Outcome of Pertrochanteric Femur Fractures with Proximal Femur Locking Compression Plate

Background: Fractures of the proximal femur, including fractures affecting the pertrochanteric region, have become a public health problem. Owing to aging of the population, we have to operate on even more elderly patients who sometimes present with significant co-morbidities. Although conventional implants have given good results in stable peritrochanteric fractures, proximal femur locking compression plate (PFLCP) which has been recently introduced is better suited for comminuted, unstable pertrochanteric fractures and osteoporotic bones. In PF-LCP, bone-implantconstruct so formed is mechanically stable and fixation failure due to screw loosening in osteoporotic bone can be reduced. Materials &Methods: This prospective study was conducted in our institute and was approved by local ethical committee. Twenty-five consecutive patients of either sex with age more than 60 years (range, 60-84) having pertrochanteric fractures were operated upon with PFLCP. A.O classification was followed in the study and Singh’s index for osteoporosis was calculated. Operating time, blood loss and any technical difficulty with the implant were recorded. Patients were followed clinically and radiologically for union at fracture site and implant-related complications for a period of 24 months. The Harris Hip Score was used to document hip functions at final follow-up. Observations: Amongst the 25 patients, the average operation time in our study was 66.60±10.57 minutes. The average radiological union was 3.40±0.63 months (13.6 weeks). Average time for full weight bearing was 13.12±1.90 weeks. There were two cases of wound infection, one case of coxa vara and one case of a proximal screw back-out. There was no case of plate lift or screw breakage. There was no case of non-union. Conclusion: The PFLCP can be a feasible alternative to the treatment of peritrochanteric fractures. Treatment with PFLCP can provide good-to-excellent healing in osteoporotic bones having comminuted and unstable peritrochanteric fractures, with a limited occurrence of complications.

Postoperative Complications of Double Pelvic Osteotomy Using Specific Plates in 305 Dogs

Objective The aim of this clinical retrospective study was to describe the postoperative complications and associated factors of double pelvic osteotomy (DPO) using DPO plates. Materials and Methods Medical records were searched for dogs that underwent unilateral or bilateral DPO using DPO plates from February 2009 to October 2018 and were re-evaluated for a minimum of 1 to 2 months postoperatively. A variety of commercially available, specific DPO plates were used. Complications were determined during the immediate postoperative period and at the time of the clinical and radiographic re-evaluations done 1 and/or 2 months postoperatively. Results A total of 458 DPO (226 right, 232 left) performed in 305 dogs satisfied the inclusion criteria. Double pelvic osteotomy plates from eight different manufacturers were used: Fixin (n = 160), Kyon (n = 154), New Generation Device (n = 63), Hofmann (n = 61), Veterinary Instrumentation (n = 12), DePuy Synthes (n = 4), Porte (n = 3) and Koenigsee (n = 1). Mean age of the dogs was 6.2 months (range: 5–8 months), and the body weight ranged from 10 to 47 kg. Overall, a total of 42 complications occurred in 38 DPO (8.2%). Complications included greenstick fracture of the ischium in 14 DPO (3%), isolated screw loosening in 13 DPO involving 16 of a total of 2,947 screws (0.5%), isolated screw breakage in 4 DPO involving 5 of 2,947 screws (0.1%), incomplete ilium fracture in 3 DPO (0.6%), partial caudal plate avulsion in 3 DPO (0.6%), iatrogenic sciatic neuropraxia in two DPO (0.4%), suspected surgical site infection (SSI) in 1 DPO (0.2%) and persistent pain and lameness caused by the implant in 2 DPO (0.4%). The case of suspected SSI and the two cases of persistent pain were classified as major complications (3 DPO, 0.6%), requiring medical and surgical intervention, respectively, whereas other 39 complications in 35 DPO were classified as minor, not requiring treatment (7.6%). Conclusion Double pelvic osteotomy using DPO plates appears to be a safe surgical option for the treatment of hip dysplasia in growing dogs; no catastrophic complications were reported and the incidence of complications (0.6% major complications and 7.6% minor complications) was low. This study showed that DPO using DPO plates and proper technique was safe in 92% of cases. The only two factors found to be significantly associated with the development of complications after DPO were the laterality (left-sided or right-sided) and body weight.

