Precontoured dynamic compression plate using patient-specific 3D-printed models in minimally invasive surgical technique for midshaft clavicle fractures.

INTRODUCTION: This study introduced a novel approach for the treatment of midshaft clavicle fractures, utilizing patient-specific 3D-printed models for accurate preoperative contouring of dynamic compression plates (DCPs) and an alternative minimally invasive plate osteosynthesis (MIPO) technique with precontoured DCPs through small vertical separated incisions. PATIENT AND METHODS: Mirror image 3D clavicular models were reproduced from 40 patients with acute displaced midshaft clavicle fractures who underwent MIPO using precontoured DCPs inserted through small, vertical separated incisions. Exclusion criteria included patients with open fractures, pathological fractures, ipsilateral limb injury, skeletal immature patients, and those who had previous clavicle fractures or surgery. Postoperative evaluation was conducted using clinical and radiographic review. The Constant-Murley and American Shoulder and Elbow Surgeons Shoulder Scores were used for clinical evaluations, and the Patient and Observer Scar Assessment Scale was used to assess surgical scars. RESULTS: The average time to union of all fractures was 12.88 weeks (range, 8-15) without loss of reduction. The patient-specific precontoured DCPs fitted well in all cases, with fracture consolidation and minimal three cortical sides connecting the fracture fragment. No hardware prominence and skin complications occurred, and clinical evaluation showed no existing difference compared with the contralateral sides. The average Constant-Murley and American Shoulder and Elbow Surgeons Shoulder Scores were 96.33 ± 3.66 and 93.26 ± 5.15, respectively. Two patients requested their implant removal, and scar qualities were satisfactory. CONCLUSIONS: Our study demonstrated that the use of a patient-specific precontoured DCP, in combination with 3D printing technology, provides accurate preoperative planning, effective fracture reduction, and improved postoperative outcomes in displaced midshaft clavicle fractures. The MIPO with a patient-specific precontoured DCP through separated vertical incisions along the Langer's lines appears to be a promising option, regarding appearance, avoiding associated complications, and obviating the need for reoperation. These results suggest that this technique has merit and can be a viable option for the treatment of midshaft clavicle fractures.

Minimally invasive plate osteosynthesis for displaced midshaft clavicle fractures: An indirect reduction using joystick technique.

BACKGROUND: A minimally invasive plate osteosynthesis (MIPO) technique has become increasingly popular in long bone fracture fixation as it could eliminate postoperative complications. However, the most challenging aspect of employing the MIPO for midshaft clavicle fractures among general orthopedic surgeons is the technically demanding that indirect reduction is typically a closed maneuver. METHODS: We present a consecutive series of patients with displaced midshaft clavicle fractures undergoing clavicular fixation using the MIPO technique between January 2017 and October 2019. The joystick technique was used to obtain anatomical reduction. Clinical outcomes were assessed using the Constant-Murley and the American shoulder and elbow surgeons shoulder scores. RESULTS: Thirty patients with a mean age of 42.44 years were included. The functional shoulder scores showed no disabilities compared with those of a healthy population. No major complications requiring re-operation were noted, and all fractures were completely healed with an average time of 12.53 weeks. CONCLUSION: This study demonstrated that facilitating the MIPO for midshaft clavicle fractures using simple operative devices and techniques was possible. The joystick technique with the use of an external fixator for temporary stabilization is a safe and effective method that can be added to achieve anatomical alignment with the fracture site unexposed. This technique could be performed either in a fresh fracture or a delayed case with failed conservative treatment.

Safe zone of supraclavicular nerve during clavicle fixation and its anatomical variations, a cadaveric study.

