C-arm Free O-arm Navigated Posterior Atlantoaxial Fixation in Down Syndrome: A Technical Note.

The surgical treatment of pediatric atlantoaxial subluxation (AAS) in Down syndrome (DS) remains technically challenging due to radiation exposure and complications such as vertebral artery injury and nonunion. The established treatment is fixation with a C1 lateral mass screw and C2 pedicle screw (modified Goel technique). However, this technique requires fluoroscopy for C1 screw insertion. To avoid exposing the operating team to radiation we present here a new C-arm free O-arm navigated surgical procedure for pediatric AAS in DS. A 5-year-old male DS patient had neck pain and unsteady gait. Radiograms showed AAS with an atlantodental interval of 10 mm, and irreducible subluxation on extension. CT scan showed Os odontoideum and AAS. MRI demonstrated spinal cord compression between the C1 posterior arch and odontoid process. We performed a C-arm free O-arm navigated modified Goel procedure with postoperative halo-vest immobilization. At oneyear follow-up, good neurological recovery and solid bone fusion were observed. The patient had no complications such as epidural hematoma, infection, or nerve or vessel injury. This novel procedure is a useful and safe technique that protects surgeons and staff from radiation risk.

Hastes telescópicas para correção de deformidades e prevenção de fraturas em crianças e adolescentes em fase de crescimento com osteogênese imperfeita / Telescopic rods for deformity correction and fracture prevention in growing children and adolescents with osteogenesis imperfecta

INTRODUÇÃO: A OI é uma doença genética caracterizada por fragilidade óssea e fraturas recorrentes por mínimo trauma, além de deformidades de ossos longos e, nos casos mais graves, consequente incapacidade funcional para deambulação. Além do tratamento medicamentoso para aumentar densidade mineral óssea, cirurgias ortopédicas com inserção de dispositivos intramedulares são indicadas para corrigir as deformidades e estabilizar as fraturas. Entre estes dispositivos implantáveis disponíveis estão: fios (Kirschner ou Steinmann) e hastes (flexíveis ou extensíveis). Com o objetivo de alinhar os ossos longos prevenindo e corrigindo curvaturas que propiciem fraturas, a escolha por haste extensível, também chamada telescópica, para criança ou adolescente ainda em fase de crescimento se justifica por sua capacidade de se estender, acompanhando o crescimento ósseo e, possivelmente, reduzindo o número de revisões cirúrgicas para substituição do implante. Contudo, apesar da evolução das hastes extensíveis ao longo dos anos, chegando ao atual modelo Fassier Duval (FD), complicações pós-operatórias podem ocorrer e demandar revisão cirúrgica, assim como ocorre com as hastes e os dispositivos não extensíveis. TECNOLOGIA: Hastes intramedulares telescópicas (extensíveis). PERGUNTA: O uso de hastes intramedulares telescópicas (extensíveis, tipo Fassier Duval) é seguro e eficaz para correção de deformidades ósseas, redução das incidências de fraturas, revisões e complicações cirúrgicas, além de incremento dos resultados de

Effectiveness and safety assessment of orthopedic device (LSM-01) for low back pain: A randomized, single-blinded, sham-controlled, parallel-group, pilot clinical trial.