Experimental study on the factors affecting torque of beam-type implant torque wrenches

Background Screw breakage and loosening are the most common mechanical complications associated with implant treatment, and they may occur due to excess or inadequate screw tightening torque. When fastening and fixing the implant superstructure, screws are tightened using a torque wrench, which is essential for an accurate tightening force. However, the characteristics of the torque wrench have not been fully verified. Therefore, we aimed to clarify the factors affecting the torque with a focus on beam-type torque wrenches, which are the main types of wrenches. Methods The torque values generated by beam-type torque wrenches from eight manufacturers were measured using a torque gauge. To investigate the influence of the location of the beam relative to the scale, measurements were performed with a scale aligned with the trailing edge, center, and leading edge of the beam respectively. Additionally, measurements were taken at 90°, 60°, and 30° to examine the effect of the angle at which the examiner read the torque value. Under each condition, a single examiner applied the recommended torque to each manufacturer's screws five times in a clockwise direction. The average measured torque, standard deviation, bias, and coefficient of variation were calculated and compared accordingly. Results Wrenches from six manufacturers demonstrated excellent accuracy for measurements at the center of the beam (bias within ± 4%). For measurements at 90°, equipments from five manufacturers displayed excellent accuracy (bias within ± 7%), and seven showed excellent repeatability (coefficient of variation ≤ 2%). Conclusion The scale should be aligned with the center of the beam and read from 90° while using a torque wrench. The accuracy and repeatability torques generated by the wrenches differed according to the manufacturer, scale width, scale line width, beam width, and distance between the scale and beam center. Based on these results, we suggest that a torque wrench must be selected after determining the difference in the structure of the torque wrench.

Outcomes of Posterior Arthroscopic Subtalar Arthrodesis for Medial Facet Talocalcaneal Coalition

Background: Medial facet talocalcaneal coalition can be a painful condition. This study aimed to determine clinical and radiographic outcomes of posterior arthroscopic subtalar arthrodesis (PASTA) for adult patients presenting with symptomatic medial facet talocalcaneal coalition and normal hindfoot alignment, with a minimal follow-up of 18 months. Methods: Between June 2017 and July 2019, this procedure was performed on 8 feet (8 patients; mean age, 55 [42-70] years; mean BMI, 29.8 [24.4-45.0] kg/m2). Clinical assessment was performed using Visual Analog Scale for Pain (VAS-P), Foot and Ankle Outcome Score (FAOS) and the 36-Item Short-Form Health Survey (SF-36). Patient satisfaction was assessed at the last available follow-up as “very satisfied”, “satisfied” or “unsatisfied”. Radiographic analysis was performed using plain radiography, computed tomography (CT) scan and magnetic resonance imaging (MRI). The primary outcome was to determine both clinical and radiographic outcomes. Results: The mean follow-up was 25.1 (18.2-34.2) months. The authors found statistically significant improvement on all clinical scores (VASP-P, FAOS and SF-36). They registered 6 “very satisfied” patients, 2 “satisfied” patients and no “unsatisfied” patient. Fusion of the subtalar joint was observed in all patients by 12 weeks and in 5 of them as soon as 8 weeks postoperatively (mean, 9.5 [8-12] weeks). There were no cases of delayed fusion or nonunion of the subtalar joint, superficial or deep infection, neurovascular damage, thromboembolic event, screw breakage, need for hardware removal or revision surgery. Conclusion: This study found that PASTA is a safe and reliable technique for adult patients presenting with symptomatic medial facet talocalcaneal coalition and normal hindfoot alignment, demonstrating and maintaining clinical improvement at an average follow-up of 2 years. Level of Evidence: Level IV, case series.