BACKGROUND: Supraclavicular nerve injury is usually at risk during clavicular fracture fixation. This study aimed to examine the anatomical features and estimate the precise location of supraclavicular nerve branches related to adjacent structural landmarks and to evaluate the differences between sex and side. To highlight the clinical purposes and surgical relevance, this study attempted to define a surgical safe zone that would probably protect the supraclavicular nerve during clavicle fixation. METHOD: A total of 64 shoulders obtained from 15 female and 17 male adult cadavers were examined, identifying the branching patterns of the supraclavicular nerve, measuring the clavicle length and the course of the supraclavicular nerve referring to the sternoclavicular (SC) and acromioclavicular (AC) joint. Data were categorized by sex and side, and their differences were evaluated using Student T-Test and Mann-Whitney U Test. Clinically relevant predictable safe zones were also statistically analyzed. RESULT: The results revealed 7 branching patterns of the supraclavicular nerve. The medial and lateral nerve branches formed a shared trunk, and the medial nerve branches separated to form the intermediate branch, i.e., the most frequent pattern (67.19%). The safe zones were determined to be 6.1 mm among both sexes of the SC joint medially, and 0.7 mm among females and 0 mm among males of the AC joint laterally. Surgical incisions between 29.3 to 51.2% and 60.5 to 79.7% of the clavicle length from the SC joint were the safe zones at the midclavicular shaft among both sexes. CONCLUSION: The findings of this study have provided new insights into the anatomy of the supraclavicular nerve and its variations. It has been revealed that the terminal branches of the nerve consistently pass over the clavicle in a predictable pattern, emphasizing the importance of considering the supraclavicular nerve's safe zones during clinically relevant surgeries. Nevertheless, due to individual anatomical variations, meticulous dissection between these safe zones is necessary to avoid iatrogenic nerve injury among patients. LEVEL OF EVIDENCE: Basic Science Study, Anatomic Study.

Cytotoxic effect of artemisinin and its derivatives on human osteosarcoma cell lines.

BACKGROUND: Osteosarcoma is the most common, non-hematopoietic, primary bone cancer Current standard treatment is to use neoadjuvant chemotherapy followed by surgical resection. However many complications from chemotherapy have been reported. Some studies have reported artemisinin derivatives showed cytotoxic and anti-angiogenic properties. OBJECTIVE: To investigate cytotoxic properties ofartemisinin and its derivatives on human osteosarcoma cell lines. MATERIAL AND METHOD: Osteosarcoma cell lines (MG63 and 148B) were continuously cultured. MTT assay was used to evaluate cytotoxic properties ofartemisinin derivatives at 48 hours of incubation. These cell lines were also tested against doxorubicin as a control. Each IC50 value represented the mean ofat least 3 experiments. Independent t-test was used to test differences between groups. RESULTS: Artemisinin and its derivatives at micromolar range exhibited anti-cancer growth activities in human osteosarcoma cell lines. Among them, RKA182 the new synthetic tetraoxane is the most effective in inhibiting cell growth. In addition, water-soluble properties ofdrugs may be the main factor in cytotoxicity. CONCLUSION: The promising result shows that artemisinin and its derivative inhibits the growth of human osteosarcoma cells. This study indicated that RKA182 may be apotent andpromising agent to combat osteosarcoma. Further studies should be conducted of new synthetic drugs as possible anti-cancer drugs or adjuvant therapy in the clinical treatment of osteosarcoma.

Abstaining from symptomatic implants of modified tension band wiring by nonabsorbable suture fixation for transverse patella fractures.

BACKGROUND: Modified tension band fixation has become commonly used for transverse patella fractures. The conventional stainless steel wire provides sufficient stability but may be associated with complications. OBJECTIVE: The study aimed to evaluate the effectiveness of a new modified tension band fixation technique for transverse patella fractures using a nonabsorbable suture. MATERIAL AND METHODS: We present the result of a prospective series using a nonabsorbable suture (FiberWire) for transverse patella fractures. The mean follow-up period totaled 12 months. A total of 16 patients were evaluated by radiographic and clinical review. The postoperative clinical evaluation employed Lysholm and Böstman scores. RESULT: All clinical results on follow-up were good to excellent. Minimal intra-articular joint stepping and further fracture displacement were recorded. No patient needed re-operation, and functional outcomes of the knee were satisfactory. No significant differences were found between the injured and contralateral knee range of motion. No symptomatic implants and skin complications were noted, and all fractures were completed heal within 15 weeks. CONCLUSION: FiberWire provided sufficient stability and reduced postoperative complications. The results proved appropriate, and the technique has merit, as it obviates the need for re-operation.