BACKGROUND: More than 80% of the population suffer from low back pain at some time during their lives. An orthopedic device (LSM-01) will be used to alleviate back pain caused by muscle tension. LSM-01, which has a rotating roller, stimulates meridian-muscles around the governor vessel, bladder meridian, and gall bladder meridian. METHODS: This study will be a randomized, single-blinded, sham-controlled, parallel-group, pilot clinical trial. Subjects will be randomly allocated to the treatment group (LSM-01) or the control group (sham device). The duration of the clinical trial will be 2 weeks. The primary outcomes will be measured using the visual analog scale; the secondary outcomes will include pressure pain threshold, Oswestry Disability Index, and Patient Global Impression of Change. Statistical analysis will be performed for the full study population. Analysis of covariance will be conducted to identify differences in pain before and after the application of the device. DISCUSSION: This clinical trial will evaluate the safety and efficacy of the LSM-01 device. As a pilot study, this investigation includes a limited number of subjects. The results of this pilot trial will form a basis for a large-scale clinical trial, which will be conducted in the future. CLINICAL TRIAL REGISTRATION: This study protocol is registered with the Clinical Research Information Service (CRIS) of Korea. Clinical trial registration number: CRIS-KCT0006425. Registered: October 5, 2021; https://cris.nih.go.kr/cris/search/detailSearch.do?search_lang=E&search_page=L&pageSize=10&page=undefined&seq=20056&status=5&seq_group=20056.

Oblique Lateral Interbody Fusion with Anterolateral Screw Fixation Is as Effective as with Posterior Percutaneous Pedicle Screw Fixation in Treating Single-Segment Mild Degenerative Lumbar Diseases.

BACKGROUND Oblique lateral interbody fusion (OLIF) is a new and minimally invasive surgery. This study aimed to compare the clinical efficacy and safety of oblique lateral interbody fusion with anterolateral screw fixation and with posterior percutaneous screw fixation in treating single-segment mild degenerative lumbar diseases. MATERIAL AND METHODS A retrospective analysis was performed on 51 patients with single-segment mild degenerative lumbar diseases who received OLIF from April 2017 to January 2020 in Hong Hui Hospital, Xi'an Jiao Tong University; 24 and 27 patients received OLIF with anterolateral screw fixation (OLIF+AF) and OLIF with posterior percutaneous screw fixation (OLIF+PF), respectively. Anesthesia time, operation time, intraoperative blood loss, intraoperative fluoroscopy number, hospital stay, postoperative complications, Visual Analog Scale (VAS) score, Oswestry Disability Index (ODI) score, anterior and posterior disc heights, foraminal height, and fusion rate of the 2 groups were compared to assess clinical and radiological outcomes. RESULTS Anesthesia time, operation time, intraoperative blood loss, number of intraoperative fluoroscopy, and VAS score in the OLIF+AF group were significantly better than those in the OLIF+PF group (P<0.05). There were no significant differences in ODI score, anterior and posterior disc heights, foraminal height, fusion rate, and incidence of complications between the 2 groups (P<0.05). CONCLUSIONS OLIF+AF in treating single-segment mild degenerative lumbar diseases produces a satisfactory clinical effect. Moreover, OLIF+AF does not invade the paraspinal muscle group, thereby reducing trauma, postoperative residual low back pain, operation time, bleeding, and frequency of fluoroscopy. Thus, OLIF+AF is a feasible treatment method for single-segment mild degenerative lumbar diseases.

Mid-clavicle fracture with dislocation of the ipsilateral acromioclavicular joint treated with Endobutton system: A case report and review of the literature.

RATIONALE: Acromioclavicular joint (ACJ) dislocation combined with ipsilateral midclavicular fracture is extremely unusual and is a high-energy injury to the shoulder. A review of the literature divides the treatment of clavicular fractures is divided into nonsurgical treatment, plates, and intramedullary nailing, while the options for ACJ dislocation are elastic fixation and rigid fixation. However, there is still a lack of consensus about the most appropriate way to treat this shoulder injury. This case report involves a mid-clavicle fracture with dislocation of the ipsilateral ACJ, which was classified as type V according to Rockwood classification. PATIENT CONCERNS: A 65-year-old man came to the emergency department after a traffic accident in which he was driving a motorcycle that collided with another motorcycle and his right shoulder collided directly with the ground. Digital radiography (DR) and computed tomography (CT) scans of the right shoulder joint showed mid-clavicle fracture with dislocation of the ipsilateral ACJ, which was classified as type V according to Rockwood classification. DIAGNOSES: The diagnosis of mid-clavicle fracture with dislocation of the ipsilateral ACJ was confirmed by DR and CT. INTERVENTIONS: The patient was treated with a clavicle plate combined with the double Endobutton technique. OUTCOMES: After a 6-month follow up, the patient had excellent results for shoulder range of motion and functional. The patient's Constant-Murley score is 92. LESSONS: Mid-clavicular fracture with a high-energy injury is highly suspicious and requires perfect shoulder CT or bilateral shoulder stress position DR to confirm whether there is a combined ACJ dislocation.

