Computed Tomography Analysis of Nasal Anatomy in Dorsal Preservation Rhinoplasty

Background Subdorsal septal resection and radix osteotomy are distinctive surgical steps in preservation rhinoplasty. Objectives The aim of this study was to evaluate the nasal bone thickness, the level of the septal bony-cartilaginous junction (K area), and the distances of the frontal sinus and skull base from the transverse osteotomy line in the Turkish population by means of conventional computed tomography (CT). Methods A retrospective evaluation was made of 203 consecutive preoperative paranasal CT scans of patients (classified in terms of age and gender) who had undergone rhinoplasty surgery between January 2020 and June 2021. The nasal bone thickness at the medial canthus level, and the distances between the transverse osteotomy line and the K area, the frontal sinus, and the cribriform plate were measured. Results The mean measurements were similar in terms of age groups (P = 0.402, P = 0.542, P = 0.134 and P = 0.276 for ages 18-30, 30-40, 40-50, and >50 years, respectively). The mean nasal bone thickness and the distance between the transverse osteotomy line and the K area showed statistical significance (P = 0.001 and P = 0.001, respectively). In both genders, the mean distances between the transverse osteotomy line and the frontal sinus and the cribriform plate were similar (P = 0.921 and P = 0.280, respectively). The nasal bone was thinner and the K area position more cephalic in females. Conclusions CT plays an important role in preoperative planning. The need for resection of the ethmoid perpendicular bone may be greater in males when lowering the dorsal hump, and hence they may be more prone to skull base complications. It is therefore necessary to be more careful in the surgical stage of subdorsal septal excision in males.

Transverse olecranon osteotomy with Gigli saw: A fast and reliable technique

Objective. Distal humerus fractures constitute of approximately 2% of all fractures and 30% of elbow fractures. Olecranon osteotomy provides excellent exposure of distal humerus and articular surface. In this study, we aimed to compare transverse osteotomy with gigli saw and classical chevron osteotomy techniques in terms of osteotomy duration and clinical results. Materials and Methods. 40 elbows of 40 patients with Type B intraarticular distal humerus fractures according to AO classification were included in our study. Patients were divided into 2 groups as transverse or chevron osteotomy groups. Patients were evaluated in terms of intraoperative osteotomy time, postoperative time to union, range of motion in the elbow joint and Quick Dash scores at 6th, 12th and 24th months. Results. The mean age of the patients was 45.6 years (19-62). 40% of the patients (8 patients) in the Chevron group had more than 2 mm stepping at articular surface, while this rate was 10% (2 patients) in the gigli saw group. Union was obtained in all patients for both techniques. There was no significant difference between the mean QuickDASH scores and range of motion of the elbow joints except flexion in both groups. Range of motion of flexion was statistically better in the gigli saw group (p<0.05). Conclusions. Transverse osteotomy technique significantly reduces osteotomy and fixation time and will not cause problems in fracture union. It may be preferred because it is simpler and faster to apply than chevron osteotomy and because intra-articular stepping is less common.

Magnetomechanical stimulation of bone tissue regeneration

The aim of the research. To assess the ability of superparamagnetic nanoparticles functionalized with the RGD peptide to accelerate bone tissue recovery aft er transverse osteotomy under the infl uence of a low-frequency alternating magnetic fi eld. Material and methods. We used superparamagnetic nanoparticles ferroarabinogalactans (FeAG) functionalized with the RGD peptide for targeted binding to integrins. Th e model for assessing the ability of FeAG-RGD to accelerate bone regeneration was the transverse osteotomy of the radius of the ICR mice. To induce the process of bone tissue regeneration aft er the injection of FeAG-RGD particles, mice were placed in an alternating magnetic fi eld (50 Hz 100 Oe) for 60 min. Th e therapy was performed daily for 5 days. Results. Th e paper tested the hypothesis about the acceleration of bone tissue regeneration by the method of magnetomechanical therapy using superparamagnetic FeAG-RGD nanoparticles. It has been established that FeAG-RGD under conditions of an alternating magnetic fi eld (50 Hz 100 Oe) are able to change their orientation in space and, thus, cause mechanical stress in the proteins of the cell membrane – integrins, which trigger the process of osteogenic diff erentiation. Th e research results showed that 5 procedures of magnetomechanical therapy lead to complete restoration of bone tissue at the site of the transverse osteotomy, while in the group of control animals no fusion of bones is observed. Conclusion. Th e use of the method of magnetomechanical therapy using ferroarabinogalactans functionalized with the targeting ligand RGD for binding to integrins of osteogenic cells is a promising technology for bone tissue regeneration

Hallux Valgus Correction: Comparison of Minimally Invasive Transverse and Chevron Distal Metatarsal Osteotomy Constructs

