ◽

Equivalent Stress ◽

Stress Index ◽

Patient Specific ◽

Relative Stress ◽

The Mean ◽

One Year

Abstract Background: Early-stage osteonecrosis of the femoral head can progressively induce the bone collapse and the accuracy of the collapse risk evaluation is limited. This study aims to propose a potential collapse indicator by biomechanical evaluating the treatment effectiveness. Methods: Six patient-specific models pre- (initial presentation) and post- medical treatment were established and elastic properties of the bone were assigned with a function of spatial-variant Hounsfield unit values. Morphological and mechanical analyses were compared between pre- and post-treatment models. Results: In the morphological study, four cases show the reduced ratio of low-density necrotic volume, but not consistent with one-year follow-up results. In the mechanical analysis, the equivalent stress variation near the Ward triangle shows consistency in the one-year outcome. Moreover, a parameter - relative stress index, the ratio between the mean volume stress index and the mean volume equivalent stress, is proposed. A smaller value of the relative stress index indicates stronger bone compressive strength and its variation is consistent with the follow-up results. Conclusions: Results implicate that to evaluate the effectiveness of medical treatments, the morphologic analysis should be considered but the mechanical capability and the loading transfer path through the necrotic and viable bone play a more important role.

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Migration of the Lag Screw after Intramedullary Treatment of AO/OTA 31.A2.1-3 Pertrochanteric Fractures Does Not Result in Higher Incidence of Cut-Outs, Regardless of Which Implant Was Used: A Comparison of Gamma Nail with and without U-Blade (RC) Lag Screw and Proximal Femur Nail Antirotation (PFNA)

Journal of Clinical Medicine ◽

10.3390/jcm8050615 ◽

2019 ◽

Vol 8 (5) ◽

pp. 615 ◽

Cited By ~ 4

Author(s):

Nikolaus Wilhelm Lang ◽

Robert Breuer ◽

Hannes Beiglboeck ◽

Alexandru Munteanu ◽

Stefan Hajdu ◽

...

Keyword(s):

Femoral Head ◽

Proximal Femur ◽

Gamma Nail ◽

Pertrochanteric Fractures ◽

Lag Screw ◽

Significant Difference ◽

Tip Apex Distance ◽

Proximal Femur Nail ◽

Screw Group

The best intramedullary nail for the treatment of unstable AO/OTA 31.A2.1-3 fractures remains uncertain. A total of 237 patients (45 male, 192 female) were eligible for the assessment with an average age of 81.9 ± 10.5 years and a minimum follow-up of six months. We assessed the cut-out rate, the TAD and calTAD (Tip Apex distance) of three different implants. An overall cut-out rate of 2.5% (n = 6) was observed. The cut-out rate was 1.2% (n = 1) in the Proximal Femur Nail Antirotation (PFNA) group, 3.7% (n = 3) in the Gamma Nail group and 2.9% (n = 2) in the Gamma3® with a U-Blade (RC) lag-screw group. The TAD and calTAD differed between the cut-out and non-cut group—20.0 mm vs. 18.5 mm and 13.1 mm vs. 15.3 mm, respectively. A significantly higher TAD of 32.5 mm could be seen in the cut-out after PFNA (p < 0.0001). The only significant change in follow-up using Parker’s ratio was observed in the PFNA group (p < 0.0001). The rate of patients requiring surgery after complications was 8.4% (n = 20) without any significant difference between the three groups. The PFNA blade showed significant migration within the femoral head, however the cut-out rate remained the smallest compared to Gamma3 with or without additional U-Blade (RC) lag screw.

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Aluminium Splint Incorporated Fibreglass Cast Preserves Limb Function in Bovines with Olecranon Fracture

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.1055/s-0040-1709727 ◽

2020 ◽

Vol 33 (06) ◽

pp. 434-442

Author(s):

Vandana Sangwan ◽

Ganga P. Yadav ◽

Ashwani Kumar

Keyword(s):