Facilitating the Approval Process of Anti-Infective Technologies and Advancing Them to the Market: Insights from an FDA Workshop on Orthopaedic Device-Related Infections.

ABSTRACT: Orthopaedic device-related infection is one of the most devastating complications in orthopaedic and trauma surgery. With increasing life expectancies as well as the lifelong risk of bacterial seeding on an implant, the prevention and treatment of device-related infection remains an important area for research and development. To facilitate information exchange and enhance collaboration among various stakeholders in the orthopaedic community, the U.S. Food and Drug Administration (FDA) Center for Devices and Radiological Health (CDRH) organized an inaugural workshop on orthopaedic device-related infections, exploring the regulatory challenges that are faced when proceeding from the bench level to marketing and clinical implementation of new infection-control devices and products. This article summarizes the perspectives of scientists, clinicians, and industry partners on the current regulatory approval process for orthopaedic anti-infective technologies as well as the proposed strategies to overcome these regulatory challenges.

In vivo deformation of anatomically pre-bent rods in thoracic adolescent idiopathic scoliosis.

Some surgical strategies can maintain or restore thoracic kyphosis (TK); however, next-generation surgical schemes for adolescent idiopathic scoliosis (AIS) should consider anatomical corrections. A four-dimensional correction could be actively achieved by curving the rod. Thus, anatomically designed rods have been developed as notch-free, pre-bent rods for easier anatomical reconstruction. This study aimed to compare the initial curve corrections obtained using notch-free rods and manually bent, notched rods for the anatomical reconstruction of thoracic AIS. Two consecutive series of 60 patients who underwent anatomical posterior correction for main thoracic AIS curves were prospectively followed up. After multilevel facetectomy, except for the lowest instrumented segment, either notch-free or notched rods were used. Patient demographic data, radiographic measurements, and sagittal rod angles were analyzed within 1 week after surgery. Patients with notch-free rods had significantly higher postoperative TK than patients with notched rods (P < .001), but both groups achieved three-dimensional spinal corrections and significantly increased postoperative rates of patients with T6-T8 TK apex (P = .006 for notch-free rods and P = .008 for notched rods). The rod deformation angle at the concave side was significantly lower in the notch-free rods than in the notched rods (P < .001). The notch-free, pre-bent rod can maintain its curvature, leading to better correction or maintenance of TK after anatomical spinal correction surgery than the conventional notched rod. These results suggest the potential benefits of anatomically designed notch-free, pre-bent rods over conventional, manually bent rods.

Cervical spine fracture-dislocation in patients with ankylosing spondylitis and severe thoracic kyphosis: Application of halo vest before and during surgical management.