Category: Basic Sciences/Biologics; Bunion Introduction/Purpose: Hallux valgus is one of the most common surgically corrected forefoot deformities. Compared to open procedures, minimally invasive treatment of hallux valgus has resulted in decreased operative time, reduced complication rates, and greater patient satisfaction. Until recently in the United States, distal chevron osteotomies have been the standard for hallux valgus correction of moderate deformity. To the best of the authors’ knowledge, no studies have evaluated biomechanical strength of transverse and chevron distal metatarsal osteotomy constructs. The purpose of this study was to evaluate the biomechanical strength of transverse and chevron minimally invasive osteotomy techniques using 9 matched cadaveric pairs. Methods: A total of nine matched cadaveric specimens were randomized to transverse or chevron distal metatarsal osteotomies. Each minimally invasive surgical technique was performed by a fellowship trained orthopedic foot and ankle surgeon. Anterior- posterior and lateral radiographic images were obtained following surgical fixation. Biomechanical testing was performed on an Instron Mechanical System. Ultimate load to failure, yield load, and stiffness were assessed across the fixation construct with fulcrum within the metatarsal shaft proximal to screw fixation and compression load at the sesamoid bones. A pre-load of 10N was applied to the sesamoid bones by the compression post to stabilize the sample. Subsequently, a compression rate was applied to the sample at 10mm/min until failure was observed. Mean and standard deviations were assessed and compared across cohorts. Results: All nine cadaveric specimens were male. There was no difference in average percent metadiaphyseal shift among transverse (36%) and chevron (38%) osteotomies. The most common mode of failure among transverse and chevron osteotomies was fracture at screw insertion site (55.6%), followed by failure at osteotomy site (44.4%). One paired sample was noted to have poor bone quality prior to biomechanical testing. There was a trend towards increased ultimate load to failure (p=0.480) and stiffness (p=0.438) among transverse osteotomy compared to chevron osteotomy, however, no statistically significant difference was observed. Conclusion: Biomechanical testing demonstrates no statistical difference in ultimate load to failure and stiffness between minimally invasive transverse and chevron distal metatarsal osteotomy constructs. A trend towards increased ultimate load and stiffness in the transverse osteotomy cohort was observed. Chevron osteotomies violate the entire plantar cortex and may result in early failure by relative ease of cutout through cancellous bone compared to transverse osteotomies in which failure would require cortical bone cutout. Future studies are required to evaluate strength of construct in a larger sample. Analysis is limited, healing may provide additional strength that is not simulated in cadaveric studies.

Viability of polyamide 12 intramedullary rods coated with hydroxyapatite in experimentally induced fractures in young roosters (white Plymouth rock)

The present study aimed the viability evaluation of solid intramedullary rods made with polyamide 12 and coated with hydroxyapatite in experimentally osteotomized humerus of young roosters (white Plymouth rock). Sixteen animals of 45 days old each were used. After general anesthesia, they underwent to complete transverse osteotomy of the right humerus diaphysis to implant the already described rods which filled the entire length of the medullary cavity and were fixed by two cortical stainless steel screws in each bone fragment. The surgical technique was well succeeded without any trans-operative intercurrence. Through clinical and radiographic examination, it was observed that soon after the anesthesia recovery, six rods (37,5%) broke next to the fracture focus and the same was noticed with the others (62,5%) on seventh day post-surgery. Based on the obtained results, it can be hypothesized that polyamide 12 rods resistance could have been affected by all the thermal stages necessary to its incorporation with hydroxyapatite. Furthermore, the roosters’ age may also have contributed to adverse outcomes. However, future researches will be necessary to confirm those hypotheses.

Optimal Location of Subtrochanteric Osteotomy in Total Hip Arthroplasty for Crowe Type IV Developmental Dysplasia of Hip

Background When reconstructing a hip with developmental dysplasia and high dislocation, sub-trochanteric shortening osteotomy is typically needed for placing the acetabular component in the appropriate anatomical position. However, the procedure can result in complications such as non-union of the osteotomy. We evaluated the contact area and the coincidence rate between the proximal and distal fragments at different femoral osteotomy levels and lengths. We then determined the optimal location of subtrochanteric femoral shortening transverse osteotomy in patients with unilateral Crowe type IV developmental dysplasia of the hip (DDH). The consistency between the proximal and distal segments was assessed as a possible predictive indicator of the union at the osteotomy site. Methods We retrospectively reviewed 57 patients with unilateral Crowe type IV DDH who underwent X-ray imaging of both hip joints. We labelled the inner and outer diameters of the circular ring as N (mm) and M (mm), respectively. We defined the overlapped area between the proximal and distal ring as contact area S (mm 2 ), and the ratio of contact area to distal ring area as coincidence rate R. Results N varied from 9.8–15.2 mm and M varied from 20.7–24 mm, both demonstrated a decreasing trend in the proximal to distal direction. At osteotomy lengths ranging from 0.5–2 cm, there were no differences in S between the different levels of osteotomy in each group. At osteotomy lengths ≤ 2.5 cm, a significant higher coincidence rate was noted from 2 cm below the lesser trochanter to other positions below the level. At osteotomy lengths from 3–5.5 cm, a significantly higher coincidence rate was observed from the level of 1.5 cm below the lesser trochanter to other positions below the level. Conclusions Our findings suggest that femoral shortening transverse osteotomy at the optimal subtrochanteric level can predictably increase the contact area and coincidence rate, which may contribute to the union at the osteotomy site. Considering the stability of the prostheses, it appears appropriate that osteotomy location should be shifted slightly distally.