The talar body prosthesis treated end-stage ankle arthritis with talar body deficient: a 6-13 years of follow-up outcomes and 6-year survivorship.

INTRODUCTION: Talar body deficient provides a unique challenge for ankle arthritis treatment. We studied the clinical-radiographic outcomes at 6 to 13 years and 6 year prosthesis survivorship of patients treated for ankle arthritis with poor talar body bone stock using a talar body prosthesis (TBP). MATERIALS AND METHODS: Between 2008 and 2015, we treated 32 consecutive end-stage ankle arthritis patients with talar body deficiency by TBP implantation and fascia interposition. One patient was excluded with a diagnosis of inflammatory arthritis. We assessed visual analogue scale (VAS) of ankle pain, sagittal range of motion, American Orthopaedics Foot and Ankle Society (AOFAS) ankle-hindfoot score, Foot Ankle Ability Measure (FAAM) of activity daily living (ADL), prosthesis tibiotalar surface angle, radiographic prosthesis loosening, adjacent joint arthritis and complication. Pre-operative to last follow-up outcomes (at 6-13 years) were compared. Prosthesis survivorship was analyzed at 6 year follow-up. p < 0.05 was considered a significant difference. RESULTS: There was statistically significant improvement of median VAS ankle pain, as 8.0 (IQR 1.0) to 1.0 (IQR 2.0), AOFAS ankle-hindfoot score from 48 (IQR 21) to 80 (IQR 7.0), FAAM of ADL from50.0 (28.0) to 88.0 (IQR 15.0), and sagittal ROM from 20o (IQR 19°) to 33° (IQR 14°), p < 0.05. The median tibiotalar surface angle was statistically significant improved from 85.0° (IQR 8.0°) to 89.0° (IQR 3.0°), p < 0.001. No radiographic prosthesis loosening or adjacent talonavicular-calcaneocuboid joint arthritis. The 6 year prosthesis survivorship was 93.5% (95% CI 84.9-100.0%). End of survivorship was observed in 2 patients due to progressive valgus tilting at 16° and 18°, respectively. No prosthesis was revised. CONCLUSIONS: TBP implantation with fascia replacing the articular end of distal tibia provided significant better pre- to post-operative clinical outcomes and had 6 year survivorship as 93.5% for the treatment of ankle arthritis with talar body deficient. LEVEL OF EVIDENCE: IV.

Radiographic manifestation of hip dislocation after total hip arthroplasty.

OBJECTIVE: The authors hypothesized that a patient who has posterior hip dislocation after total hip replacement does not have the same clinical manifestations of malposition as with a natural hip. The present study aimed to study clinical manifestation of hip dislocation after total hip arthroplasty. MATERIAL AND METHOD: Thirty-five cases of posterior dislocation after total hip replacement were retrospectively studied by medical records and radiographic evaluation. The study included leg position after hip dislocation, leg length, and leg abduction/adduction angles. RESULTS: External rotation of the patient's leg was found in 13 cases (37.1%), neutral position in six cases (17.2%), and internal rotation in 16 cases (45.7%). Measurements of the femoral shaft-vertical axis angle found adduction in 17 cases (average 17.4 degrees, range 1-25 degrees), abduction in 15 cases (average 6 degrees, range 1-15 degrees), and 0 degrees in three cases. Average leg shortening was 3.55 cm (range 0.6-13.5 cm). CONCLUSION: The present study shows that patients with hip dislocation after hip replacement can manifest many signs of limb deformity in rotation (internal, external, and neutral) and abduction/adduction positions.

Posterior acetabular arc angle of unstable posterior hip fracture-dislocation.

