Minimal bone resorption after open treatment of mandibular condylar head fractures

Open treatment of condylar base and neck fractures is widely recommended, whereas treatment of condylar head fractures is still controversial and just is removal of osteosynthesis material. In this study, bone resorption and remodelling after open treatment of condylar head fractures were three-dimensionally (3D) assessed and correlated with clinical parameters in a medium follow-up. Of 18 patients with 25 condylar head fractures who underwent open reduction and internal fixation, clinical data and cone beam computed tomography (CBCT) datasets were analysed. Condylar processes were segmented in the postoperative and follow-up CBCT scans. Volumetric and linear changes were measured using a sophisticated 3D-algorithm. In the course after surgery, patients function and pain improved significantly. Low rates of postoperative complications were observed. All 3D measurements showed no significant bone resorption during the follow-up period. Open reduction of condylar head fractures leads to good patients outcomes and low rates of long-term complications. This study underlines the feasibility and importance of open treatment of condylar head fractures and may help to spread its acceptance as the preferred treatment option.

"Transosseous Osteosynthesis" — a Promising Station for an Objective Structured Clinical Examination of Traumatologists and Orthopedists

The training of transosseous osteosynthesis for traumatologists-orthopedists is actual. Purpose of the research: development of OSKE stations in teaching the method of transosseous osteosynthesis. Material and methods. In the course of the simulation the technique of passing the spokes through the synthetic bone, the installation of the apparatus and the biomechanics of control are practiced. Results. The developed OSKE stations allowed us to objectively assess the level of training within a specified time frame. Conclusion: OSKE is an effective tool for the control of knowledge, including the methods of transosseous osteosynthesis. The inclusion of transosseous osteosynthesis station in the accreditation of orthopedic traumatologists is an urgent task.

Is implant sonication useful when screening for infection in conversion of prior hip fracture fixation to total hip arthroplasty?

Objective To examine sonication results in presumed aseptic conversion total hip arthroplasty (THA) after hip fracture fixation and to evaluate its implications on the treatment outcome. Methods This retrospective cohort study reviewed the data from presumed aseptic patients that underwent conversion of prior internal fixation of proximal femoral fractures to THA between 2012 and 2018. Microbiological analysis was performed using sonication of osteosynthesis material and tissue samples. Treatment outcome including the occurrence of periprosthetic joint infection (PJI) was recorded. Results A total of 32 patients were included in the study. Of these, five patients (15.6%) had positive intraoperative cultures. The mean follow-up following conversion THA was 43.0 months (range, 19.0–91.5 months). Sonication was positive in three patients (9.4%), all of whom were deemed contaminated and did not develop PJI. Tissue cultures were positive in two patients (6.3%). One patient with Enterococcus faecalis received antibiotic treatment and did not develop PJI. Another patient with growth of Cutibacterium acnes that was initially classified as a contaminant later developed acute PJI caused by the same pathogen. Overall, PJI occurred in two patients (6.3%) after conversion THA. Conclusion Sonication of internal fixation devices did not add diagnostic value in clinically aseptic conversion THA. Further studies are needed to better understand the relevance of unexpected positive cultures, and to develop diagnostic criteria for the management of these patients.

Infections Musculosquelettiques De L’adulte AU Centre Hospitalier Universitaire De Brazzaville: Difficultés Diagnostiques Et De Prise En Charge