Treatment of fractures of the proximal end and humeral shaft by locked intramedullary nailing in adults: Case series and literature review

Introduction: Intramedullary nailing is a good indication for stabilizing displaced fractures of the proximal end and shaft of the humerus in adults. Methods: This was a prospective series of 24 patient, over a period of 9 months. The aim of this study is to report the epidemiological and clinical aspects of patients treated with a locked humeral nail and to show the medium-term interest, of this therapeutic method, thus discussing the complications. Results: All patients had received intramedullary nailing of the humerus. The average age was 77.08 years. The female sex was more represented with 66.66% and the right side was frequently fractured with 83.33%. We distinguished 50% of cases involving the proximal end of the humerus, 45.87% of cases of the humeral shaft and one case of concomitant fracture of the proximal end and that of the humeral shaft. The postoperative infection rate is zero in our series and we reported 1 case of distal locking screw breakage, 1 case of iterative fracture on short Telegraph nail, 1 case of proximal screw retraction on long Telegraph nail and 1 case of perforation of the humeral head with a proximal locking screw. Conclusion: humeral intramedullary nailing is a good alternative in fixing proximal end and humeral shaft fractures without considerable complications or damages for the rotator cuff muscles.

A biomechanical comparison of steel screws versus PLLA and magnesium screws for the Latarjet procedure

Introduction The fixation of the coracoid process onto the glenoid is an important step of the Latarjet procedure, and implant-associated complications are a relevant and severe problem. This study compares the fixation strength and failure mode of two biodegradable materials with stainless-steel screws. Methods 24 Fresh-frozen cadaveric scapulae were divided into three groups of equal size and received a coracoid transfer. Cadavers were matched according to their bone mineral density (BMD). In group 1, small-fragment screws made of stainless steel were used. In the second group, magnesium screws were used, and in the third group, screws consisted of polylactic acid (PLLA). A continuously increasing sinusoidal cyclic compression force was applied until failure occurred, which was defined as graft displacement relative to its initial position of more than 5 mm. Results At 5-mm displacement, the axial force values showed a mean of 374 ± 92 N (range 219–479 N) in group 1 (steel). The force values in group 2 (magnesium) had a mean of 299 ± 57 N (range 190–357 N). In group 3 (PLLA), failure occurred at 231 ± 83 N (range 109–355 N). The difference between group 1 (steel) and group 2 (magnesium) was not statistically significant (P = 0.212), while the difference between group 1 (steel) and group 3 (PLLA) was significant (P = 0.005). Conclusion Stainless-Steel screws showed the highest stability. However, all three screw types showed axial force values of more than 200 N. Stainless steel screws and PLLA screws showed screw cut-out as the most common failure mode, while magnesium screws showed screw breakage in the majority of cases. Evidence Controlled laboratory study.

Unstable trochanteric Fracture Fixation with P.F.N. augmented by T.B.W.

Biomechanically Proximal Femoral Nail (PFN) is a better choice of implant. Still it is associated with screw breakage, cut out through femoral head,”Z” effect, reverse “Z” effect and lateral migration of screws. The purpose of this study is to evaluate the results of augmented PFN in terms of post operative complication and failure rates in unstable trochanteric fracture. Methodology: We did study of 21 unstable trochanteric fractures from Jan 2016 to Nov .2020. 14 patients were males & 7 patients were females. Age group between 25 to 80 was included in this group. There were 15 A0 A2 (2.2, 2.3) and 6 were A0 A3 (3.1, 3.2, 3.3). All fractures were fixed with 25cm, 1350 PFN mainly 11 mm, 12mm in diameter augmented with one or two 16 gauge tension band wire, strengthening lateral trochanteric wall and holding either communiated fragments or lesser trochanteric fracture. Results: The bone healing was observed in all cases with mean period of 16 weeks. Two patients developed complication of TBW breakage; one developed lateral migration of screws. Patients were followed till # union. At the end of follow up the Salvati and Wilson hip function was 30 (out of 40) in 80% patients. Conclusion: The stabilization of lateral trochanteric wall fracture and communicated fragments with additional one or two TBW increases the stability of construct enhancing bony union & better results.