PURPOSE: Posterior hip fracture-dislocation needs stability evaluation. A previous study in the normal acetabulum has shown that the coronal posterior acetabular arc angle (PAAA) could be used to assess an unstable posterior hip fracture. Our study was designed to assess PAAA of unstable posterior hip fracture-dislocation and whether posterior acetabular wall fracture involves the superior acetabular dome. METHODS: Using coronal computed tomography (CT) of the acetabulum and 3D reconstruction of the lateral pelvis, we measured coronal, vertical PAAA and posterior acetabular wall depth of 21 unstable posterior hip fracture-dislocations and of 50% normal contralateral acetabula. Posterior acetabular wall fracture was assessed to determine whether the fracture involved the superior acetabular dome and then defined as a high or low wall fracture using vertical PAAA in reference to the centroacetabulo-greater sciatic notch line. RESULTS: The coronal PAAA of unstable posterior hip fracture-dislocations and of 50% of the posterior acetabular wall of normal the contralateral acetabulum were 54.48° (9.09°) and 57.43° (5.88°) and corresponded to 15.06 (4.39) and 15.61 (2.01) mm of the posterior acetabular wall without significant difference (p > 0.05). The vertical PAAA of unstable posterior hip fracture-dislocation was 101.67° (20.44°). There were 16 high posterior acetabular wall fractures with 35.00 (16.18) vertical PAAA involving the acetabular dome and 5 low wall fractures. High posterior wall fractures resulted in four avascular necroses of the femoral head, three sciatic nerve injuries and one osteoarthritic hip. CONCLUSION: Coronal and vertical PAAA of unstable posterior hip fracture-dislocations were 54.48° and 101.67°. Vertical PAAA assesses high or low posterior acetabular wall fracture by referring to the centroacetabulo-greater sciatic notch line. High posterior wall fracture seems to be the most frequent and is involved with many complications.

Posterior acetabular arc angle of the femoral head assesses instability of posterior fracture-dislocation of the hip.

PURPOSE: Unstable posterior fracture-dislocation of the hip is determined by the wall defect or acetabular fracture index. The unstable hip is a result of inadequate posterior acetabular coverage of the femoral head from the posterior acetabular wall fracture. In order to measure total posterior acetabular coverage of the femoral head and avoid using the contralateral acetabulum as a calculation reference, the posterior acetabular arc angle of the femoral head was measured to assess stability of posterior fracture-dislocation of the hip. METHODS: Using coronal computed tomography (CT) scan of the normal contralateral acetabulum at the level of the widest acetabular diameter and thinnest medial wall of 60 acetabular fractures, posterior acetabular arc angles of the femoral head in intact, 20 % and 50 % defects of posterior acetabular walls were measured. The angles were measured from the acetabular centre to the thinnest medial wall and to the top, inner cortex of 80 % and 50 % posterior acetabular walls. RESULTS: Average intact, 80 % and 50 % posterior acetabular walls were 33.82 ± 4.30, 26.88 ± 3.33 and 16.91 ± 2.15 mm which corresponded to 92.25 ± 11.34, 77.42 ± 10.04 and 50.63 ± 6.58° of posterior acetabular arc angles of the femoral head. The intraclass correlation coefficient (ICC) of the measurements including correlation of conversion of posterior acetabular wall depths to posterior acetabular arc angles of the femoral head were more than 0.82 and 0.89. CONCLUSIONS: The measurement technique of posterior acetabular arc angle of the femoral head has strong reliability. Therefore, stable or unstable posterior fracture-dislocation of the hip can be determined in terms of more than 77 degrees or less than 50 degrees of posterior acetabular arc angles of the femoral head instead of less than 20 % or more than 50 % posterior acetabular wall defect.

A comparison of survival rates for hip fracture patients with or without subsequent osteoporotic vertebral compression fractures.

Little is known about the effect of a subsequent osteoporotic vertebral compression fracture on the survival rate of patients with a previous hip fracture. In this study, we aimed to compare the survival rates of hip fracture patients with and without subsequent osteoporotic vertebral compression fractures and determine the risk factors associated with subsequent fracture. During 2000-2008, 933 initial hip fracture patients were reviewed and divided into two groups: subsequent fracture group (160 patients) and single hip fracture group (i.e., no subsequent fracture; 773 patients). All information pertaining to their most recent fracture event(s), including mortality causes/rates, were recorded. Differences in mortality rates and hazard ratios (HRs) between the two groups were also analyzed. The 1-year and 1-to-5-year mortality rates were 1.3% and 1.9%, respectively, in the subsequent fracture group, and 4.7% and 1.4%, respectively, in the single hip fracture group, with no significant differences observed. Interestingly, the HR for mortality was significantly higher in the single hip fracture group than in the subsequent fracture group (p < 0.05). The significant risk factors for subsequent fractures were identified as knee osteoarthritis, neurological disease, and an initial hip fracture with intertrochanteric involvement. Our findings indicate that the occurrence of a vertebral compression fracture after an initial hip fracture does not greatly impact patient survival. Conversely, patients presenting with a single hip fracture have a significantly higher mortality-HR, indicating that single hip fracture patients without subsequent fracture should be provided with the same standard of care as patients with subsequent fractures.

