Biomechanical characteristics of the meniscocapsular junction of the posterior segment of the medial meniscus.

PURPOSE: Despite extensive literature available on the mechanical properties of knee ligaments and menisci, research on the mechanical properties of the meniscus-capsular junction (MCJ) is lacking. This study aims to investigate the biomechanical behavior of the MCJ of the medial meniscus using a tensile failure test. MATERIALS AND METHODS: Seven dissected cadaveric knees were used for biomechanical analysis. Tensile failure tests were performed using an INSTRON ElectroPuls E1000 stress system to measure stress/strain curves, maximum load at failure, elastic limit load, elongation at break, elongation at the elastic limit, and linear stiffness, were collected and analyzed. RESULTS: All ruptures occurred at the MCJ. The MCJ displayed similar mechanical properties to knee ligaments. Average values were: maximum load at failure (63.9 ± 3.2 N), yield load (52.9 N ± 2.6 N), elongation at break (2.5 mm ± 0.3 mm), elongation at the elastic limit (1.25 mm ± 0.15 mm), strain at break (47.0% ± 3.5%), strain at yield (23.2% ± 2.3%), and stiffness (56.6 ± 9. N/mm-1). CONCLUSION: The meniscus-capsular junction's mechanical properties are similar to other knee ligaments and may play a role in knee stability. The findings provide insights into the the behavior of the meniscus-capsular junction could have clinical implications for diagnosing and surgical treatment of meniscocapsular lesions.

Laparoscopic treatment of fourteen cases of pelvic ring disruption: a case series.

PURPOSE: Open surgical approaches for the treatment of anterior pelvic arc lesions are associated with several complications. We present the first retrospective descriptive case series on the use of laparoscopy as an alternative. METHODS: This descriptive, retrospective, single-centre study enrolled all patients who underwent laparoscopy for the treatment of pelvic ring disruption between May 2020 and March 2022. The primary outcome was the procedure failure rate based on conversion to open surgery. Secondary outcomes were the duration of the surgical procedure, x-ray exposure, length of hospitalisation, postoperative pain assessment, and functional scores at the last follow-up. RESULTS: The study included two females and 12 males. The mean age of the study participants was 44.2 (23-67) years. In total, nine (64.3%) patients had pubic symphysis disjunction, four (28.6%) had bilateral fractures of the obturator frames, and one (7%) had both. None of the patients required conversion to open surgery. The median operating times for symphysis pubis disruption, obturator frame fracture, and patients with both injuries were 90.0 (60-120), 135 (105-180), and 240 min, respectively. The median overall operating time was 102.5 (60-240) min. The median Iowa Pelvic Score and Majeed Functional Score at the last follow-up were 87 (70-99) and 84 (70-100), respectively. CONCLUSION: Laparoscopic internal fixation is a reliable treatment for pelvic ring disruption. The clinical and radiological outcomes of our patients suggest the usefulness of this technique as an alternative to open approaches.

The "Metaizeau trick" to facilitate medullary pubic ramus screw insertion: A technical note.

Minimally invasive procedures have recently seen an increase in the treatment of pelvic ring disruptions and select acetabular fractures. Similar to ilio-sacral screws, the superior pubic ramus screw is becoming a preferred method for treating unstable pelvic ring fractures. While the osteology of the superior pubic ramus is well understood and has inherent variability, standard screw insertion techniques work effectively in most cases. If the anatomy prevents the standard approach, there are alternative methods that can be employed for successful screw placement, or there might be a need for an open reduction and internal fixation with plates. Such techniques can be material-intensive and time-consuming. In this paper, we introduce a straightforward method that utilizes the Metaizeau nail as a guide wire to facilitate screw insertion in most instances, termed the "Metaizeau trick". Metaizeau nails, commonly found in trauma centers, are designed to locate a pathway effortlessly using this method. LEVEL OF EVIDENCE: IV.

Study of the position of six volar locking plates for distal radius fracture relative to the watershed line.