Cervical spine fracture-dislocation in patients with ankylosing spondylitis (AS) and severe thoracic kyphosis is extremely unstable. This study was performed to investigate the efficacy and safety of halo vest application before and during surgery for these patients. We retrospectively analyzed the case histories, operations, neurologic outcomes, follow-up data, and imaging records of 25 patients with AS and severe thoracic kyphosis who underwent surgical treatment of cervical fracture-dislocation in our department from 2008 to 2019. A halo vest was used to reduce and immobilize the fractured spinal column ends before and during surgery. The neurologic injury was evaluated using the American Spinal Injury Association (ASIA) impairment scale score, visual analog scale (VAS) score, and Japanese Orthopaedic Association (JOA) score before and after the operation. Twenty-two patients achieved closed anatomical reduction; two achieved successful reduction and one underwent failed reduction after halo vest application. No fracture site displacement occurred after movement into the prone position. No patients developed secondary neurological deterioration. The mean Cobb angle of thoracic kyphosis was 69.0° ± 12.3°. All patients underwent posterior or combined anterior-posterior surgery. The ASIA grade improved significantly (P < 0.01). The mean VAS and JOA scores also increased significantly after the operation (14.6 ± 3.0 vs. 10.4 ± 4.3 and 0.5 ± 0.6 vs. 4.6 ± 1.9, respectively; P < 0.01). One patient died 3 weeks after the operation. No other severe complications occurred. All patients had reached solid bony fusion by the 12-month follow-up. Use of a halo vest before and during the operation is safe and effective in patients with AS and severe thoracic kyphosis who develop cervical fracture-dislocation. This technique makes positioning, awake nasoendotracheal intubation, nursing, and the operation more convenient. It can also provide satisfactory reduction and rigid immobilization and prevent secondary neurologic deterioration.

Fracturas diafisiarias de tibia tratadas con placa lateral por técnica mínimamente invasiva / Lateral minimally invasive plate osteosynthesis technique for tibial shaft fractures

Las técnicas quirúrgicas mínimamente invasivas ayudan a que el proceso natural de la consolidación ósea ocurra proporcionando estabilidad biomecánica suficiente para obtener los mejores resultados. El objetivo de este trabajo es mostrar los resultados clínicos y radiológicos del tratamiento de las fracturas diafisiarias de tibia con osteosíntesis mínimamente invasiva con placa por cara lateral. Se realizó un estudio clínico observacional, prospectivo, longitudinal y no concurrente. Se incluyeron pacientes mayores de 18 años, de ambos sexos, con diagnósticos de fracturas diafisiarias de tibia 42A, 42B ó 42C, abiertas o cerradas. Se estableció tiempo de seguimiento mínimo de 6 meses. Se incluyeron 23 pacientes, 82,60% de sexo masculino. Promedio de edad de 21±5,63(16­49) años. La fractura más frecuente fue la 42B2 en 26,00% de los casos, y 34,80% fracturas fueron abiertas. A las 12 semanas, 65,10% habían alcanzado consolidación Montoya III; y para la semana 16, 91,30% de los pacientes. De acuerdo a la escala ASAMI, se alcanzaron resultados excelentes en 100,00% pacientes para la semana 16. No se presentaron complicaciones como infección, aflojamiento séptico o aséptico del implante, ni fatiga del mismo. El uso de la técnica MIPO para tratamiento de fracturas diafisiarias de la tibia, por cara lateral es una técnica efectiva y segura, con alta tasas de consolidación, mínimas complicaciones y buenos resultados finales(AU)

Minimally invasive surgical techniques help the natural bone healing process to occur, by providing enough biomechanical stability to obtain the best results. The objective is to show the clinical and radiological results of the treatment of diaphyseal tibial fractures with minimally invasive osteosynthesis with lateral plating. An observational, prospective, longitudinal and non-concurrent clinical study was made. Patients older than 18 years, both sexes, with diagnoses of open or closed tibial shaft fractures 42A, 42B or 42C, were included. A minimum follow-up time of 6 months was established. 23 patients were included, 82,60% male. Average age of 21 years. The most frequent fracture was 42B2 in 26,00% cases, and 34,80% were open fractures. At 12 weeks, 65,10% had reached Montoya III consolidation criterias; and for week 16, 91,30% of the patients. According to the ASAMI scale, excellent results were achieved in 100,00% patients. There were no complications such as infection, septic or aseptic loosening of the implant, or fatigue of the implant. The use of the MIPO technique for the treatment of diaphyseal fractures of the tibia on the lateral aspect is an effective and safe technique, with high rates of union, minimal complications and good final results(AU)

Strategies for Enhancing Polyester-Based Materials for Bone Fixation Applications.

