Isolated C1 arch fractures: C1-2 fusion vs. C1 osteosynthesis - surgical strategies for potentially unstable injuries.

STUDY DESIGN: Narrative Review. OBJECTIVES: The premise of this review is to provide a review of the literature pertaining to studies describing outcomes of surgical cohorts when implementing C1 osteosynthesis for arch fractures with or without transverse atlantal ligamentous (TAL) injury. METHODS: A comprehensive search strategy was implemented across several search engines to identify studies which evaluate the outcomes of C1 osteosynthesis for patients with C1 arch fractures with and without TAL injury. RESULTS: Ten studies were identified. Parameters reported included osteosynthesis fusion rates, deformity correction, preservation of motion segments, patient reported outcome measures and overall complications. Overall, C1 osteosynthesis showed excellent fusion rates with complications comparable to traditional techniques denoted in literature. Furthermore, the osteosynthesis technique depicted good overall deformity correction and preservation of motion segments, in addition to good patient reported outcomes. CONCLUSION: It appears C1 osteosynthesis offers a safe and efficacious alternative option for the surgical treatment of C1 fractures with TAL rupture. It has the potential to reduce deformity, increase ROM, improve PROMs and has complication rates comparable with those of fusion techniques. However more robust prospective evidence is required.

Stable Clinical and Radiological Outcomes at Medium and over 5 Year Follow Up of Calcaneus Fracture Open Reduction Internal Fixation Using a Sinus Tarsi Approach.

The sinus tarsi approach is increasingly growing in popularity for open reduction internal fixation of calcaneus fractures. Multiple studies have demonstrated favorable short-term results compared to the traditional extensile L incision, however long-term data over 5 years is currently limited to a single retrospective case series. Following local ethical approval, all patients who had completed a minimum 5 years from time of operation were contacted with a Standardized Telephone Questionnaire completed. This followed a previous retrospective chart review, with follow up telephone or clinic consultation performed by Davey et al. of this cohort at mean 35 months. Thirty-four fractures (31 patients) completed minimum 5 year follow up from the eligible group of 54 fractures (49 patients). Regarding functional outcomes, a significant improvement in mean Maryland Foot Score was observed between short- (mean 35.8 months) and medium-term (mean 81.9 months) of 77.6 (SD 15.0) to 86 (SD 7.9) (p = .0082). There was no significant difference in postoperative and long term radiographic Bohler's angle (p = .9683). Eleven feet (32%) proceeded to require reoperation, with removal of metal performed in 10 (29%), fusion in 2 (6%), and skin grafting following wound breakdown for 1 (3%). Four feet (12.9%) experienced post operative wound complications, including 3 (9.68%) cases of infection and 2 (6.45%) of delayed wound healing. This study demonstrated stable clinical and radiographic outcomes over 5 years following Calcaneus Fracture Open Reduction Internal Fixation using a sinus tarsi approach, supporting its continued usage when treating intraarticular calcaneus fractures for which operative intervention is indicated.

Changing trends in hip fracture epidemiology in the Republic of Ireland: a follow-up study.

A national, population-based study of hip fracture epidemiology is reported following a previously published study for the same population to ascertain the accuracy of projected incidence rates. Results suggest a decline in age-specific incidence rates in females but not males, and an over-estimation of same in the previously reported projections. PURPOSE: Accurate estimates of hip fracture numbers and incidence rates are necessary for health service resource planning. A study in 2009 estimated projected figures for 2016 and 2026, for the Republic of Ireland. The purpose of the current study was to scrutinize these projections, based upon actual population and fracture statistics for the year 2016. METHODS: Population data was obtained from the Central Statistics Office, and hip fracture data was obtained from the National HIPE Database for the year 2016, using similar search criteria to the previously published study. Hip fracture numbers and incidence rates were calculated. The calculated figures were compared to projected figures from the previous report. RESULTS: Population projection models used in the 2009 paper accurately reflected the 2016 Irish population. For younger age groups, projected number of fractures closely estimated actual numbers, however, for those over 70 years of age, hip fracture projections overestimated the actual fracture numbers observed. There was a significant difference in the age-specific hip fracture rates in the over 70 s sub-groups compared to the published results of the 2009 study. CONCLUSIONS: Hip fracture numbers continue to increase, though the age-specific incidence rates in the Republic of Ireland are reducing in the older age groups. The previously published study over-estimated hip fracture projections for the year 2016 (and potentially 2026) due to a false assumption of a stable age-specific incidence rate in the Republic of Ireland, which is in fact reducing.

Multimodal imaging of composite carbon fiber-based implants for orthopedic spinal fixation.

OBJECTIVE: As cancer treatments continue to improve, the incidence of spinal metastases and the need for surgical management of these with fixation procedures are growing rapidly. Traditionally metallic implants, composed of titanium alloy, have been used in surgical fixation of unstable or symptomatic vertebral metastases or traumatic injuries. Metallic implants, however, cause significant artifact on post-operative imaging, degrading image quality and limiting interpretation, and can also impair the planning and delivery of radiotherapy. Composite carbon fiber-based materials, such as carbon fiber-reinforced polyetheretherketone (PEEK), have been developed to overcome these issues and are now available for spinal fixation procedures. We aimed to review the multimodal imaging features of these new implants. MATERIALS AND METHODS: Current literature and a case example from our institution were used to describe the multimodal imaging characteristics and considerations of new carbon fiber-based spinal fixation implants. RESULTS: New carbon fiber-based spinal implants allow far greater visualization of surrounding structures on post-operative cross-sectional imaging, significantly improving diagnostic accuracy and precision of radiotherapy planning, and do not significantly absorb or scatter X-ray photons during radiotherapy delivery. There are, however, important surgical and radiologic considerations associated with the use of carbon fiber-based implants which radiologists must be aware of, such as implications for surgical planning and intra-operative fluoroscopic and post-operative plain radiographic imaging. CONCLUSION: The use of carbon fiber-based implants, rather than traditional metallic implants, for spinal fixation offers significant advantages for post-operative diagnostic imaging and radiotherapy planning and delivery.