INTRODUCTION: Volar plate malpositioning in the treatment of distal radial fracture can lead to tendinitis or even tendon tear, especially when the plate position is very distal. We studied the impact of design on plate position in the distal radius. The primary aim was to compare the position of six volar wrist plates relative to the watershed line using the Soong classification. The secondary objectives were to assess the epidemiology of volar locking plate fixation within the administrative Département of Finistère (northwestern France) and to study whether the type of fracture played a role in plate position. HYPOTHESIS: The plate design itself influences positioning relative to the watershed line on the Soong classification. MATERIALS AND METHODS: A total of 2723 volar locking plate fixation cases were analyzed and categorized according to the Soong classification. Plates used were divided into six groups based on design: Zimmer Biomet®, Newclip Technics®, Stryker®, Synthes®, Medartis® and Medartis® Footprint. The number of Soong 0 + 1 plates (i.e., plates graded 0 and 1 taken together) was determined for each design, then compared using the Marascuilo procedure with a significance level of α = 0.05. RESULTS: On the Marascuilo procedure, we found significant differences in the number of Soong grade 0 + 1 plates. The Zimmer Biomet and Newclip Technics® plates were significantly more often proximal to the watershed line than the Synthes and Medartis Footprint plates. Plate position with the Medartis® design was significantly more proximal to the watershed line than for its companion design, the Medartis® Footprint plate. The rate of volar locking plate fixation of distal radial fractures over the past 10 years increased in Finistère. Also, the type of fracture affected the choice of plate when different designs were available within a hospital center (Medartis® Footprint plate used in 2R3A fractures). CONCLUSION: Our study highlights a significant difference in volar locking plate position relative to the watershed line between the various models available. Plate design is a deciding factor when treating distal radial fracture, to avoid impingement when implant removal is not routinely planned.

Augmented versus non-augmented Trochanteric Fixation Nail-Advanced (TFNA) nails for treating trochanteric fractures in patients over sixty-five years of age.

PURPOSE: Intramedullary nailing is a common treatment for pertrochanteric fractures. However, implant-related mechanical failures, such as cut-out and cut-through, lead to higher rates of revision surgery, loss of autonomy, and mortality. Cemented augmentation enhances the bone-implant interface. This study compared the frequency of mechanical failures between augmented and non-augmented Trochanteric Fixation Nail-Advanced (TFNA) nails. METHODS: This descriptive, retrospective study at a level 1 trauma centre included patients aged > 65 years with pertrochanteric fractures treated by a short augmented or non-augmented TFNA nail. The primary outcome was the comparison of cut-out or cut-through rates between groups at three and six months postoperatively. RESULTS: Of the 181 patients analysed, 103 had augmented TFNA nails and 78 had non-augmented TFNA nails. There were no statistically significant differences between groups in terms of demographic characteristics, AO/OTA classification, or quality of reduction. The failure rate was significantly lower in the augmented group than in the non-augmented group: 1 (0.97%) versus 9 (11.54%) (p = 0.005). At six months postoperatively, there was no significant difference between the two groups concerning functional recovery, as measured by the Parker and EuroQoL 5-Dimensions scores. CONCLUSIONS: For patients aged over 65 years, the use of the augmented TFNA nail may reduce the risk of fixation failures such as cut-out.

Construction and validation of a functional diagnostic score in anterior cruciate ligament ruptures of the knee in the immediate post-traumatic period. Preliminary results of a multicenter prospective study.