Loss of correction after medial opening wedge high tibial osteotomy: a comparison of locking plates without bone grafts and non-locking compression plates with bone grafts.

BACKGROUND: A loss of correction is one of the common complications after medial opening wedge high tibial osteotomy (MOWHTO) and can lead to deteriorate outcomes. The technique of fixation plays an important role in maintaining the correction angle until union. OBJECTIVE: The present study aims to compare the amount of correction loss between two different fixation techniques after MOWHTO. MATERIAL AND METHOD: Between 2005 and 2007, 67 knees from 54 patients who underwent MOWHTO were reviewed and classified into the following groups: group A, treated with T-buttress plate fixation and autologous tricortical iliac bone graft, and group B, operated upon with a locking compression medial high tibial plate without any augmentation. Preoperatively and at 1, 12 and 24 months postoperatively, medial proximal tibial angles (MPTA) were measured and the loss of correction angle was determined by measuring the decrease in MPTAs at 1 and 2 years after the operation. The differences in clinical and radiographic outcomes were analyzed using Student's t-test and the Chi-squared test. RESULTS: The overall loss of correction at 2 years in group A (2.0 +/- 2.7 degrees) was higher than in group B (0.3 +/- 3.3 degree) (p = 0.026). The majority of correction loss occurred in the first year (1.6 +/- 2.6 and 0.4 +/- 2.6 degrees in groups A and B, respectively). During the second year, there was slightly more loss in group A (0.4 +/- 1.3 degree), while a stable angle was found in group B (-0.1 +/- 2.5 degree). All osteotomies were united and a 7.5% incidence of overall complications was reported. CONCLUSION: Maintenance of the correction angle after MOWHTO depended on the fixation technique. The authors recommend that 2 degrees more than the planned overcorrection point is required in the non-locking plate system, with no need for such a measure in the locking plate system.

Comparison of bacterial count in tap water between first burst and running tap water.

OBJECTIVE: To compare the number of bacterial counts in tap water at first burst and running tap water. MATERIAL AND METHOD: The present study was performed in thirty-two first burst water samples and twenty-nine running tap water samples after two minutes, collected from an operation room at one standard hospital and analyzed for the mean, median, and 95% achieved confidence interval of CFU/ml. All water samples were cultured and investigated for total bacterial counts, which were expressed as colony forming unit per milliliter (CFU/ml). RESULTS: The bacterial count was statistically significantly about three times higher in the samples of the first burst tap water in comparison with the group of samples after letting the tap water run for two minutes 98.7, 78.5, 60.5-120.0 vs. 29.1, 25.8, 16.6-33.2 CFU/ml. CONCLUSION: Two minutes running tap water contains about three times less bacterial count than first burst tap water

Comparison effectiveness of custom-made versus conventional aluminum splint for distal phalange injury.

BACKGROUND: Finger splint is a simple and common method for finger immobilization. The flexible aluminum foam-padded splint is a convenient off-the-shelf inexpensive splint. But there're some studies favor expensively custom-made thermoplastic splint due to its less likely result in treatment failure. Therefore the authors have modified the conventional aluminum finger splint in the foam-padded part to improve the fitting and compliance of the patients. OBJECTIVE: To compare the fitting of custom-made aluminum finger splint with conventional aluminum finger splint. MATERIAL AND METHOD: Sixty volunteers were randomized to apply 30 conventional or custom-made aluminum splints on 4th digit in non dominated hand for one week. The fitting of each splint was measured by displacement of the splint between initial placement and one week later. Patient satisfaction and pain was measured by visual analog score (VAS). RESULTS: The slip and deviation in custom-made group were less than the conventional group significantly (mean of slip 0.86 mm vs. 2.23 mm, p < 0.001, mean of deviation 1.1 degrees vs. 2.23 degrees,p < 0.001) but the longitudinal migration was not significantly difference between both groups (mean 1.6 mm in custom-made group vs. 1.46 mm in conventional group, p = 0.67). The patient satisfaction demonstrated no significant difference between both groups (mean VAS 7.76 in custom-made group vs. 7.3 in conventional group, p = 0.31). Two patients terminated from the present study before one week in custom-made group and one patient in the conventional group (6.67% vs. 3.33%, p = 0.554). CONCLUSION: The custom-made aluminum finger splint can improve the fitting to the finger pulp. However, patient satisfaction and compliance are not significantly different between both groups.

