Combined Lateral Plateau and PCL Injury in a Pediatric Patient: A Case Report.

Introduction: Posterior cruciate ligament (PCL) injuries and tibial plateau fractures are common orthopedic injuries. In the pediatric population, femoral-sided avulsions are the most common injury pattern for PCL injuries. However, there is limited literature on the characterization and treatment of pediatric PCL avulsion with concomitant tibial plateau fracture. Case Report: We present the case of an adolescent female who was involved in an all-terrain vehicle rollover. The patient sustained a femoral-sided PCL avulsion injury with an associated lateral tibial plateau fracture. The PCL avulsion was treated through arthroscopic cruciate repair, while the tibial plateau fracture was managed with open reduction and internal fixation (ORIF). Conclusion: This case report highlights a rare combination of a femoral-sided PCL avulsion and lateral tibial plateau fracture in a pediatric patient. The treatment involved arthroscopic cruciate repair for the PCL avulsion and ORIF for the tibial plateau fracture. Further studies are needed to establish optimal management strategies for similar cases.

A Novel Protocol for Nasal Decolonization Using Prolonged Application of an Alcohol-Based Nasal Antiseptic Reduces Surgical Site Infections in Total Joint Arthroplasty Patients: A Retrospective Cohort Study.

Background: Current nasal decolonization strategies utilize pre-operative agents without consideration for short-term re-colonization or de novo colonization. Many strategies utilize an antibiotic-based agent, raising concerns of limited gram-negative antimicrobial coverage and the emergence of resistant bacterial strains. This study evaluated the clinical utility of a non-antibiotic, alcohol-based nasal decolonization agent in decreasing surgical site infection (SSI) rates after total joint arthroplasty. Patients and Methods: We retrospectively compared an 18-month cohort of elective primary total joint arthroplasty patients treated peri-operatively with an alcohol-based sanitizer to historical controls. The alcohol-based agent was administered pre-operatively the day of surgery and for two weeks after surgery. Patients were followed for 90 days and assessed for signs or symptoms of SSI. Patient and caregiver compliance was recorded. There were 779 patients included in the experimental group and 647 included in the historical control group. Results: Patients receiving alcohol-based nasal decolonization had a lower rate of SSI compared with controls not receiving nasal decolonization (0.64% [5/779] vs. 1.55% [10/647]; p = 0.048; odds ratio, 2.43). Utilization of an alcohol-based nasal sanitizer in the pre-operative and prolonged post-operative setting decreased infection rates by 41.3% in our elective total joint arthroplasty setting. Conclusions: When used pre- and post-operatively, alcohol-based nasal decolonization of bacteria in patients undergoing total joint arthroplasty led to a substantial decrease in SSIs.

Normal Values of the Second Interosseous Pinch: A Measurement of Pure Ulnar-Innervated Intrinsic Muscles of the Hand.

PURPOSE: The second palmar interosseous muscle is innervated solely by the ulnar nerve, and second palmar interosseous pinch (2IP) strength may be a good indicator of ulnar nerve motor function. The goal of this study was to describe the 2IP test and establish its normative values, stratified by age, sex, and dominance. METHODS: Volunteers were recruited to participate in this study at various community locations. Patients over the age of 18 years were eligible for this study. Demographic information on all subjects was collected. The volunteers were asked to pinch a hydraulic pinch gauge between the index and middle finger proximal phalanges with the proximal and distal interphalangeal joints flexed and without recruiting the thumb. Three 2IP measurements were taken for each hand. Descriptive statistics and analysis of covariance were performed to determine the effect of age, sex, dominance, and side on 2IP. We analyzed the 2IP strength using the 2IP test across 3 trials to determine whether it was affected by repeated testing. RESULTS: Two hundred thirty-eight patients met the inclusion criteria (45 ± 21 years, 55% women, 87% right-hand dominant). There was no statistically significant difference between dominant and nondominant hands or among the 3 trials. There was a statistically significant correlation between age and 2IP strength ranging between 0.32 and 0.44 kg. Age and sex showed a statistically significant association with 2IP strength, with patients of older age and women having weaker 2IP. CONCLUSIONS: We determined normative values for 2IP strength using a sample from a normal population. More studies are needed to validate these results. CLINICAL RELEVANCE: Second interosseous pinch strength may be a useful tool to assess ulnar nerve function.

Percutaneous Threaded Pin Fixation of Distal Radius Fracture in the Athlete.