INTRODUCTION: Knee ligament injuries are frequent and their number is constantly increasing with the development of sports activities. Dynamic knee maneuvers usually make it possible to diagnose anterior cruciate ligament (ACL) injuries but they remain difficult to perform in the early post-traumatic phase. This leads to the almost systematic use of MRI scans, many of which turn out to be superfluous. The aim of this study was to construct a screening score based solely on history-taking, in order to help diagnose ACL injuries, and to define thresholds that could help inform recommendations for MRI usage. The hypothesis was that this score could distinguish a population of patients with a ruptured ACL from a population of patients with other knee injuries. MATERIAL AND METHODS: This prospective multicenter study included 166 patients. Patients were included if they were between 18 and 55 years of age, with knee trauma that had occurred in the last 10 days, and without a bone fracture on standard radiographs. They were excluded if the trauma required immediate surgical management and if they had a history of knee trauma. The screening score was completed by the physician. The score included the following items: assessment of pain, immediate post-traumatic functional impairment, notion of a "pop", feeling of instability and presence of a swelling. An MRI was systematically performed and the patient consulted a referring physician to compare the initial score with the diagnosis. RESULTS: Eighty-six patients had an injured ACL and 80 had a healthy ACL. Two thresholds could be identified. For a score lower than 4, the risk of an ACL injury was low with a sensitivity of 96% and a negative predictive value of 87%. For a score above 8, the ACL injury was highly probable with a specificity of 88% and a positive predictive value of 83%. DISCUSSION/CONCLUSION: The score was able to distinguish a population of patients with a ruptured ACL from a population of patients with other knee injuries. These preliminary results confirm that the selected items are relevant and that the score can help improve the diagnostic orientation of patients with recent knee trauma. Increasing the sample size in combination with an analysis of influencing factors will determine whether the performance of this score can be refined. LEVEL OF EVIDENCE: II prospective multicenter study.

Is a Total Hip Arthroplasty Stem in Varus a Risk Factor of Long-Term Mechanical Complication?

BACKGROUND: The impact of implanting cementless femoral stems in varus alignment on long-term mechanical complications remains poorly defined in the literature. The aim of our study was to compare survivorship and functional and radiographic outcomes of stems in varus alignment to those in neutral alignment with and average follow-up of 10 years. METHODS: This single-center, multisurgeon, retrospective case-control study compared a group of 105 total hip arthroplasty (THA) patients who had varus stem alignment (Varus Stem) to a matching group of 105 THA patients who had neutral stem alignment, operated on between January 2007 and December 2012. The primary outcome measure was implant survival. Secondary outcomes included functional (Harris Hip Score, Postel Merle d'Aubigné Score, thigh pain, dislocation and hip range of motion) and radiographic outcomes (radiolucency, osseointegration, heterotopic ossification, subsidence, and stress shielding). RESULTS: There was no significant difference in implant survival between the 2 groups with 95.7% (±2.46) in the Varus Stem group versus 97.7% (±1.64) in the Neutral Stem group (P = .41) after an average follow-up of 10 years. There was no significant difference in clinical and radiographic outcomes between groups. CONCLUSION: Cementless femoral stems in varus alignment were not the cause of mechanical complications with an average follow-up of 10 years. The comparison between groups in terms of implant survival, functional, and radiographic outcomes does not show any significant differences. Positioning a femoral stem in varus alignment may be an alternative for surgeons wishing to restore preoperative offset and to ensure satisfactory hip stability.

Immediate full weight bearing after pelvic percutaneous fixation by screw for simple acetabular and pelvic ring fractures in patients older than sixty five years.

PURPOSE: The aim of this study was to assess the walking and weight-bearing abilities of patients older than 65 years with a simple acetabular or pelvic ring fracture treated with pelvic percutaneous screwing (PPS). METHODS: This study included 27 patients. This was a retrospective, single-centre observational study conducted in a level 1 trauma centre from September 2019 to April 2021. All patients older than 65 years who underwent PPS for an acetabular or pelvic ring fracture were included. RESULTS: All patients were able to walk and bear weight at one day after PPS. The mean walking distance increased from 19.4 m the day after the operation to 59.8 m, 497.8 m, and 1402 m at discharge, three and six weeks after the operation, respectively. The average pain visual analog scale scores before and after the operation were 4.1 (range, 3.6-5.1; standard deviation [SD], 0.63) and 0.9 (range, 0.5-1.2; SD, 0.25), respectively (p < .0001). The average daily dose of paracetamol used before and after the operation was 2.2 (range, 1.7-3.1; SD, 0.59) g/d and 1.3 (range, 0.6-1.7; SD, 0.40) g/d, respectively (p = .0232). The average daily dose of morphine used before and after the operation was 5.7 (range, 4.7-6.7; SD, 0.76) mg/d and 1.6 (range, 0.5-2.9; SD, 1.09) mg/d, respectively (p = .0001). CONCLUSION: All included patients were able to walk at one day after PPS. PPS was associated with reduced pain as well as a reduction in paracetamol and morphine use.