The second fracture of the same clavicle: prevalence and fracture configurations.

OBJECTIVE: To study second fracture at the same clavicle including prevalence, fracture configurations related to malunion types of the first fracture, and healing. MATERIAL AND METHOD: Between 2008 and 2011, the authors reviewed medical records and radiographs of the clavicles of patients who sustained acute clavicular fractures from motorcycle accident. Second fracture at the same clavicle and prevalence were studied. Malunion of the first fracture of the same clavicle were typed and configurations of the second fracture at the same clavicles were described related to type of the malunion. RESULTS: There were 552 clavicular fractures. Four cases of which sustained a second fracture at the same clavicles. Malunion of the first clavicular fracture of the four cases were typed: type I, extension, type II, flexion, and type III, bayonet. There were one, two, and one case of second clavicular fractures of the type I, II, and III clavicular malunion. The configuration of second clavicular fracture of the type I malunion clavicle is located at lateral fragment, inferior displacement, and dorsal angulation with dorsal cortex conminution. The type II malunion clavicle is located at lateral fragment with minimal displacement. For the type III malunion clavicle, the second fracture is located at medial fragment with mild inferior displacement and inferior angulation. The four cases of the second fractures of the same clavicles healed within two months without complication. CONCLUSION: The prevalence of second fracture at the same clacicles was 7.2:1000. The three types of the first fracture malunion were extension, flexion, and bayonet. The configuration of the second fracture at the same clavicles depends on malunion types of the first clavicular fracture. They healed without complication.

Displaced articular calcaneus fractures: classification and fracture scores: a preliminary study.

OBJECTIVE: To review and group configurations of displaced articular calcaneal fracture advantaged for classification and radiographic fracture scores. MATERIAL AND METHOD: Between 2002 and 2011, medical records and radiographs of patients who sustained acute displaced articular calcaneal fractures were reviewed. The calcanealfracture configurations were grouped as avulsion, bending, burst, or combination. Radiographic displaced articular calcaneal fracture score was designed to include Bohler and Gissane angles, degrees of posterior subtalar joint line parallel, degrees of varus, and burst. The calcaneal fracture score was modified as power of the fracture response to treatment (PFRT). Prevalence of the fracture types, pre- and post-reduction fracture scores including PFRT were studied and statistically analyzed. RESULTS: Sixty-four patients had 77 acute displaced articular calcaneal fractures. The classification consisted of type I avulsion, type II compression bending, type III compression burst, type IV avulsion burst, and type V bending burst. Type IV is the most common. The radiographic calcaneal fracture scores were 10 points. Pre-, post-reduction calcaneal fracture scores and PFRTof type I, II, III, IV, and V were 4.17 (0.41), 0 and 1 (0), 4.63 (2.13), 0.50 (0.93) and 0.84 (0.35), 6.94 (2.05), 3.18 (1.38) and 0.50 (0.27), 8.03 (1.12), 3.03 (2.42) and 0.62 (0.30), and 7.22 (2.11), 3.00 (2.50) and 0.59 (0.29) respectively. Statistical analysis showed significant difference (p < 0.05). PFRT for screw and pin fixation of type I plus II, IV and V were 1.00 (0) and 1.00 (0), 0.64 (0.27) and 0.60 (0.36), and 0.54 (0.28) and 0.51 (0.45) respectively. PFRT for plate of type III was 0.54 (0.16). PFRT for casting of type I plus II, III, and IV were 0.50 (0.71), 0.27 (0.46), and 0.35 (0.33) respectively. CONCLUSION: The classification consisted of five types, which were based on injury mechanisms as avulsion, bending, and burst. The radiographic calcaneal fracture scores contained 10 points and were used for determining complexity of the fractures. PFRT was used for evaluating efficacy of fracture treatment.

