Bone allografting: an original method for biological osteosynthesis and bone reinforcement in children with osteogenesis imperfecta.

PURPOSE: Osteogenesis imperfecta (OI) is a genetic disorder responsible for various symptoms including deformities and frequent fractures. Bone allografting is poorly documented in this condition. The objective of this study was to describe our experience and assessments in a consecutive series of OI patients. METHODS: Thirty-nine lower limb allograft procedures (28 femurs, 11 tibias) were performed in 26OI patients (mean age, 12.9 years). They were classified as type III of Sillence (17), type IV (6), and 3 recessive forms. The indications for surgery were correction of deformity (19), fracture (16), and non-union (4). In all cases, bone allografting was added to reinforce areas of fragility and in 28 cases for osteosynthesis to lock the rotations at the osteotomy site and to avoid screwed metallic plate. The duration of bone consolidation and allograft fusion was assessed. Complications and Gillette functional score were reported. RESULTS: The mean follow-up was 6.7years (range, 2 to 10 years). On average, bone consolidation was achieved after 3.3 months and graft fusion after 7.7 months. No bone allograft-related complications were observed and there was any secondary displacement. The Gillette functional score was improved in 23 patients and stable in three cases. Complications were reported in two cases: one partial allograft resorption and one delayed consolidation of a non-union. One refracture was observed but after a significant trauma in a child who had regained significant physical activity. CONCLUSIONS: Bone allografting in children with OI is a reliable method of biological fixation, allowing efficient fusion and contributing to increased bone capital and functional outcome.

MINIMALLY INVASIVE OSTEOSYNTHESIS FOR CLAVICULAR FRACTURE WITH LOCKED PLATE.

Objective: To evaluate the clinical and radiographic results of the surgical treatment of fractures of the middle third of the clavicle, using the technique of minimally invasive plate osteosynthesis (MIPO) with locking. Methods: Prospective case series, evaluating displaced fractures of the middle third of the clavicle submitted to MIPO with locking, with procedures performed by a single surgeon. Patients were evaluated at 12 months using the University of Los Angeles (UCLA) scale and anteroposterior radiographs of the clavicles with 45° cranial and caudal inclination, as well as reporting complications. Results: In total, 15 patients were evaluated. The median of surgical time was 50 minutes (IQR 35). The UCLA scale had a median of 35 (IQR 2) at 12 months. All patients presented fracture healing. Minor complications occurred in three cases (20%), with two (13.3%) evolving with plate prominence and one (6.7%) with local paresthesia, while major complications occurred in only one case (6.7%), with suture dehiscence requiring surgical re-approach. Conclusion: MIPO with locking is a viable option for the treatment of displaced fractures of the middle third of the clavicle, with excellent results according to the UCLA scale, fracture healing in all cases, and a low rate of complications. Level of Evidence IV, Case Series.

Objetivo: Avaliar os resultados clínicos e radiográficos do tratamento cirúrgico de fraturas do terço médio da clavícula pela técnica de osteossíntese minimamente invasiva com placa (OMIP) bloqueada. Métodos: Série de casos prospectiva que avaliou fraturas desviadas do terço médio da clavícula submetidas à OMIP bloqueada, com procedimentos realizados por um único cirurgião. Os pacientes foram avaliados aos 12 meses por meio da escala da Universidade da Califórnia em Los Angeles (UCLA) e por radiografias das clavículas em anteroposterior (AP) com inclinação cranial e caudal de 45°, além de relatos de complicações. Resultados: Foram avaliados 15 pacientes. A mediana do tempo cirúrgico foi de 50 minutos (IIQ 35). A escala da UCLA aos 12 meses teve mediana de 35 (IIQ 2). Todos os pacientes apresentaram consolidação da fratura. Complicações menores ocorreram em três casos (20%): dois (13,3%) com proeminência da placa e um (6,7%) com parestesia local. Maiores complicações ocorreram em apenas um caso (6,7%), com deiscência de sutura, necessitando de reabordagem cirúrgica. Conclusão: A OMIP bloqueada se mostrou uma opção viável ao tratamento das fraturas desviadas do terço médio da clavícula, com resultados excelentes de acordo com a escala UCLA, consolidação em todos os casos e baixo índice de complicações. Nível de Evidência IV, Série de Casos.