Use of a Trochanteric Fixation Nail-Advanced (TFNA) with cement augmentation for treatment of trochanteric fractures in patients greater than sixty five years of age.

PURPOSE: Intramedullary nailing is the standard treatment of trochanteric fractures. Mechanical failure such as cut-out and cut-through are associated with high rates of revision surgery, functional impairment, and mortality. The aim of the study was to evaluate the rate of mechanical failure of the cement augmented screws of Trochanteric Fixation Nail-Advanced (TFNA) nails. PATIENTS AND METHODS: A descriptive, retrospective, multi-operator, single-centre study was performed at our level 1 trauma centre between June 2019 and June 2020. Patients were included if they were > 65 years of age, presented with a trochanteric fracture treated with an augmented TFNA nail with 6 months of follow-up. The primary outcome was fixation failure rate (cut-out or cut-through) at three and six post-operative months. Secondary endpoints were intra-operative data, clinical scores, and radiographic analysis. RESULTS: Forty-five patients (38 women and 7 men) were analysed. The mean age was 82.84 years (65-102, 9.50). There were no instances of mechanical failure in our series, after either three or six months of follow-up. No patient exhibited cut-out or cut-through. The mean amount of cement injected was 4.72 mL (3-6; 1.05). The mean length of surgery was 37.59 min (25-55; 6.48), and the mean intra-operative radiation exposure was 91.47 cGycm2 (25.04-201.81; 51.40) for a mean duration of 43.11 s (17-86; 16.81). The mean duration of hospitalisation was 6.38 days (2-11; 2.27). CONCLUSIONS: Our clinical results suggest that cement-augmented TFNA screws can be successfully used in the management of trochanteric fractures in patients > 65 years of age.

Epidemiology and characteristics of firearm injuries in a French level I trauma centre, 2009-2019.

BACKGROUND: Firearm injuries (FI) are an increasing problem in Europe but there have been few European epidemiological studies on civilian FI, particularly in France. This study investigated the epidemiology of FI at a French level I trauma centre. METHODS: A retrospective cohort study was conducted of all patients admitted to our centre with an FI between January 2009 and December 2019. We investigated the epidemiological trends of FI during the study period, and characterised the FI. RESULTS: A total of 162 patients were victims of FI. Prevalence was 0.11% and the mean annual incidence was 10.4 per 100 000 habs. A significant increase has been observed over the last 10 years, from 5 cases in 2009 (3.1%) to 30 in 2019 (18.5%). Of the 162 victims, 85 (52.5%) died as a direct result of the FI: 72 suicides (88.9%) and 9 victims of urban violence (11.1%) (armed public environment disorder). 95.3% of the patients died before reaching at the hospital. There were 95 cases (58.7%) of suicide and 33 cases (20.4%) of urban violence. The head was shot in 87 cases (48.9%), the thorax in 32 cases (18.5%) and the lower limbs in 24 cases (13.5%). A total of 106 surgeries were performed on 54 patients (33.3%). CONCLUSIONS: We identified 162 cases of FI with a mean annual incidence of 10.4 per 100 000 habs. A significant increase in FI was observed over the last 10 years. 52.2% of patients died, and the main context was suicide or attempted suicide.