A new classification for combined greater tuberosity fracture and anterior shoulder dislocation: A study of fracture configurations and displacement after reduction.

OBJECTIVE: The aim of this study was to propose a new classification of combined greater tuberosity (GT) fractures and anterior shoulder dislocation and studied the degree of displacement, functional outcomes, and need for additional surgery after reduction. METHODS: A cross-sectional study was conducted. We evaluated radiographs of patients treated for combined GT fractures and anterior shoulder dislocation. Three morphologies were proposed; type 1 (a small avulsion), type 2 (GT fractures without articular head involvement), and type 3 (GT associated with articular head fractures). Two orthopedic surgeons independently measured all radiographs and classified fractures into three types. Patients were interviewed by telephone to assess functional outcomes (the simple shoulder test (SST) and EQ-5D-5L), and additional shoulder surgery was also performed. RESULTS: There were 52 eligible patients; 32 were male (61.5%) and the mean age was 57.3 · 17.1 years. Most cases were low-energy injuries (61.5%). Of all the cases, 32.7% were type I, 59.6% type II, and 7.7% type III cases. There were differences in the degree of displacement in each group at pre, post-reduction (both horizontal and vertical planes) and at two weeks post-reduction for HD (p < 0.05). Type III had more displacement than type I at pre- and post-reduction with a P value of less than 0.05. Type III also had higher rates of displacement than type II at post-reduction and at two-week postreduction (vertical plane). The intra and inter-rater reliabilities of measurement (ICC > 0.8) were in good to excellent agreement with the kappa value (>0.9). Three out of 52 cases (5.8%) required an additional surgery after closed reduction. Patients had good functional outcomes (SST score of 8) with an excellent utility index of EQ-5D-5L (0.9). CONCLUSION: This new classification exhibited good-to-excellent intra-and inter-rater reliabilities, with an ability to determine injury type. Type III seems to be linked to higher risk of fracture displacement and may require additional surgery. LEVEL OF EVIDENCE: Level IV, Diagnostic Study.

Visual analogue scale foot and ankle: validity and reliability of Thai version of the new outcome score in subjective form.

BACKGROUND: Nowadays, measuring score in the form of subjective questionnaires is the important tool for clinical evaluation of the foot and ankle-related problems. VisualAnalogue Scale-Foot and Ankle (VAS-FA) is the newly developed subjective questionnaire, which has sufficiency of validity and reliability from a previous study OBJECTIVE: Translate the original English version of VAS-FA into the Thai version and evaluate the validity and reliability of Thai VAS-FA in patients with foot and ankle-related problems. MATERIAL AND METHOD: According to the forward-backward translation protocol, original VAS-FA was translated into the Thai version. Thai VAS-FA and validated Thai Short Form-36 (SF-36) questionnaires were distributed to 42 Thai patients to complete. For validation, Thai VAS-FA scores were correlated with SF-36 scores. For reliability, the test-retest reliability and internal consistency were analyzed. RESULTS: Thai VAS-FA score demonstrated the sufficient correlations with physical functioning (PF), role physical (RP), bodily pain (BP) domains, and total score of SF-36 (statistically significant with p < 0.001 level and r > 0.5 values). The result of reliability revealed highly intra-class correlation coefficient as 0.995 from test-retest study. The internal consistency was excellent with Cronbach alpha: 0.995. CONCLUSION: The original VAS-FA score is a well-validated, subjective, visual-analogue-scale based outcome score. The Thai version of VAS-FA form maintained the validity and reliability of the original version. This newly translated-validated score can be distributed for the evaluation of the functions, symptoms, and limitation of activities in Thai patients with foot and ankle problems.

Efficacy of gentle traction, abduction and external rotation maneuver under sedative-free for reduction of acute anterior shoulder dislocation: retrospective comparative study.

