Modification of Biocorrosion and Cellular Response of Magnesium Alloy WE43 by Multiaxial Deformation

The study shows that multiaxial deformation (MAD) treatment leads to grain refinement in magnesium alloy WE43. Compared to the initial state, the MAD-processed alloy exhibited smoother biocorrosion dynamics in a fetal bovine serum and in a complete cell growth medium. Examination by microCT demonstrated retardation of the decline in the alloy volume and the Hounsfield unit values. An attendant reduction in the rate of accumulation of the biodegradation products in the immersion medium, a less pronounced alkalization, and inhibited sedimentation of biodegradation products on the surface of the alloy were observed after MAD. These effects were accompanied with an increase in the osteogenic mesenchymal stromal cell viability on the alloy surface and in a medium containing their extracts. It is expected that the more orderly dynamics of biodegradation of the WE43 alloy after MAD and the stimulation of cell colonization will effectively promote stable osteosynthesis, making repeat implant extraction surgeries unnecessary.

Polytraumatized patient with two columns fracture of the acetabulum and skin abrasion, which incision to use with soft tissue: A case report at 15 years follow-up

Posterior fractures of the acetabulum are the most frequent pattern of acetabular fractures. Based on the works of Judet and Letournel, accurate reduction and stable osteosynthesis with early mobilization have become the gold standard for the treatment of posterior acetabular fractures. Recently, a less invasive approach has been described to decrease Kocher-Langenbeck (K-L) approach complications. The clinical case describes a patient affected by two-column fractures of the acetabulum with skin abrasions of the gluteus. The clinical evaluation was based on Merle d’Aubigne and Postel scoring, which Matta has modified. The approach used is a modified, less invasive K-L: a straight skin incision from the midpoint between the posterior superior iliac spine and the posterior tip of the greater trochanter. We observed the essential advantages using this approach were a lesser split of the gluteus maximus and no risk of damage for the superior gluteal nerve. In the early postoperative rehabilitation, we examined the strength of the gluteus maximus, which was better than in patients treated with the typical Kocher–Langenbeck approach. The patient resumed after fifteen years after surgery; hip mobility is complete and painless.

Cementation of proximal femoral nails of the very elderly subject in per-trochanteric fractures

The management of pertrochanteric fractures (PTF) in the very elderly relies on early verticalisation to limit complications of the decubitus and this requires stable osteosynthesis allowing immediate full support without risk of mechanical failure. The aim of the study was to analyse the value of cementing the cervicocephalic blade during osteosynthesis with a proximal femoral nail. A prospective bicentric comparative study was con- ducted. Patients over 90 years of age with PTF were included. Centre A used a PFNA (Proximal Femoral Nail Antirotation) nail without blade cementing and Centre B used the same nail with blade cementing. The primary endpoint was the occurrence of disassembly of the osteosynthesis requiring revision surgery. Secondary endpoints were functional out- come (resumption of walking), postoperative pain and duration of surgery. Sixty-four patients were included in Centre A and 23 patients were included in Centre B. Mean age, gender, functional abilities before fracture, fracture type and tip-apex distance were comparable between the groups. Postoperative pain and duration of surgery did not show significant differences between the groups. Four patients operated on with an uncemented PFNA (6.25%) and one patient operated on with a cemented PFNA nail (4.35%) showed early dismantling. The rate of patients returning to walking was significantly higher in the cemented group (p=0.00005). No significant differences in the rate of dismantling were observed between the two groups. However, the group operated on with a cemented PFNA showed better functional recovery with a significantly higher rate of walking recovery.

