Augmenting a dynamic hip screw with a calcium sulfate/hydroxyapatite biomaterial.

Internal fixation failure in hip fractures can lead to reoperation. Calcium sulfate/hydroxyapatite (CaS/HA) is a biomaterial that can be used for augmenting fracture fixation. We aimed to determine whether an injection of 2 ml CaS/HA increases the fixation of a dynamic hip screw inserted in synthetic and human trabecular bone. The study consists of two parts: 1) synthetic bone blocks (n = 74), with three subgroups: empty (cannulated screw, no injection), cannulated, and fenestrated; and 2) osteoporotic human femoral heads (n = 29), with the same subgroups. The heads were imaged using µCT. Bone volume fraction, insertion angle, and head diameter were measured. Pullout tests were performed and peak force, stiffness, and work were measured. The fenestrated group showed increases in pullout strength compared to no injection in the synthetic blocks. The cannulated group showed a higher pullout strength in low-density blocks. In the femoral heads, the variation was larger and there were no significant differences between groups. The bone volume fraction correlated with the peak force and work, and the insertion angle correlated with the stiffness. CaS/HA can improve the fixation of a dynamic hip screw. For clinical use, spreading of the material around the threads of the screw must be ensured.

Section's osseous slice biopsy during major amputation of lower extremity: preliminary results of prospective cohort study.

BACKGROUND: The purpose of this cohort study was to assess the incidence of positive cultures in section's osseous slice biopsy (SOB) taken at the level of major limb amputation. In case of positive cultures we sought whether the microorganisms present in SOB could take origin from the primary infection site necessitating the amputation. The impact of diabetes on culture results was also investigated. METHODS: This prospective cohort study, which aimed to confirm the results of the pilot study, analysed patients who underwent major limb amputation between 2012 and 2013 in three Lithuanian hospitals. SOBs at the amputation site (surgical bone biopsies) and percutaneous bone biopsies of the distal site were performed simultaneously during limb amputation. Tissue cultures were analysed by microbiologists, and species along with antibiograms were reported. Histopathological assessment and bacterial typing were also evaluated. A positive culture was defined as the identification of at least 1 bacteria not belonging to the skin flora, at least 2 bacteria belonging to the skin flora with the same antibiotic susceptibility profiles or the same bacteria belonging to the skin flora in two different sites. Fisher's exact test and Student's test were used to compare the populations and the microbiological results. The statistical significance level was set at P < 0.05. RESULTS: Sixty-nine patients (35 males/34 females), mean age 68.7 (S = 13.6) years, including 21 (30.4%) with diabetes underwent the major limb amputation. Forty-five amputations (65.2%) were done above the knee. In total, 207 SOBs and 207 percutaneous distal site biopsies were studied. SOB cultures were positive in 11 (15.9%) cases. In 5 (45.5%) cases the same microorganisms were identified in both SOB and distal biopsy cultures. No association between culture results and presence of diabetes was identified. CONCLUSIONS: Our results suggest that, independently of the diabetes status, foot infection may silently spread along the bone and can achieve the site of major limb amputation. Additional investigations aiming to confirm this hypothesis and to evaluate a prognostic value are in progress.

[Efficiency of arthroscopic treatment in the knee osteoarthritis]. / Artroskopine operacija gali atitolinti kelio sanario endoprotezavima.

UNLABELLED: THE AIM OF THE STUDY was to estimate the effectiveness of arthroscopic operations for patients suffering from knee osteoarthritis; to determine if it is possible to decrease pain, increase range of motions and mobility function. MATERIAL AND METHODS: The subjects of the study were patients with grade III and grade IV with knee osteoarthritis (Outerbridge classification), who underwent arthroscopic operations at Kaunas Red Cross Hospital in 1993-2000. They were followed after arthroscopic operations: debridement, partial synovectomy, meniscus resection and elimination of free bodies. Two hundred eighteen patients were examined by questionnaire; 137 (62.8%) were females and 81 (37.2%) were males. The age range was from 19 till 77 years (average 53.09 years). Follow-up was 1-8 years (average 2.56 years). We estimated knee score and function score pre-op and 0.5 year, 1 year, 3 years and more than 3 years post-op. RESULTS: Six months post-op 58.3% of patients were satisfied, 41.7% had no changes or even worsened. One year post-op 77.5% of patients were satisfied; 3 years post-op 64 patients were followed, 78.1% were satisfied; more than 3 years post-op 45 patients were followed, 82.2% were satisfied. The results six months post-op are as following: 33.9% very good, 38.1% good, 22.9% satisfactory and 5.1% bad. One year post-op the very good and good results increased. Only 64 patients were followed-up three years post-op; 64.1% had very good results and 25.0% had good results, satisfactory and bad results were in the range of 10.9%. The shorter time till arthroscopic intervention and performing arthroscopic debridement gave positive influence on good and very good results. Instability due to ACL rupture, big osteophytes, subchondral sclerosis, valgus deformation and grade III-IV patellofemoral cartilage changes gave worse results. Synovectomy had no influence on the results. CONCLUSIONS: Arthroscopy is a minimally invasive palliative intervention for the patients with the knee osteoarthritis.