BACKGROUND: The purpose of this study was to examine the outcomes and return to play with early rehabilitation in athletes who sustained unstable extra-articular distal radius fractures treated with a purpose-designed threaded pin technique. METHODS: This prospective study examined athletes with displaced and unstable distal radius fractures treated surgically with purpose-designed threaded pins. Patients were enrolled in an early rehabilitation protocol, with formal therapy initiated on postoperative days 1 to 3. Range of motion and strength measurements were documented throughout the postoperative period, noting the time until return to athletic competition. These results were compared with historical values using other forms of fixation. RESULTS: Nineteen athletes, average age of 35 years, were treated with threaded pin technique with early rehabilitation; all had complete healing and maintained alignment based on radiographic evaluation. The average time span between surgery and release to competition was 8 weeks, with all but 1 patient returning to sport within 12 weeks of injury. Average postoperative flexion measured 58°, extension was 57°, pronation was 81°, and supination was 74°. JAMAR grip strength in position 3 measured 25.22 kg, which equated to 73% of the uninjured side's grip strength at the time of release to play. CONCLUSIONS: Surgical fixation using a purpose-designed threaded pin is a useful alternative to volar plating for isolated radial styloid and extra-articular distal radius fractures in athletes. The purpose-designed threaded pin may afford athletes rapid recovery during the early postoperative period, preserving strength and dexterity and minimizing time lost before return to play.

Programmed Multidrug Delivery Based on Bio-Inspired Capsule-Integrated Nanocoatings for Infected Bone Defect Treatment.

Infection and delayed wound healing are two major serious complications related to traumatic injuries and cause a significant burden to patients and society. Most currently available drug delivery materials typically carry a single drug, lack protection from drug loading, and face challenges in on-demand and precisely controlled drug release. Here, we report a flower (Cirsium arvense)-inspired capsule-integrated multilayer nanofilm (FICIF), synthesized using a layer-by-layer self-assembly, for programmed multiple drug co-delivery for trauma (open fracture as an example) treatments. Our approach allows polypeptide multilayer nanofilms and innovative impregnated capsules to assemble hierarchical reservoirs with specific drug binding sites, shielding protection capability, and ordered packing structures. The resultant FICIF nanocarriers enable sustained and on-demand co-delivery of a unique immune-tuning cytokine (interleukin 12p70) and a growth factor (bone morphogenetic protein 2) in clinical use, resulting in extraordinary anti-infection (3 orders of magnitude improved bacterial killing) and bone regeneration (5 times enhanced bone healing) in treating infected rat femur fractures. The successful synthesis of these biomimetic high-performance delivery nanocoatings is expected to serve as a source of inspiration for the development of biomaterials for various clinical applications.

Threaded Pin and Volar Plate Fixation of Distal Radius Fractures: Early Functional Recovery.

Purpose: To assess the results of threaded pin fixation and volar plate fixation of extra-articular distal radius fractures. Methods: A retrospective case comparison study of patients undergoing operative fixation of distal radius fracture and postoperative therapy at 1 hand clinic was performed. Clinical variables included implant type along with the assessment of the volar tilt; radial height; postoperative wrist flexion, extension, pronation, and supination; key pinch; and grip strength. The duration of postoperative hand therapy was recorded. An independent Student t test was used to compare the 2 groups. Results: Forty-three patients were identified (21 threaded pin and 22 volar plate). The mean ages were 46 years and 54 years for the threaded pin and the volar plate groups, respectively. Preoperative and postoperative radiographic parameters were similar for both the groups. No loss of reduction was observed. There were no statistically significant differences for postoperative range of motion or pinch and grip strength at the time of discharge from therapy. The threaded pin group had a mean duration of 65 days of therapy, and the volar plate group had a mean duration of 132 days of therapy. Conclusions: Both groups achieved equivalent range of motion and functional recovery; however, the threaded pin group required significantly less therapy than the volar plate group. At the time of discharge from therapy, radiographic and clinical outcomes were similar for both types of implants, but the patients treated with a threaded pin required significantly less therapy and were discharged from therapy an average of 67 days sooner than the patients undergoing volar plate fixation. Type of study/level of evidence: Therapeutic IV.

Unfavorable Contribution of a Tissue-Engineering Cartilage Graft to Osteochondral Defect Repair in Young Rabbits.