Study Design ◽

Traumatic Event ◽

Weight Bearing ◽

Olecranon Fracture ◽

Limb Function ◽

Common Cause ◽

Olecranon Process ◽

One Year ◽

Olecranon Fractures

Abstract Objective Olecranon process fractures are rare in bovines. The aim of the study was to put on record satisfactory limb usage in cattle and buffaloes suffering from olecranon fractures and treated conservatively, primarily for carpal contracture or to prevent it, using aluminum splints incorporated within a fiberglass cast along with stall confinement. Study Design This one year study included 19 olecranon fractures in bovines (15 buffaloes and 4 cattle). Out of 19, 12 bovines (9 buffaloes and 3 cattle) were treated primarily to manage the associated carpal contracture, using external coaptation of aluminium splints incorporated within a fiberglass cast for 6 to 8 weeks. The owners of the remaining 7 bovines (6 buffaloes and 1 bullock) were only advised to keep their animal in stall-confinement, due to various reasons. Results Slipping and falling on hard surfaces was the primary aetiology of olecranon fractures (17/19). Most of the fractures (14/19) were presented more than 10 days after a traumatic event, with a mean duration of 24.0 ± 26.6 days. On follow up, all the treated bovines showed satisfactory limb usage whereas all stall-confined buffaloes showed no improvement. Conclusion Slipping and falling on hard surfaces is a common cause of olecranon fracture in bovines. Olecranon fractures associated carpal contracture can be successfully treated/prevented by applying full limb cast (if possible including elbow) along with aluminum splints leading to satisfactory limb usage in bovines. Further it is concluded that stall confinement alone is insufficient to prevent limb contracture (which usually develops with olecranon fracture in bovines) leading to permanent non-weight bearing disability.

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One Year Follow-up of Functional Recovery in Neovascular AMD During Monthly Anti-VEGF Treatment

American Journal of Ophthalmology ◽

10.1016/j.ajo.2013.05.037 ◽

2013 ◽

Vol 156 (4) ◽

pp. 633-643.e2 ◽

Cited By ~ 23

Author(s):

Marion R. Munk ◽

Christopher Kiss ◽

Wolfgang Huf ◽

Florian Sulzbacher ◽

Philipp Roberts ◽

...

Keyword(s):

Functional Recovery ◽

Neovascular Amd ◽

Anti Vegf ◽

One Year

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Clinical comparison between two stabilization methods in distal tibial angular deviation corrected by the CORA method

Acta Scientiae Veterinariae ◽

10.22456/1679-9216.99560 ◽

2020 ◽

Vol 48 ◽

Author(s):

Caio Afonso Dos Santos Malta ◽

Leonardo Augusto Lopes Muzzi ◽

Larissa Teixeira Pacheco ◽

Daniel Munhoz Garcia Perez Neto ◽

Vanessa Matos Pires ◽

...

Keyword(s):

Bone Healing ◽

Locking Plate ◽

Wedge Osteotomy ◽

Angular Deviation ◽

Complication Rates ◽

Closed Wedge ◽

Pelvic Limb ◽

The Right ◽

Bone Deformities

Background: Angular deformity is characterized by the deviation of part of the bone that can occur in three different planes, frontal, sagittal and transverse. Trauma on physeal plates is the most common cause of angular deviations of the limbs in dogs. Currently the CORA (Center of Rotation of Angulation) methodology is the best way to evaluate and surgically correct these deformities. The objective of this study is to describe the surgical procedures performed to treat the uniapical valgus deviation affecting both tibial bones in a dog, comparing the outcomes of hybrid external skeletal fixator used in the right pelvic limb in relation to the locking plate used in the left pelvic limb.Case: A 10-month old Border Collie dog was attended at the University Veterinary Hospital with history of lameness and deviation of both pelvic limbs. In the orthopedic examination, it was possible to identify bilateral valgus deviation in the region of the tibio-tarsal joints and moderate lameness, with absence of pain or joint crepitation. Radiographic examination showed that the deformity was only uniapical in the frontal plane, affecting both tibial bones of the dog. Signs of osteoarthrosis were not observed and the preoperative examinations were within the normal limits for the species. The deformities were corrected in two surgical times starting with the procedure in the right tibia, which appeared to be clinically worse. Due to the fact that it was a bilateral affection and there was not a healthy pelvic limb to obtain the normal angles values of this dog, for planning according to the CORA methodology, the values of the tibial mechanical angles for dogs of similar size were taken from the literature. For surgical correction of the right tibia, a closed wedge osteotomy was performed following the second rule of Paley, with bone stabilization using type IB hybrid external skeletal fixator (ESF). The radiographic follow-up was done every 30 days postoperatively, however at 60 days the dog presented with severe lameness and the ESF had to be removed due to the breaking of one of the wires that composed the ring of the hybrid system. The limb continued to be treated by external bandages and total bone healing occurred at 210 days after surgery. Only after the complete recovery of the right limb, the left pelvic limb was operated and was also corrected by closed wedge osteotomy from the second Paley's rule. However, the bone stabilization was achieved with the use of a T-shaped locking plate. Radiographic follow-up was performed every 30 days postoperatively and at 60 days the osteotomy gap was already consolidated and the dog showed good weight bearing in the pelvic limbs without signs of lameness or pain.Discussion: Currently, it is indicated that bone deformities in small animals should be corrected using the CORA methodology. The hybrid ESF is one of the most commonly used fixation systems for bone stabilization after corrective osteotomies due to great versatility, however, the reported complication rates are relatively high. The locking plates with special shapes, such as the "T" plate used in this study, provide the stable fixation of osteotomies with limited bone stock, as they allow the introduction of larger number of screws per area. Thus, this latter type of implant becomes advantageous for the correction of bone deformities close to the joints. It is concluded that CORA methodology is really effective in the planning of corrective surgeries of angular deviations in dogs. In this case report, the resulting tibial angles after the surgical corrections were within the normal range for healthy dogs of similar size. However, the use of locking plate provided better results with early bone healing and fewer complications than the type IB hybrid ESF.