Polyester-based materials are established options, regarding the manufacturing of bone fixation devices and devices in routine clinical use. This paper reviews the approaches researchers have taken to develop these materials to improve their mechanical and biological performances. Polymer blending, copolymerisation, and the use of particulates and fibre bioceramic materials to make composite materials and surface modifications have all been studied. Polymer blending, copolymerisation, and particulate composite approaches have been adopted commercially, with the primary focus on influencing the in vivo degradation rate. There are emerging opportunities in novel polymer blends and nanoscale particulate systems, to tune bulk properties, and, in terms of surface functionalisation, to optimise the initial interaction of devices with the implanted environment, offering the potential to improve the clinical performances of fracture fixation devices.

Clinical Results of Unilateral Dynamic Rod Application in the Short-Medium Period.

AIM: To evaluate the clinical results of patients who underwent unilateral dynamic rod stabilization after unilateral facet joint excision during spinal surgery. MATERIAL AND METHODS: Twenty patients who were diagnosed with degenerative spinal disease or spinal tumor, who were operated on using a unilateral approach, who underwent facet joint resection, and who were stabilized with a unilateral dynamic rod were examined. Visual analog scale (VAS) and Oswestry disability index (ODI) scores were used to clinically evaluate the cases during the preoperative and postoperative periods. Radiological examinations for sagittal alignment, segmental angle, and bone fusion were also conducted. RESULTS: The mean preoperative VAS and ODI scores were 7.6 and 71.7, respectively, and the 12 < sup > th < /sup > postoperative month scores were 1.1 and 12.8, respectively. The mean segmental angle measurements were 22.1° in the preoperative period and 21.6° at the postoperative 12 < sup > th < /sup > month. No deterioration in sagittal alignment and no bone fusion were observed. CONCLUSION: We can protect segmental movements and provide sufficient stability by applying unilateral dynamic rod stabilization after unilateral facetectomy. In addition, applying screws to one side can reduce operation time and cost as well as the possibility of complications.

Bacteriophage therapy for bone and joint infections.

Antibiotic resistance represents a threat to human health. It has been suggested that by 2050, antibiotic-resistant infections could cause ten million deaths each year. In orthopaedics, many patients undergoing surgery suffer from complications resulting from implant-associated infection. In these circumstances secondary surgery is usually required and chronic and/or relapsing disease may ensue. The development of effective treatments for antibiotic-resistant infections is needed. Recent evidence shows that bacteriophage (phages; viruses that infect bacteria) therapy may represent a viable and successful solution. In this review, a brief description of bone and joint infection and the nature of bacteriophages is presented, as well as a summary of our current knowledge on the use of bacteriophages in the treatment of bacterial infections. We present contemporary published in vitro and in vivo data as well as data from clinical trials, as they relate to bone and joint infections. We discuss the potential use of bacteriophage therapy in orthopaedic infections. This area of research is beginning to reveal successful results, but mostly in nonorthopaedic fields. We believe that bacteriophage therapy has potential therapeutic value for implant-associated infections in orthopaedics. Cite this article: Bone Joint J 2021;103-B(2):234-244.

The influence of duration of infection on outcome of debridement and implant retention in fracture-related infection.