Objectif: Rapporter les difficultés diagnostiques et de prise en charge des infections musculosquelettiques. Patients et méthodes: Etude rétrospective menée dans les services de Rhumatologie et de Traumatologie/Orthopédie du CHU de Brazzaville du 1er Janvier 2017 au 30 Septembre 2020. Nous avons colligé et analysé les dossiers des patients hospitalisés pour infections musculosquelettiques. Le diagnostic d’infection musculosquelettique était retenu sur critères de Wald Vogel et al. Résultats: La fréquence hospitalière était de 1.9%. Les hommes prédominaient (54.8%) avec un sex-ratio de 1.2. L’âge moyen était de 41.7ans (extrêmes 17 et 77 ans). Treize de nos patients étaient les travailleurs indépendants , 12 sans-emploi, les salariés et les étudiants respectivement dans 9 et 8 cas. La majorité de nos patients provenait du milieu rural dans 29 cas (69.1%). Il s’agissait de 13 cas (30.9%) d’ostéomyélites/Ostéites, 12 cas (28.5%) d’arthrites infectieuses, 9 cas (21.4%) de spondylodiscites tuberculoses, 4 cas (9.6%) d’infections sur matériel d’ostéosynthèse et les myosites suppurées. Seuls 6 patients (14%) avaient réalisé une imagerie en coupes (l’IRM dans 4 cas ,la TDM dans 2 cas), avec un délai moyen de réalisation de 6,1 jours (extrêmes 4 et 10 jours) et l’échographie ostéoarticulaire dans 6 cas (14%). L’analyse bactériologique était effectuée dans 25 cas (59.5%), parmi eux, une Pyo culture dans 11 cas (44%), l’analyse du liquide articulaire dans 5 cas (20%), les hémocultures 2 cas et la biopsie osseuse dans 1 cas(4%), avec un délai moyen de réalisation de 5,8 jours (extrêmes 2 et 11 jours). La culture était positive dans 13 cas (52%). Les principaux germes isolés étaient : le streptocoque dans 5 cas (38.4%), le staphylocoque 3 cas (23.1%), l’entérobactérie et le Pseudomonas dans 2cas (15.4%), le bacteroides dans 1 cas (7.7%). Conclusion: Les infections musculosquelettiques sont une urgence diagnostique et thérapeutique et de diagnostic souvent tardif. Les principales difficultés sont le bas niveau socioéconomique et la faible accessibilité du plateau technique. Objective: This paper focuses on reporting the difficulties in diagnosing and managing musculoskeletal infections. Patients and Methods: Retrospective study was conducted in the Rheumatology and Traumatology/Orthopedics departments of the Brazzaville University Hospital from January 1st, 2017 to September 30th, 2020. The files of hospitalized patients were collected and analyzed for musculoskeletal infections. The diagnosis of musculoskeletal infection was made according to the criteria of Wald Vogel et al. Results: The hospital frequency was 1.9%. Men predominated (54.8%) with a sex ratio of 1.2. The average age was 41.7 years (range 17 and 77). Thirteen of the patients were self-employed, while 12 were unemployed. There were also 9 employees and 8 students. The majority of patients came from rural areas in 29 cases (69.1%). These were 13 cases (30.9%) of osteomyelitis/Osteitis, 12 cases (28.5%) of infectious arthritis, 9 cases (21.4%) of tuberculosis spondylodiscitis, 4 cases (9.6% ) of infections on osteosynthesis material and suppurative myositis. Only 6 patients (14%) had performed sectional imaging (MRI in 4 cases, CT in 2 cases), with an average completion time of 6.1 days (range 4 and 10 days). There were also 6 cases of ultrasound osteoarticular (14%). Bacteriological analysis was performed in 25 cases (59.5%): Pyo culture in 11 cases (44%), joint fluid analysis in 5 cases (20%), blood cultures in 2 cases and bone biopsy in 1 case (4%), with an average completion time of 5.8 days (range 2 and 11 days). Culture was positive in 13 cases (52%). The main germs isolated were streptococcus in 5 cases (38.4%), staphylococcus in 3 cases (23.1%), enterobacteria and Pseudomonas in 2 cases (15.4%), and bacteroides in 1 case ( 7.7%). Conclusion: Musculoskeletal infections are a diagnostic and therapeutic emergency which is often late in diagnosis. The main difficulties are the low socioeconomic level and the poor accessibility of the technical platform.

Surgical Reconstruction of Nonunion after Iatrogenic Scarf Osteotomy

We present the case of a young patient, 32 years old, with nonunion in the diaphysis of the first metatarsal after scarf osteotomy for correction of hallux valgus. After removal of the failed osteosynthesis material and preparation of the bone fragments, a calcaneal bone autograft, previously extracted from the patient, was placed in the nonunion area. The new physiological position of the first metatarsal in the three planes was checked intraoperatively, and autograft and fragment fixation was performed using a combination of a low-profile plate with six screws and two interfragmentary screws. The advantage of using an autogenous graft is that it provides corticocancellous bone and great osteogenic capacity with little antigenic capacity. This makes it an excellent option in many situations in foot and ankle surgery. Regarding the fixation method, we used the two most commonly used techniques for osteosynthesis of bone grafts in cases of bone nonunion, combining plates with locking screws and two interfragmentary screws. This provides greater stability of the bone fragments in the three planes and makes it possible to bring forward when the patient starts postsurgical loading.

Calcaneal Plate for Medial Femoral Condyle Fractures—Is This It? A Clinical Case

Management of unicondylar femoral fractures is mainly done by open reduction and internal fixation. Anatomic reduction in the articular surface is paramount in this type of lesion. Medial condyle fractures lack specific osteosynthesis material for fixation.We report a case resolved with the sparsely documented technique using calcaneal plate fixation.

Clinical application of the anterolateral thigh free flap in high energy injuries of the lower extremity

One of the recurring problems in plastic and reconstructive surgery is the loss of tissues of the lower extremities as a result of high-energy injuries. The difficulty of this reconstruction lies in the need for a sufficiently suitable and resistant tissue to allow this restoration. The thigh-free anterolateral flap, since its description in 1984, has great versatility for complex or extensive lower extremity reconstructions. We presented the case of a 37-year-old male patient who had a high-energy road accident on a bicycle, impacting a moving vehicle causing a multi fragmented fracture of the right proximal tibia AO 41 C2.2/Schatzker V. He was treated surgically with material from osteosynthesis and iliac crest graft. It is complicated by infection of the surgical wound, exposure of osteosynthesis material and absence of skin covering. Reconstruction of the upper third of the right leg was performed with a thigh-free anterolateral free flap with 2 end-to-end venous anastomoses from the flap to anterior tibial veins, and 1 end-to-end anastomosis from perforating artery to anterior tibial artery, with no associated complications. The thigh-free anterolateral free flap is a versatile and reliable mechanism for the reconstructive surgeon, as it provides excellent coverage for complex lower extremity wounds as well as low donor site morbidity. Outpatient follow-up with adequate clinical evolution was done.