BACKGROUND: Reduction technique of acute anterior shoulder dislocation is always performed under sedation or general anesthesia in order to permit successful reduction such as traction counter-traction (TCT). However, the patients take risks of sedation or anesthesia. There are several techniques of reduction that reduce the dislocation without using sedation or anesthesia such as Milch technique, gentle traction, abduction and external rotation (TAE) technique and scapular manipulation. In the present study, the authors compared efficacy of reduction of acute anterior shoulder dislocation by using TAE without sedation and TCT techniques under conscious sedation. OBJECTIVE: To compare efficacy of TAE without sedation and TCT techniques under conscious sedation for reduction of acute anterior shoulder dislocation. MATERIAL AND METHOD: Between 2001 and 2010, the authors reviewed medical records and radiographs of 76 patients who sustained one or more episodes of acute anterior shoulder dislocation and divided into two groups. Group 1 used the technique of TAE without sedation. Group 2 used the technique of TCT under conscious sedation. Group 1 and 2 consisted of 32 and 44 patients, 24 and 33 males, eight and 11 females, average age 39.13 (17-71) and 34.77 (18-76) years old, 24 and 34 right sides, eight and 10 left sides, 21 and 24 from sport injuries and 10 and 18 non-sport injuries respectively. Successful reduction, post-reduction complication and patients 'satisfaction score of 0 to 10 of both groups were evaluated and p < or = 0.05 were considered for statistical significant differences. RESULTS: The successful reduction of group 1, 2 were 90.63% (29/32) and 100% (44/44) with 95% Confidence interval 74.98 to 98.02% and 93.42 to 100% respectively. The statistical analysis showed no significant difference of both groups (p = 0.071). There was no post-reduction complication of both groups. The patients' satisfaction score of group 1, 2 were 9.38 (8-10) and 7.94 (3-10). The statistical analysis showed patients' satisfaction score of group 1 were significantly higher than group 2 (p = 0.007). CONCLUSION: TAE technique under sedative-free for reduction of acute anterior shoulder dislocation is effective, simple, and safe.

Free radicals in primary knee osteoarthritis.

Free radicals have an important role in the pathogenesis of knee osteoarthritis. Reactive oxygen species (ROS) produced by abnormal chondrocyte metabolism exceeds the physiological buffering capacity and results in oxidative stress. The excessive production of ROS can damage proteins, lipids, nucleic acids, and matrix components. They also serve as important intracellular signaling molecules that amplify the inflammatory response. An understanding of oxidative stress involved in this disease might allow the use of antioxidant therapies in the prevention and/or treatment of knee osteoarthritis.

The new intra-articular calcaneal fracture classification system in term of sustentacular fragment configurations and incorporation of posterior calcaneal facet fractures with fracture components of the calcaneal body.

OBJECTIVE: The aim of this study was to develop a new calcaneal fracture classification system which will consider sustentacular fragment configuration and relation of posterior calcaneal facet to calcaneal body. METHODS: The new classification system used sustentacular fragment configuration and relation of posterior calcaneal facet fracture with fracture components of calcaneal body as key aspects of main types and subtypes. Between 2000 and 2014, 126 intraarticular calcaneal fractures were classified according to the new classification system by using computed tomography images. The new classification system was studied in term of reliability, correlation to choices of treatment, implant fixation and quality of fracture reduction. RESULTS: Types of sustentacular fragment comprised type A, B and C. Type A sustentacular fragment included sustentacular tali containing middle calcaneal facet. In Type B and C fractures sustentacular fragment included medial aspect and entire posterior calcaneal facet as a single unit, respectively. The fractures with type A, B and C sustentacular fragments were classified as main type A, B and C intra-articular calcaneal fractures. The main type A and B comprised 4 subtypes. Subtypes A1, A3, B1, and B3 associated with avulsion and bending fragments of calcaneal body. Subtype A2, B2, and B4 associated with burst calcaneal body. Subtype B4 was not found in the study. Main type C had no subtype and associated with burst calcaneal body. The data showed good reliability. CONCLUSION: The study showed that our new intra-articular calcaneal fracture classification system correlates to choices of treatment, implant fixation and quality of fracture reduction. LEVEL OF EVIDENCE: Level IV, Study of Diagnostic Test.

Comminution plays no role in worsening fracture healing of conservatively treated middle third clavicular fractures.