Stable osteosynthesis of cage in cage technique for surgical treatment of proximal humeral fractures

Background The treatment of a displaced proximal humeral fracture is still a matter of controversy. The purpose of this study was to report outcomes at a long-term follow-up after fixation augmentation using peek (polyether-ether-ketone) cage and locking compression plate (LCP). Methods A total of 27 patients (average age 53.8 years, range 19–86 years) were treated with peek cage and LCP. All of them had a minimum radiographic and clinical follow-up of 1 years. Outcomes were assessed using the Constant-Murley score (CMS), disability of the arm, shoulder and hand (DASH) score. Complications were also recorded during follow-up. Results The average follow-up was 28 months (range 12–48 months). The mean functional outcomes were as follows: CMS, 73.3 (range 61–86); DASH, 45.9 (range 27–68). A total of 4 patients had complications: osteonecrosis developed in one patient, loss of reduction was observed in 1 patient and stiffness was occurred in two patients. Conclusion The use of peek cage and LCP has been a valuable option in the treatment of proximal humeral fractures. The complication rate was acceptable. Suitable void filler in the proximal humerus for reconstructing the medial column integrity attains mechanical stability in reducing the incidence of the complications.

Outstanding issues of modern osteosynthesis of humerus fractures

Background. Over the past twenty years, there have been significant changes in the treatment of humerus fractures. Many high-tech tools have appeared in osteosynthesis. Numerous workshops and short-term courses do not sufficiently highlight vulnerabilities of osteosynthesis with fixators. Unfortunately, in many cases, the treatment results of humerus fractures could be better. The purpose of the work was the analysis of biomechanical aspects of modern fixators for humerus fractures osteosynthesis, causes for complications and unsatisfactory results in the application of fixators. Materials and methods. We have analyzed the available literature data, X-rays of interesting cases, patients’ histories with complications, and negative results of humerus fractures osteosynthesis by intramedullary blocking rods and LCP-plates. Results. The outcome of the humerus fracture treatment largely depends on the understanding of the process of reparative regeneration. There is a tendency for a mechanistic approach in the treatment of bone fractures and their consequences. In the case of surgical neck fractures, the curved LCP-plates are used. They require the placement of at least 4 blocking screws into the bone epiphyses. This often leads to the development of aseptic necrosis. The lack of the anatomical reposition of the fragments as well as the placement of 5–7 screws into the humerus head leads to deforming arthrosis of the shoulder joint. We have observed similar complications in 10 patients. The placement of a significant number of screws into the bone head can lead to complications when a fixator breaks at the point of the plate tension change. In complex cases of humerus fractures and complications of osteosynthesis with other fixators in 170 patients, we used a device for fixing bone fragments that has been developed by us. It is protected by the patent of Ukraine N 17502. The device eliminates harmful pressure of a plate on a bone, carries out a stable osteosynthesis using the shortest possible plate. Blocking screws in a plate with insufficiently reposed fragments cause the development of pseudoarthrosis. A common complication of LCP plates is the welding effect between the screw head and the plate. Against the background of osteoporosis of the bone, the LCP plate actually acts as a prosthesis, which exacerbates the effects of osteoporosis. Late LCP plate removal in such cases might cause humerus refraction. Conclusions. Osteosynthesis of humerus fractures using LCP plates has significant advantages over traditional contact plates. Complications and negative results of osteosynthesis may occur when they are used inappropriately and when the correct methods and techniques of surgical intervention and the appropriate postoperative care are not followed.

Epidemiological and Therapeutic Developments in Pelvic Ring Fractures Type C from 2004 to 2014 – a Retrospective Data Analysis of 2,042 Patients in the German Pelvic Register (DGU)