Evaluation of the accuracy of the Sureshot® electromagnetic targeting system in distal locking of long-nailed humeral diaphyseal fractures.

INTRODUCTION: Osteosynthesis of humeral diaphyseal fractures by long intramedullary nailing is a widespread practice. Distal interlocking is a delicate and uncertain step in the procedure, and the free-hand method is adopted by most surgeons. We evaluated the accuracy of a magnetic field-guided system for distal interlocking of long intramedullary nailed humeral diaphyseal fractures. HYPOTHESIS: The field magnetic method to interlock distal screws procured satisfying success rates at first attempt in each hole. STUDY DESIGN: Single center, retrospective, descriptive and continuous. MATERIAL AND METHODS: We used the Sureshot® Distal Targeting System (DTS) and the Trigen® (Smith & Nephew) nail. All patients who presented to our center for osteosynthesis of a fracture of the humeral diaphysis by long intramedullary nailing between April 1, 2016 and June 30, 2018 were retrospectively included. RESULTS: The analyses included 32 of the 34 patients who presented during this period (mean age, 64 years). There were 51 attempts to install distal interlocking screws. The screws were interlocked successfully in 40 cases (78.4%), and there were 11 failures (21.6%). There was an average of 29 fluoroscopic views and an average cumulative dose area product of 36.90 cGcm2. DISCUSSION: We found a lower success rate than that found in the literature for the accuracy of Sureshot® DTS in long humeral nailing. We found also a lower success rate than for tibial and femoral centromedullary nailing with this system. Our study showed a success rate of only 78.4% at the first attempt for distal interlocking of Trigen® humeral long nails. LEVEL OF EVIDENCE: IV; retrospective study without control group.

The Radial Floating Cup radial head prosthesis to treat radial head fractures: functional and radiographic results after more than 12 years of mean follow-up.

INTRODUCTION: This study was performed to evaluate the long-term clinical and radiographic results of patients presenting with a radial head fracture who were treated surgically with a Judet Radial Floating Cup 2 (RFC 2) radial head prosthesis. MATERIALS AND METHODS: This was a retrospective, monocentric, observational, multi-operator, and continuous study performed between July 1997 and June 2009 on the treatment of radial head fracture using an RFC 2 radial head prosthesis. The primary efficacy endpoint was the functional status of the operated elbow, evaluated using the Disability of Arm-Shoulder-Hand (Quick-DASH) score and the Mayo Elbow Performance Index (MEPI). The secondary endpoints were mobility and stability of the operated elbow, residual pain and grip strength, nature and rate of complications, as well as possible radiographic abnormalities during follow-up. RESULTS: Twenty-two patients were treated with the RFC 2 for radial head fractures over the study period. Three (13.6%) were lost to follow-up, including one death. Of the remaining 19 patients, three RFCs had to be removed (15.8%). The final analysis involved 16 patients. The mean follow-up was 144 months (range 109-225 months; standard deviation [SD] = 49.9 months) or 12 years. The average Quick-DASH score was 23.01/100 (range 0-50; SD = 7.8) and three cases were rated as having "excellent" results according to the MEPI (18.7%), nine cases were rated as having "good" results in (56.2%), and four cases were rated as having "average" results (25%). The average mobility values were: 132° of flexion (range 120°-150°; SD = 11), 14.5° of extension deficit (range 0°-40°; SD = 5), 84.4° of pronation (range 20°-90°; SD = 8°), and 67.7° of supination (range 25°-85°; SD = 10). All patients had a stable elbow. The average grip strength on the affected side thus corresponded to 79% (range 44-100%; SD = 8.3%) of the grip strength on the healthy side. Four patients (25%) developed complications: three cases of algodystrophic syndrome (18.7%) and one case of early dislocation (6.2%). Radiographic evaluation revealed that there was a periprosthetic radio-lucencies in eight patients (50%), periarticular ossifications in 12 patients (75%), and lysis of the capitulum in two patients. There was no significant difference in MEPI ratings between patients with and without a periprosthetic radio-lucencies (P = 0.8018). CONCLUSIONS: Our results indicated that using the RFC 2 prosthesis to surgically treat radial head fractures provides good long-term functional results, including satisfactory mobility and stability.