OBJECTIVE: Middle third clavicular fracture is effectively treated by conservative means. Previous studies showed that comminution and displacement of clavicular fractures might affect fracture healing. However, the clavicle horizontally aligns in the shoulder girdle and has different biomechanics from vertical weight-bearing bones. Therefore, this study was conducted with the hypothesis that comminution has no effect in worsening fracture healing and union configurations in conservatively treated middle third clavicular fractures. METHODS: One hundred ninety-eight middle third clavicular fractures treated by conservative means were reviewed and divided into 2 groups. Group 1, simple fractures, included 97 patients. Group 2, comminuted fractures, included 101 patients. Patient demographic data, initial fracture deformities, and union configurations such as angulation, overlying, and displacement were measured. Union rate and union complications such as delayed nonunion were evaluated. Data were analyzed for statistically significant differences (p<0.05). RESULTS: Initial deformities of Group 1 and Group 2 were 11.94°±9.59° and 9.40°±8.57° angulation, 12.24±12.96 and 11.76±10.06 mm of overlying, and 13.31±8.63 and 13.72±7.42 mm of displacement, respectively, and exhibited no significant differences (p>0.05). Union rate and union complications of Group 1 were 74/97 (76.29%) and 23/97 (23.71%), respectively. For Group 2, the rates were 82/101 (81.19%) and 19/101 (18.81%), respectively. Union configuration of Group 1 and Group 2 were 13.76°±10.63° and 12.80°±8.65° angulation, 11.93±10.75 and 11.52±9.38 mm of overlying, and 9.79±8.33 and 10.74±6.68 mm of displacement, respectively, and showed no significant differences between the groups. CONCLUSION: Comminution plays no role in worsening fracture healing of conservatively treated middle third clavicular fractures in terms of healing rate, union complications, and union configurations.

Vertical pelvic ring displacement in pelvic ring injury: Measurements in pelvic outlet radiograph and in cadavers.

BACKGROUND: Vertical pelvic ring displacement (VPRD) is a serious injury and needs assessment. Pelvic outlet radiographs are routinely taken. However, relationship of radiographic and actual VPRD is still in question. Thus, measurement of VPRD from pelvic radiographs was studied. MATERIALS AND METHODS: 2 dry pelvic bones and 1 sacrum from same cadaver was reconstructed to be the pelvic ring. Five specimens were enrolled. 10, 20 and 30 mm vertical displacement of right pelvic bone was performed at levels of sacroiliac joint and pubic symphysis for representing right VPRD. Then, the pelvis was set sacral inclination at 60° from X-ray table for outlet and anteroposterior pelvic radiographs. Right VPRD was measured by referring to superior most pelvic articular surface of both sacroiliac joints and sacral long axis. Radiographic VPRD and actual displacement were analyzed by Pearson correlation coefficient at more than 0.90 for the strong correlation and strongly significant simple regression analysis was set at P < 0.01. RESULTS: Radiographic VPRD from outlet and anteroposterior pelvic views at 10 mm actual displacement were 20.12 ± 1.98 and 4.08 ± 3.76 mm, at 20 mm were 40.31 ± 1.97 and 9.94 ± 7.27 mm and at 30 mm were 58.56 ± 2.53 and 11.29 ± 2.89 mm. Statistical analyses showed that radiographic VPRD from pelvic outlet view is 1.95 times of actual displacement with strong correlation at 0.992 coefficient and strongly significant regression analysis (P < 0.001) with 0.984 of R (2) value. Whereas, the measurement from anteroposterior pelvic radiograph was not strongly significant. CONCLUSION: Pelvic outlet radiograph provides efficient measurement of VPRD with 2 times of actual displacement.

Measurement technique of calcaneal varus from axial view radiograph.