Background Pelvic ring fractures type C present a special challenge due to their high instability, the possible accompanying injuries and the high mortality rate of up to 18.9%. The aim of this retrospective analysis was to use the data from the DGU pelvic register to identify changes in the epidemiology and therapy for type C pelvic ring fractures between 2004 and 2014. Materials and Methods 2,042 patients with type C pelvic ring injury were retrospectively included. Three time periods with roughly equal patient groups were specified and differences in epidemiology and the type of therapy were evaluated. For the surgical cases, the time of the operation, the duration of the operation, blood loss, the location of the fracture and the type of osteosynthesis were evaluated and the reduction result was recorded. Results For the period under review, there is an age shift in the incidence of a type C pelvic ring fracture towards older age. The isolated pelvic injury has increased, while the proportion of pelvic injuries in the context of polytrauma has steadily decreased. Complications and mortality decreased as a percentage. The tendency towards minimally invasive procedures could be shown in the surgical care. Navigated procedures in the area of the pelvic ring have so far not proven successful. Conclusions We were able to show that the majority of the patients are increasingly old, that there is no relevant trauma in the history and that there is an increase in the isolated pelvic fracture type C and a decrease in the number of polytraumatised or multiply injured patients. In conjunction with mortality from pelvic ring injuries, the successes of standardised, pelvic-specific emergency management, an adapted time of operation outside the vulnerable phase and stable osteosynthesis care, which enable early functional follow-up treatment, are also evident.

Iatrogenic Fracture of the Lower Jaw: A Rare Complication of Lower Molar Extraction

Iatrogenic mandible fracture is a rare complication of a tooth extraction with an incidence between 0.0033–0.0034%. This study retrospectively analyzes a total of 8 patients who underwent lower molar extraction associated with mandible fracture during tooth removal in the period from April 2006 to March 2019. The assessed parameters were age and sex of patients, method of tooth extraction, side distribution of fracture, type of extracted tooth, the position of a lower third molar, presence of bone pathological lesion formed in connection with a tooth, displacement of bone fragments, and sensory impairment in the innervation area of the mental nerve. The position and impaction of the lower third molars were evaluated according to Pell and Gregory’s classification and Winter’s classification. One fracture was left-sided, and 7 fractures were right-sided. In 6 cases, Winter’s extraction elevator was used. In 7 patients, the mandible fracture was treated surgically by performing stable osteosynthesis with the plates and screws. One patient was treated conservatively. This work analyzes the causes of iatrogenic mandible fractures and provides recommendations to reduce the risk of their occurrence.

SOME ASPECTS OF MAXILLOFACIAL SURGERY OF SMALL NONPRODUCTIVE ANIMALS

An analytical review is presented, the purpose of which is todetermine the most important vectors when choosing approaches to reparative osteogenesis in dogs and cats with fractures of the bones of the upper and / or lower jaw. Medical care for all types of fractures should rely on such vectors of functionally stable osteosynthesis as adequate rigid fixation, minimally invasiveness, structural stability, safety and effectiveness of the new product's effect on bone regeneration and on the whole organism as a whole.

Failure after proximal humeral fracture osteosynthesis: a one year analysis of hospital-related healthcare cost

Purpose The issue of rising healthcare costs and limited resources is a topic of worldwide discussion over the last several decades. We hypothesized that failure of proximal humeral fracture osteosynthesis is presumed to be an important determinant in healthcare resources and related costs. The aim of this study was to calculate the total hospital-related healthcare cost of proximal humeral fracture osteosynthesis over one year focusing on failure. Methods A total of 121 patients with a proximal humeral fracture treated by angular stable osteosynthesis were included in this retrospective study. All hospital-related healthcare costs were investigated. Five main hospital-related cost categories were defined: hospitalization cost, honoraria, day care admission, materials, and pharmaceuticals. Results A total healthcare cost of € 1,139,448 was calculated for the whole patient group. Twelve patients needed revision surgery due to complications or fixation-related failure. This failure rate alone costed € 190,809 of the healthcare resources. In other words, failure after proximal humeral fracture osteosynthesis costed 17% of the total healthcare expenditure inone year. Conclusion This study demonstrates that a high amount of hospital-related healthcare resources is spent because of failure after proximal humeral fracture osteosynthesis. Further research is necessary and should investigate on how to prevent failure. This is not only in the patient’s interest, but it is also of great importance for maintaining a healthy healthcare system.