Study on glenoid component in anatomical total shoulder arthroplasty in Nagapattinam district

<p class="abstract"><strong>Background:</strong> Depending upon the mechanism of dysfunction or injury a shoulder arthroplasty can either be a partial or total replacement. Shoulder arthroplasty surgery has shown remarkable progress during the last few decades. The objective was to study the effect of prosthesis positioning in reverse shoulder arthroplasty on radiological and clinical outcomes.</p><p class="abstract"><strong>Methods:</strong> This was a prospective comparative non-randomized study of 37 patients who underwent reverse shoulder arthroplasty (RSA) in Government District Head Quarters Hospital Nagapattinam with a follow-up ranging from March 2018 to January 2019 (11 months).<strong></strong></p><p class="abstract"><strong>Results:</strong> Grade 1 indicated a notch limited to the scapular pillar, grade 2 reached the inferior screw of the baseplate, grade 3 extended beyond the inferior screw and grade 4 reached the central peg of the baseplate. Glenoid loosening was defined as radiolucencies under the baseplate or around the peg or screws, screw breakage, or glenoid migration.</p><p class="abstract"><strong>Conclusions:</strong> Outcome measures were improved regardless of the LHO. At 3 months follow-up increased LHO harmed shoulder function and gave more shoulder pain at rest and exertion but did not affect the quality of life, health status, or ROM. At 12 months follow-up, LHO had no relation with the outcome measures. Further studies are warranted to investigate the influence of LHO on long-term prosthetic survival.</p>

Application of Inverse Neural Networks for Optimal Pretension of Absorbable Mini Plate and Screw System

Mandibular fractures are common facial lesions typically treated with titanium plate and screw systems; nevertheless, this material is associated with secondary effects. Absorbable material for implants is an alternative to titanium, but there are also problems such as incomplete screw insertion and screw breakage due to high pretension in the screw caused by the insertion torque. The purpose of this paper is to find the optimal screw pretension (SP) in absorbable plate and screw systems by means of artificial neural network (ANN) and its inverse (ANNi). This optimal SP must satisfy a desired maximum von Mises strain (MVMS). For training the ANN, a database was generated by means of a design of experiments (DOE). Each DOE configuration was solved by means of finite element method (FEM) calculations. To obtain the optimal value for (SP) in the mini absorbable screw for fracture fixation, a strategy to invert the ANN is developed. Using the ANN coefficients, a sensitive study was performed to identify the influence of the design parameters in the MVMS. The optimal SP obtained was 14.9742 N. The MVMS condition was satisfied with an error less than 1.1% in comparison with FEM and ANN results. The screw shaft length is the most influencing MVMS parameter.

Factors Affecting Torque of Beam Type Implant Torque Wrench

Background: Screw breakage and loosening are the most common mechanical complications in implant treatment. One of the causes is the excess or deficiency of the screw tightening torque; thus, the use of a torque wrench is a prerequisite for achieving an accurate tightening torque. Therefore, we focused on the beam-type torque wrenches, which are the main type, to clarify the factors affecting this torque.Results: The torque values of the beam-type torque wrenches for the eight manufacturers were measured using a torque gauge. For investigating the influence of the location of the beam placed on the scale, the measurement was performed with the scale aligned with the upper edge, center, and lower edge of the beam. Additionally, measurements were taken at 90°, 60°, and 30° to examine the effect of the angle at which the examiner read the torque value. Under each condition, a single examiner applied the recommended torque value of each manufacturer's screws five times clockwise. The average measured torque, standard deviation, bias, and coefficient of variation were calculated and compared. Equipment from six manufacturers demonstrated the best accuracy for measurements at the center of the beam (bias within ± 4%). For measurements at 90°, equipment from five manufacturers displayed the highest accuracy (bias within ± 7%), and seven showed the highest repeatability (coefficient of variation 2% or less).Conclusion: It was recommended that the center of the beam should be aligned with the scale and read from 90°, while tightening the torque wrench. The accuracy and repeatability differed according to the manufacturer, scale width, scale line width, and beam width, while the distance between scale and beam center was related to accuracy and repeatability. Based on these results, it was suggested that a torque wrench must be selected after grasping the difference depending on the structure of the model to be used.