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Effect of Stem Cell Augmented Micronized Allograft on Arthrodesis in the Ankle and Foot

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00217 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0021

Author(s):

Amanda Fantry ◽

Joshua Bowler ◽

Yahya Daoud ◽

James Brodsky

Keyword(s):

Stem Cell ◽

Femoral Head ◽

Bone Graft ◽

Biologic Agents ◽

Smoking History ◽

Posttraumatic Arthritis ◽

History Of ◽

One Year ◽

Radiographic Union

Category: Basic Sciences/Biologics Introduction/Purpose: Both primary and revision arthrodesis are mainstays of foot and ankle surgery. Many studies have investigated the effect of autograft, varying forms of bone graft substitutes, and of biologic agents on bone healing, including in the setting of arthrodesis. A commercially available stem cell augmented micronized allograft (Via Graft®) is comprised of micronized (100-300 microns) allograft bone with marrow-isolated adult multilineage inducible cells (MIAMI cells). It has been proposed as an alternative to autograft and as an adjunct to arthrodesis. We present a series of 86 patients with minimum one-year follow-up who underwent either primary or revision arthrodesis with Via Graft®, with or without additional graft. Methods: Between 2015 and 2016, 86 patients treated with Via Graft® were identified with minimum one-year follow-up. Data was collected including demographic information, BMI, smoking history, medical comorbidities; indication for fusion (including Charcot arthropathy, posttraumatic arthritis, rheumatoid arthritis, AVN, congenital anomalies, neuromuscular disorders, revision surgery, post-infectious, previous total ankle arthroplasty, posterior tibial tendon dysfunction); procedure performed (ankle, hindfoot, midfoot, or forefoot fusion), number of joints fused, use of additional graft, radiographic union, and complications. Fusion was evaluated based upon radiographic or CT evidence of osseous bridging. The unit of the analysis was the joint. Generalized Linear Mixed Model (GLMM) was utilized to evaluate the association between fusion and the data set described above. Statistical analyses were performed using SAS® 9.4. Results: 191 joints were fused in 86 patients (F: 48, M: 38). Mean age was 58.7 years, mean follow-up was 15.8 months. Radiographic union was achieved in 163/191 (85.3%) joints. Age, gender, smoking status, presence of diabetes, history of Charcot, revision fusion, or use of cancellous autograft or allograft demonstrated no statistically significant differences in fusion rates. Intramedullary talocalcaneal arthrodesis (IMTCA), with or without additional joints fused simultaneously (p=.001), use of structural allograft (most commonly femoral head)(p<.001), structural autograft (p=.001), history of previous TAA (p<.0001), and history of AVN (p=.042) demonstrated statistically significant rates of nonunion, despite use of Via Graft® (Table 1). Conclusion: This study is the largest series to date of Via Graft® augmentation of arthrodesis. Lower union rates were found to be associated with patients undergoing hindfoot fusion with an IMTCA with or without additional joints fused, a history of failed total ankle replacement or AVN of the talus, and use of femoral head allograft. However, this preliminary study requires further analysis given the difficult and salvage nature of these cases. As bony union is multifactorial, the selection of bone graft and biologic agents is an important factor, but may not be sufficient to overcome the biology of the host.

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