BACKGROUND: Medial displaced posterior calcaneal tubercle creates varus deformity of an intraarticular calcaneal fracture. The fracture involves posterior calcaneal facet and the calcaneal body so we developed a measurement technique representing the angle between posterior facet and long axis of calcaneus using lateral malleolus and longitudinal bone trabeculae of posterior calcaneal tubercle as references to obtain calcaneal varus angle. MATERIALS AND METHODS: 52 axial view calcaneal radiographs of 26 volunteers were studied. Angles between posterior facet and long axis of calcaneus were measured using the measurements 1 and 2. Angle of measurement 1, as gold standard, was obtained from long axis and posterior facet of calcaneus whereas measurement 2 was obtained from a line, perpendicular to apex curve of lateral cortex of the lateral malleolus and a line parallel to the longitudinal bone trabeculae of posterior calcaneal tubercle. No more than 3° of difference in the angle of both measurements was accepted. Reliability of the measurement 2 was statistically tested. RESULTS: Angles of measurement 1 and 2 were 90.04° ± 4.00° and 90.58° ± 3.78°. Mean of different degrees of both measurements was 0.54° ± 2.31° with 95% of confidence interval: 0.10°-1.88°. The statistical analysis of measurement 1 and 2 showed more than 0.75 of ICC and 0.826 of Pearson correlation coefficient. CONCLUSION: Technique of measurement 2 using lateral malleolus and longitudinal bone trabeculae of posterior calcaneal tubercle as references has strong reliability for representing the angle between long axis and posterior facet of calcaneus to achieve calcaneal varus angle.

The Talar Body Prosthesis: Results at Ten to Thirty-six Years of Follow-up.

BACKGROUND: Satisfactory results of implantation of the talar body prosthesis were reported in 1997, although some complications associated with the initial design were noted. The present study evaluated outcomes of treatment with a modified talar body prosthesis. METHODS: Of the thirty-six talar body prostheses implanted with use of a transmalleolar surgical approach from 1974 to 2011, thirty-three were available for follow-up at ten to thirty-six years or had failed prior to that time. The indication for implantation had been osteonecrosis in twenty-three patients, a comminuted talar fracture in eight, and a talar body tumor in two. RESULTS: Twenty-eight of the thirty-three prostheses were still in place at the time of final follow-up and five had failed prior to five years. The duration of follow-up was ten to twenty years in eight patients, twenty to thirty years in eleven, and thirty to thirty-six years in nine. The AOFAS (American Orthopaedic Foot & Ankle Society) ankle-hindfoot score did not differ significantly among these three groups. Patients over sixty-five years of age with underlying disease that impeded walking ability had lower AOFAS scores. Early prosthesis failure occurred as a result of size mismatch in two patients, tumor recurrence in one, infection in one, and osteonecrosis of the talar head and neck in one. These failures, which occurred at eight to fifty-seven months, were treated with tibiotalar arthrodesis in three patients, prosthesis revision in one, and below-the-knee amputation in one. CONCLUSIONS: Although early prosthesis failure may occur, survival of the talar body prosthesis can provide satisfactory ankle and foot function. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Acetabular roof arc angles and anatomic biomechanical superior acetabular weight bearing area.

BACKGROUND: Acetabular fracture involves whether superior articular weight bearing area and stability of the hip are assessed by acetabular roof arc angles comprising medial, anterior and posterior. Many previous studies, based on clinical, biomechanics and anatomic superior articular surface of acetabulum showed different degrees of the angles. Anatomic biomechanical superior acetabular weight bearing area (ABSAWBA) of the femoral head can be identified as radiographic subchondral bone density at superior acetabular dome. The fracture passes through ABSAWBA creating traumatic hip arthritis. Therefore, acetabular roof arc angles of ABSAWBA were studied in order to find out that the most appropriate degrees of recommended acetabular roof arc angles in the previous studies had no ABSAWBA involvement. MATERIALS AND METHODS: ABSAWBA of femoral head was identified 68 acetabular fractures and 13 isolated pelvic fractures without unstable pelvic ring injury were enrolled. Acetabular roof arc angle was measured on anteroposterior, obturator and iliac oblique view radiographs of normal contralateral acetabulum using programmatic automation controller digital system and measurement tools. RESULTS: Average medial, anterior and posterior acetabular roof arc angles of the ABSAWBA of 94 normal acetabulum were 39.09 (7.41), 42.49 (8.15) and 55.26 (10.08) degrees, respectively. CONCLUSIONS: Less than 39°, 42° and 55° of medial, anterior and posterior acetabular roof arc angles involve ABSAWBA of the femoral head. Application of the study results showed that 45°, 45° and 62° from the previous studies are the most appropriate medial, anterior and posterior acetabular roof arc angles without involvement of the ABSAWBA respectively.