Hyperbaric oxygen adjuvant therapy in severe mangled extremities.

BACKGROUND: Mangled Extremity Severity Score (MESS) was first described more than 30 years ago by attempting to predict the need for empiric amputation. In severe traumatic crush and blast injuries, achieving satisfactory limb salvage may be difficult. Notably, a MESS of 7 or higher is consistently predictive of amputation. Additionally, Hyperbaric Oxygen Therapy (HBOT) has been described for many purposes, and related studies have reported HBOT showed benefits in wound healing properties. OBJECTIVE: The study aimed to evaluate the results of a prospective series of a new modality of adjuvant HBOT for severe mangled extremities. METHOD: A total of 18 patients were evaluated for clinical and radiographic review. Current standard treatments followed by adjuvant HBOT were administered, and the mean follow-up period was 22 months. Time to wound closure, the number of surgeries and adjuvant HBOT treatment were analyzed for patient clinical evaluation. Complications and limb amputation rates were also recorded. RESULT: Most clinical findings on follow-up were good to excellent after adjunctive HBOT. Minimal soft tissue infection was recorded, and limb salvage was successful in most cases. Only 1 patient (5.56 %) needed limb amputation because of a dying limb with chronic refractory osteomyelitis. CONCLUSION: HBOT is an excellent adjunctive option in severely mangled extremities. Nevertheless, the main treatments are eliminating infection and managing surgery, and are promising in the recovery of severe extremity injuries. Although the MESS was evaluated at 7 or higher, limb salvage procedures followed by HBOT should be considered.

Late Presentation of Recurrent Symptomatic Amputation Neuroma.

INTRODUCTION: Post-traumatic amputation neuroma is one of the common complications that involve optimal functional outcomes. The current literature has a few examples of late presentation of traumatic stump neuroma. However, no available examples of late presentation of recurrent symptomatic amputation neuroma causing impaired functional outcomes have been reported. CASE REPORT: We present a case of recurrent symptomatic stump neuroma after above-knee amputation and neurectomy for 28 years. CONCLUSION: Late presentation of recurrent stump neuroma is an unusual condition, requiring early detection and treatment to gain better functionality. The patient scenario is unique and valuable for future management, including case awareness regarding this unique pathology.

Outcomes Following Temporary Kapandji Pinning Technique and Distal Radial LCP Fixation for Intra-Articular Fractures of the Displaced Distal Radius.

In partially or completely displaced intra-articular fracture of the distal radius , achieving satisfactory reduction and maintenance of good reduction before applying the plate may be difficult. Especially to accomplish the anatomic volar tilt remains a problem. Typically, the Kapandji technique has been described to reduce and stabilize a large displaced and extra-articular fracture of the distal radius. We present the results of a prospective series using the temporary Kapandji technique for K-wire intrafocal fixation followed by rigid fixation with distal radial locking compression plate. The mean follow-up period totaled 12 months. A total of 57 patients were evaluated by radiographic and clinical review. The modified Mayo wrist score was used for postoperative patient evaluation. The clinical results on follow-up were good to excellent. Minimal joint stiffness and functional outcomes of the wrist and elbow were satisfactory. Statically significant differences were found between the preoperative and postoperative radiologic parameters. No skin infection due to K-wire insertion was noted, and the fracture healed completely in every case. This paper reports the results of 57 cases of intra-articular fractures of the distal radius treated by Kapandji wires as a reduction tool and definitive fixation by the application of a locked volar plate. It could be performed easily and reliably. K-wires were used to temporarily maintain reduction throughout the rigid fixation without further displacement in the follow-up clinic. The results proved appropriate, and the technique has merit, as it obviates the need for dorsal exposure in most cases.