Minimally invasive osteosynthesis for clavicular fracture with locked plate / Osteossíntese minimamente invasiva para fratura da clavícula com placa bloqueada

ABSTRACT Objective: To evaluate the clinical and radiographic results of the surgical treatment of fractures of the middle third of the clavicle, using the technique of minimally invasive plate osteosynthesis (MIPO) with locking. Methods: Prospective case series, evaluating displaced fractures of the middle third of the clavicle submitted to MIPO with locking, with procedures performed by a single surgeon. Patients were evaluated at 12 months using the University of Los Angeles (UCLA) scale and anteroposterior radiographs of the clavicles with 45° cranial and caudal inclination, as well as reporting complications. Results: In total, 15 patients were evaluated. The median of surgical time was 50 minutes (IQR 35). The UCLA scale had a median of 35 (IQR 2) at 12 months. All patients presented fracture healing. Minor complications occurred in three cases (20%), with two (13.3%) evolving with plate prominence and one (6.7%) with local paresthesia, while major complications occurred in only one case (6.7%), with suture dehiscence requiring surgical re-approach. Conclusion: MIPO with locking is a viable option for the treatment of displaced fractures of the middle third of the clavicle, with excellent results according to the UCLA scale, fracture healing in all cases, and a low rate of complications. Level of Evidence IV, Case Series.

RESUMO Objetivo: Avaliar os resultados clínicos e radiográficos do tratamento cirúrgico de fraturas do terço médio da clavícula pela técnica de osteossíntese minimamente invasiva com placa (OMIP) bloqueada. Métodos: Série de casos prospectiva que avaliou fraturas desviadas do terço médio da clavícula submetidas à OMIP bloqueada, com procedimentos realizados por um único cirurgião. Os pacientes foram avaliados aos 12 meses por meio da escala da Universidade da Califórnia em Los Angeles (UCLA) e por radiografias das clavículas em anteroposterior (AP) com inclinação cranial e caudal de 45°, além de relatos de complicações. Resultados: Foram avaliados 15 pacientes. A mediana do tempo cirúrgico foi de 50 minutos (IIQ 35). A escala da UCLA aos 12 meses teve mediana de 35 (IIQ 2). Todos os pacientes apresentaram consolidação da fratura. Complicações menores ocorreram em três casos (20%): dois (13,3%) com proeminência da placa e um (6,7%) com parestesia local. Maiores complicações ocorreram em apenas um caso (6,7%), com deiscência de sutura, necessitando de reabordagem cirúrgica. Conclusão: A OMIP bloqueada se mostrou uma opção viável ao tratamento das fraturas desviadas do terço médio da clavícula, com resultados excelentes de acordo com a escala UCLA, consolidação em todos os casos e baixo índice de complicações. Nível de Evidência IV, Série de Casos.

Strength of Products Made of Ultrafine-Grained Titanium for Bone Osteosynthesis.

This paper evaluates the fatigue strength of ultrafine-grained (UFG) Grade 4 Ti in the low-cycle fatigue region, as well as the strength of medical implants (plates and screws) made of UFG Ti under various types of loading in comparison with the strength of products made of coarse-grained (CG) Ti. To produce a UFG state, titanium billets after annealing were processed by the ECAP-Conform technique. The fatigue of the prismatic specimens with a thickness of 10 mm from CG and UFG Ti was tested by the three-point bending method using an Instron 8802 facility. The modeling and evaluation of the stress-strain state in the ANSYS software package for finite-element analysis revealed, in particular, the localization of equivalent stresses in the area of hole edges and at fillets during the tension of the plates. The performed research has demonstrated that medical implants (plates and screws) from UFG Grade 4 Ti have a higher strength under different types of loading (tension, fatigue strength, torsion) in comparison with products from CG Ti. This opens up a possibility for the miniaturization of medical products from UFG Ti while preserving their main performance properties at an acceptable level.