AIMS: The principle strategies of fracture-related infection (FRI) treatment are debridement, antimicrobial therapy, and implant retention (DAIR) or debridement, antimicrobial therapy, and implant removal/exchange. Increasing the period between fracture fixation and FRI revision surgery is believed to be associated with higher failure rates after DAIR. However, a clear time-related cut-off has never been scientifically defined. This systematic review analyzed the influence of the interval between fracture fixation and FRI revision surgery on success rates after DAIR. METHODS: A systematic literature search was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, in PubMed (including MEDLINE), Embase, and Web of Science Core Collection, investigating the outcome after DAIR procedures of long bone FRIs in clinical studies published until January 2020. RESULTS: Six studies, comprising 276 patients, met the inclusion criteria. Data from this review showed that with a short duration of infection (up to three weeks) and under strict preconditions, retention of the implant is associated with high success rates of 86% to 100%. In delayed infections with a fracture fixation-FRI revision surgery interval of three to ten weeks, absence of recurrent infection was reported in 82% to 89%. Data on late FRIs, with a fracture fixation-FRI revision surgery interval of more than ten weeks, are scarce and a success rate of 67% was reported. CONCLUSION: Acute/early FRI, with a short duration of infection, can successfully be treated with DAIR up to ten weeks after osteosynthesis. The limited available data suggest that chronic/late onset FRI treated with DAIR may be associated with a higher rate of recurrence. Successful outcome is dependent on managing all aspects of the infection. Thus, time from fracture fixation is not the only factor that should be considered in treatment planning of FRI. Due to the heterogeneity of the available data, these conclusions have to be interpreted with caution. Cite this article: Bone Joint J 2021;103-B(2):213-221.

Presurgical Short-Term Halo-Pelvic Traction for Severe Rigid Scoliosis (Cobb Angle >120°): A 2-Year Follow-up Review of 62 Patients.

STUDY DESIGN: A 2-year follow-up review of 62 patients with severe rigid scoliosis (>120°). OBJECTIVE: To evaluate the effectiveness and safety of halo-pelvic traction (HPT) for treating severe rigid scoliosis (>120°). SUMMARY OF BACKGROUND DATA: Severe rigid scoliosis (>120°) is still a challenge for spine surgeons. A combination of presurgical HPT traction, osteotomy, and internal fixation could be a safe and effective solution for these cases. METHODS: We reviewed the records of all the patients with severe rigid scoliosis (>120°) treated with presurgical HPT from 2013 through 2017. Radiographic measurements were performed. The period of traction, estimated blood loss, operation time, complications, and bed rest period were recorded. RESULTS: A total of 62 patients who had 2-year radiological follow-up were included in the study. In 30 patients, vertebral column resection (VCR) was performed aiming to achieve a better correction rate. In patients who received a VCR, the average preoperative Cobb angle was 133.6°, and the average correction rate at 2 years after surgery was 65.4%. Compared with the average height before treatment, at 2 years after surgery the average height was 12.5 cm greater. In patients who did NOT received VCR, the average preoperative Cobb angle was 131.5°, and the average correction rate at 2 years after surgery was 64.1%. Compared with the average height before treatment, at 2 years after surgery the average height was 14.0 cm greater. Common complications during HPT included infected pelvic pins, brachial plexus palsy, and weakness of the lower extremities. No patients experienced permanent neurological deficits or death. CONCLUSION: For severe rigid scoliosis with a Cobb angle greater than 120°, a combination of short-term presurgical HPT and posterior surgery is an effective and safe solution. After 4 to 6 weeks of presurgical HPT the Cobb angle can be decreased by approximately 50%, providing a favorable condition for spine corrective surgery.Level of Evidence: 3.

Identification of skeletal remains by orthopaedic implant: A case report and brief review of the literature.

Establishing identity from skeletal remains is a challenging task for forensic experts. Identification in such cases can be achieved by dental records, post-mortem radiography and DNA profiling. However, these methods require additional data for comparisons. Positive identification can also be achieved using implanted medical devices. This is a rapid and inexpensive method, as long as a central database is maintained for effective tracking of such devices. We present a case report in which identity was established from skeletal remains using information furnished on the implanted metallic dynamic hip screw and side plate. This case report discusses the legal scenario in India and globally with regard to medical devices and their utility for forensic application. It emphasises the need for legal provision relating to medical devices in India, which would compel the manufacturer to use unique identification numbers for each medical device and to maintain a person-specific database.

Clinical and radiological results of kyphectomy and sliding growing rod surgery technique performed in children with myelomeningocele.