A stem cell-based tissue-engineering approach is a promising strategy for treatment of cartilage defects. However, there are conflicting data in the feasibility of using this approach in young recipients. A young rabbit model with an average age of 7.7 months old was used to evaluate the effect of a tissue-engineering approach on the treatment of osteochondral defects. Following in vitro evaluation of proliferation and chondrogenic capacity of infrapatellar fat pad-derived stem cells (IPFSCs) after expansion on either tissue culture plastic (TCP) or decellularized extracellular matrix (dECM), a premature tissue construct engineered from pretreated IPFSCs was used to repair osteochondral defects in young rabbits. We found that dECM expanded IPFSCs exhibited higher proliferation and chondrogenic differentiation compared to TCP expanded cells in both pellet and tissue construct culture systems. Six weeks after creation of bilateral osteochondral defects in the femoral trochlear groove of rabbits, the Empty group (left untreated) had the best cartilage resurfacing with the highest score in Modified O'Driscoll Scale (MODS) than the other groups; however, this score had no significant difference compared to that of 15-week samples, indicating that young rabbits stop growing cartilage once they reach 9 months old. Interestingly, implantation of premature tissue constructs from both dECM and TCP groups exhibited significantly improved cartilage repair at 15 weeks compared to those at six weeks (about 9 months old), indicating that a tissue-engineering approach is able to repair adult cartilage defects. We also found that implanted pre-labeled cells in premature tissue constructs were undetectable in resurfaced cartilage at both time points. This study suggests that young rabbits (less than 9 months old) might respond differently to the classical tissue-engineering approach that is considered as a potential treatment for cartilage defects in adult rabbits.

Effect on Foot Width With Triplanar Tarsometatarsal Arthrodesis for Hallux Valgus.

BACKGROUND: Foot width reduction is a desirable cosmetic and functional outcome for patients with hallux valgus. Triplanar first tarsometatarsal (TMT) arthrodesis could achieve this goal by 3-dimensional correction of the deformity. The aim of this study was to evaluate changes in bony and soft tissue width in patients undergoing triplanar first TMT arthrodesis. METHODS: After receiving Institutional Review Board approval, charts were retrospectively reviewed for patients undergoing triplanar first TMT arthrodesis for hallux valgus at 4 institutions between 2016 and 2019. Patients who underwent concomitant first metatarsal head osteotomies (eg, Silver or Chevron) or fifth metatarsal osteotomies were excluded. Preoperative and postoperative anteroposterior weightbearing radiographs were compared to evaluate for changes in bony and soft tissue width. One hundred forty-eight feet from 144 patients (48.1 ± 15.7 years, 92.5% female) met inclusion criteria. RESULTS: Preoperative osseous foot width was 96.2 mm, compared to 85.8 mm postoperatively (P < .001). Preoperative soft tissue width was 106.6 mm, compared to 99.3 mm postoperatively (P < .001). Postoperatively, patients had an average 10.4 ± 4.0 mm reduction (10.8% reduction) in osseous width and average 7.3 ± 4.0 mm reduction (6.8% reduction) in soft tissue width. CONCLUSIONS: Triplanar first TMT arthrodesis reduced both osseous and soft tissue foot width, providing a desirable cosmetic and functional outcome for patients with hallux valgus. Future studies are needed to determine if patient satisfaction and outcome measures correlate with reductions in foot width. Level of evidence: Level III, retrospective comparative study.

Hallux Valgus.

Hallux valgus is a common condition that results from a complex positional deformity of the first ray. The bunion or medial prominence that results from the lateral deviation and pronation of the hallux is only one component of the 3-dimensional deformity. Hallux valgus can lead to considerable pain and altered joint mechanics. The precise biomechanical etiology remains under debate. Predisposing factors include female sex, age, constricting footwear, and family history. Metatarsus adductus, equinus contracture, hammertoe deformity, and pes planus often coexist with hallux valgus. Nonoperative treatment involves patient education, shoe modifications, toe pads and positioning devices, and activity modifications. Surgery is considered in patients who fail nonoperative treatment with the goal of pain relief, correction of the deformity, improved first ray stability, and improved quality of life. More than 100 different procedures have been described to treat hallux valgus; they include combinations of soft tissue balancing, metatarsal osteotomies, and fusion of either the metatarsophalangeal (MTP) or tarsometatarsal (TMT) joint. The choice of procedures depends on the severity and location of the deformity as well as surgeon preference. Recent advances in operative techniques include minimally invasive surgery and correction of rotational deformity.