Treatment of postoperative tibial chronic osteomyelitis using bone transport techniques; an observational study.

PURPOSE: Postoperative Tibial chronic osteomyelitis is one of the most challenging orthopaedic conditions especially when extensive, the anatomy of subcutaneous anteromedial part of the tibia with less soft tissue coverage complicates the situation. The extent of infected tibial part varies in size and duration from one patient to another. We report our experience using Bifocal and Monofocal bone transport techniques with regard to clinical outcome, recurrence of infection and re-fracture rate. METHODS: This is a retrospective observational review of 49 patients with postoperative Tibial chronic osteomyelitis which were treated using either Bifocal distraction compression BFDCO technique group I (31 patients) or Monofocal compression osteosynthesis MFCO technique Group II (18 patients). The average age of the patients was (41.6 ± 13.1 years), (range: 17-67 years). Leg length discrepancy was measured in 33 (58.9%) patients with an average of (1.4 ± 1.7 cm). Contracture of the ankle joint and equinus deformity were detected in 36 (64.3%) patients. Pre and Post-operative radiography together with Modified Irzhansky A.A et al. leg functional assessment system were used to assess the functional outcome. RESULTS: The time spent in the Ilizarov fixator (External Fixation Index) in the first group was (142 ± 72 days) and in the second group was (75 ± 54 days). The infection recurred in 2 patients (6%) in group I and in 5 patients (28%) in group II. Lack of consolidation or re-fracture within 6 months after the dismantling of the apparatus was detected in 6 patients (19.5%) in group I and in 5 patients (27.8%) in group II. Lack of consolidation or re-fracture within 6 months after dismantling of the apparatus in group I was detected in 6 patients (19.5%) in group I and in 5 patients (27.8%) in Group II. The average functional state score (AFSS) in the first group was (12.45 ± 2.41) on admission and increased to (16.16 ± 2.99) on the final follow-up which corresponded to a "good" result. In the second group II the AFSS was (12.11 ± 2.22) on admission and increased to (15.06 ± 2.88) at the final follow-up which corresponded to a "satisfactory" result. CONCLUSION: Treatment of Tibial chronic osteomyelitis using either Bifocal or Monofocal bone transport is an effective method. However our results have demonstrated better functional outcome and less infection recurrence and re-fracture rates when using the Bifocal distraction compression technique (BFDCO).

New miniplate for osteosynthesis of mandibular angle fractures designed to improve formation of new bone.

The purpose of this article is to present the study of a new miniplate designed to keep the maximum strains developed in the cortical bone near the fracture line during accidental biting to values below the threshold causing bone resorption. Designed to offer maximum fracture stability with minimal implanted volume and patient intrusion, the design uses a novel approach to account for the effects of the distance from the fracture line to the nearest screws. Its geometry minimizes the peak forces that can develop during most cases of mandible biomechanical loadings. A three-dimensional (3D) osteosynthesis finite element model for a human mandible confirmed the operational effectiveness of the miniplate. It also provided numerical estimates for the strains and screw forces in the cortical surface during incisor bites with clinically relevant forces of 200 N. Two prototypes, 0.6 mm and 0.8 mm in thickness, were repeatedly tested on fractured sheep mandibles, fixed in a purpose-built jig, to loads up to 150% of the maximum forces developed by human patients. The tests indicated good fracture stability, and the proof tests carried for each of the two prototypes terminated at more than 350 N due to failure of the loading cable and respectively, secondary mandible fractures occurring away from the miniplate.