BACKGROUND: The aim of this study was to present clinical and radiological results of myelomeningocele (MMC) patients treated with the sliding growing rod (SGR) technique after kyphectomy. METHODS: Between 2016 and 2019, 30 patients (21 males and nine females) who underwent the SGR technique with kyphectomy and posterior instrumentation due to MMC were retrospectively reviewed. Patients' pre- and postoperative kyphosis, scoliosis, correction rates, bleeding during surgery, blood supply during and after surgery, operation time, instrumentation levels, number of vertebrae removed, MMC onset levels, hospital stay, annual lengthening amounts, and complications were evaluated. RESULTS: The mean patient age was 6.9 (4-10) years. Mean preoperative kyphosis was 115° (87-166°), mean early postoperative kyphosis was 3.9° (20-10°), and final follow-up postoperative kyphosis was 5.1° (22-8°). In nine patients presenting with scoliosis, scoliosis was evaluated as 60.2° (115-35°) preoperative, as 12.9° (32-0°) early postoperative, and 15.7° (34-0°) in the final measurement. The kyphotic deformity correction rate was 96.5%, and the scoliotic deformity correction rate was 74.9%. A statistically significant difference was seen between pre- and early postoperative values in kyphosis and scoliosis measurements (p < 0.05). The annual prolongation of the patients was calculated as averages of 0.72 and 0.77 cm/year between T1-T12 and T1-S1, respectively. CONCLUSION: Kyphectomy performed during the early MMC period patients appears to be an excellent method for facilitating rehabilitation and daily care of these patients. It appears that the SGR technique, which provides lung volume protection and lengthening with kyphectomy, is a safe and reliable method in patients. LEVEL OF EVIDENCE: Level 4.

Biomechanical Study of Different Femoral Fixation Devices in the Reconstruction of the Medial Patellofemoral Ligament in Porcine Knees / Estudo biomecânico de diferentes dispositivos de fixação femoral na reconstrução do ligamento patelofemoral medial em joelhos de suínos

Abstract Objective To evaluate different femoral fixation devices for medial patellofemoral ligament reconstruction and compare their effectiveness regarding fixation strength up to failure in porcine knees. Methods Thirty porcine knees were used, divided into three groups of 10 knees. The removed grafts were dissected from the extensor tendons of porcine feet. In each group, the graft was fixed to the femur with an interference screw, an anchor, or adductor tenodesis. The three methods were subjected to biomechanical tests using a universal Tensile testing machine at a speed of 20 mm/minute. Results The highest average linear resistance under lateral traction occurred in group 1, "screw fixation" (185.45 ± 41.22 N), followed by group 2, "anchor fixation" (152.97 ± 49, 43 N); the lower average was observed in group 3, "tenodesis fixation" (76.69 ± 18.90 N). According to the fixed error margin (5%), there was a significant difference between groups (p < 0.001); in addition, multiple comparison tests (between group pairs) also showed significant differences. Variability was small, since the variance coefficient was lower than 33.3%. Conclusion Interference screws in bone tunnels and mountable anchors fixation with high resistance wire are strong enough for femoral fixation in porcine medial patellofemoral ligament reconstruction. Adductor tenodesis, however, was deemed fragile for such purpose.

Resumo Objetivo Avaliar diferentes dispositivos de fixação femoral na reconstrução do ligamento patelofemoral medial para comparar sua eficácia quanto à força de fixação até a falha em joelhos suínos. Métodos Foram ensaiados 30 joelhos de suínos subdivididos em 3 grupos de 10 joelhos. Os enxertos retirados foram dissecados de tendões extensores das patas dos suínos. Cada grupo teve o enxerto fixado ao fêmur com parafuso de interferência, âncora, ou tenodese no tendão adutor. Os 3 métodos foram submetidos à testes biomecânicos utilizando uma máquina universal de ensaio de tração com uma velocidade de 20 mm/min. Resultados Verificamos que a média mais elevada da resistência linear sob tração lateral (185,45 ± 41,22 N) ocorreu no grupo 1: "fixação por parafuso," seguido do grupo 2: "fixação por âncora" (152,97 ± 49,43 N), e a média foi menor no grupo 3: "fixação por tenodese" (76,69 ± 18,90 N). Para a margem de erro fixada (5%), comprovou-se a diferença significativa entre os grupos (p < 0,001) e também através dos testes de comparações múltiplas (entre os pares de grupos) verificou-se a ocorrência de diferenças significativas. A variabilidade expressada por meio do coeficiente de variação mostrou-se reduzida, já que a referida medida foi inferior a 33,3%. Conclusão O uso de parafusos de interferência no túnel ósseo de joelhos porcinos é suficientemente forte para fixação femoral na reconstrução do ligamento patelofemoral medial, assim como a fixação com âncoras montáveis com fio de alta resistência. Entretanto, a tenodese no tendão adutor mostrou-se frágil para essa finalidade.

Evaluation of complications in patients with open fractures of the upper and lower extremity treated with internal fixation after the external fixation.

BACKGROUND: Open fractures constitute an important mortality and morbidity cause among all musculoskeletal system injuries and bring along many social and economic problems. The cost occurring due to both long treatment duration and the delay in returning to work made these conditions more complicated. The present study aims to evaluate of the complications which may occur in cases with an application of internal fixation following external fixator in upper and lower extremity open fractures retrospectively. METHODS: Forty-nine patients, who applied to the emergency service between 2007 and 2013, participated in this study. Thirty-two of these patients consisted of the patients to whom external fixator was first placed, and then internal fixation was performed by us, while 17 patients were treated in another center with the external fixator, and then their treatments were performed by us. All patients' injury mechanism, duration of follow-up with an external fixator, whether debridement was performed after external fixator, the period between external fixation and internal fixation, pin site infection, duration of the union, delayed union, nonunion, whether bone graft was used during internal fixation, internal fixation type, reoperation, development of osteomyelitis and follow-up parameters were recorded. RESULTS: Results were evaluated separately for radius, humerus, tibia and femur fractures. Of the 49 patients, 39 were male, and 10 were female. Mean follow-up time for tibia 28.6 months, for femur 34, for humerus 26.9, for Radius 27 months. Of the 49 patients who participated in this study, 15 applied with upper extremity (11 humeri, 4 Radius) injury and 34 applied with lower extremity (25 tibias, 9 femora) injury. Of the 49 patients, 32 had pin tract infection, 11 had nonunion, 11 had delayed union, two had osteomyelitis. CONCLUSION: Open fractures are always hard to treat. After external fixation to the internal fixation process have some complications, phsycians should be aware of all these problems and plan according to the situation.

Novel repair of a quadriceps tendon rupture after a total knee arthroplasty using gracilis and semitendinosus autografts.

BACKGROUND: Multiple techniques have been described for repair of quadriceps tendon rupture after total knee arthroplasty (TKA) with unsatisfactory outcomes. We present a novel technique for repair using hamstring tendon autografts. METHODS: A 54 year-old morbidly obese patient presented five months after quadriceps tendon rupture. Direct repair was performed using two anchors in the patella in addition to augmentation with semitendinosus and gracilis tendon autografts. RESULTS: Satisfactory outcomes were achieved with no residual pain and ability to perform a straight leg raise at three weeks postoperatively. There was no extensor lag at five weeks postoperatively. CONCLUSIONS: Most previous reports of a similar complication were treated using synthetic materials. Using hamstring tendon autografts as described in this report provides an alternative surgical option for reconstruction of quadriceps tendon rupture in the setting of TKA, with potentially favorable outcomes and minimal donor site morbidity. Further studies are needed to evaluate long-term outcome of this procedure and to delineate the gold standard of treatment.