The role of three-dimensional printing in coronavirus disease-19 medical management: A French nationwide survey.

Objectives: Coronavirus disease-19 (COVID-19) has spread worldwide and poses various challenges to healthcare services. The limited supply of medical and personal-protective equipment has affected the ability of many countries to respond to the crisis. Three-dimensional printing (3DP) is well suited to addressing these shortages. We assessed the medical role of 3DP during the COVID-19 outbreak in hospitals in France. Design: Retrospective survey. Setting and intervention: We included and questioned all French level-1 and -2 COVID-certified centers. Participants: One hundred and thirty-eight COVID-certified centers were contacted across France: 38 (27.5 %) level 1 and 100 (72.5 %) level 2 centers. The analysis focused on 133 centers (96.37 %), among which 98 (73.68 %) used 3DP. Main outcome measures: The primary endpoint was the number of pieces printed in 3D. The secondary endpoints were the mode, type, and benefits of 3DP. Results: The total number of pieces printed in 3D nationwide was 84,886: 76,000 pieces of individual protective equipment (IPE) (89.53 %), 6335 pieces of biomedical equipment (7.47 %), and 2551 prototypes (3.01 %). In 91 cases (92.85 %), 3DP was performed using external printers. The pieces 3D-printed by the various centers helped around 6109 patients and protected around 41,091 caregivers. Conclusions: 3DP produced more than 84,000 pieces at 98 centers, helped more than 6000 patients, and protected more than 41,000 caregivers. Therefore, 3DP played a major role in medical aid during the COVID-19 outbreak in France.

Ramp Lesions of the Posterior Segment of the Medial Meniscus: What Is Repaired? A Qualitative Histological Study of the Meniscocapsular and Meniscotibial Attachments.

BACKGROUND: Lesions of the posterior segment of the medial meniscus are the most common intraarticular lesions associated with ACL injuries. Ramp lesions are tears in the peripheral attachment of the posterior horn of the medial meniscus. Such injuries are difficult to detect on preoperative MRI. Arthroscopically, the prevalence of these lesions can reach 24%. Anatomical descriptions of the posterior horn of the medial meniscus are becoming clearer, however, histological descriptions are lacking, especially with regard to the presence or absence of capillaries. QUESTIONS/PURPOSES: The present qualitative histologic study focused on the posterior segment of the medial meniscus and the meniscocapsular and meniscotibial junctions. Specifically, the objective of this study was to analyze the posterior segment of the medial meniscus and the meniscosynovial junction and to determine whether the meniscus tibial ligament exists. METHODS: We dissected 10 unpaired cadaveric knees (five male, five female, age range 55 to 66 years), five left and five right, from the French "Don du corps" body donation program via a posterior approach to the posteromedial capsule. We excluded specimens with intra-articular abnormalities (ACL rupture, meniscal tear, arthrosis) preceding dissection by arthrotomy. We thus accessed the posterior segment of the medial meniscus and the meniscosynovial junction. The proximal capsule, posterior segment of the medial meniscus, entire meniscal capsular-tibial junction, and a fragment of the tibia were removed en bloc. For each knee, three sagittal spaced sections of the posterior segment of the medial meniscus (Zone 4 as defined by Smigielski) were performed. Two experienced pathologists performed qualitative histological analysis on the 30 samples after Hematoxylin and eosin staining, and Safranin O staining. RESULTS: Macroscopically, the meniscotibial attachments were pellucid and homogeneous, as were the meniscocapsular attachments; however, the meniscocapsular attachments appeared to be denser in both the anterior and posterior regions of the capsule. Microscopy of the meniscosynovial junction revealed loose collagen fibers that were partially oriented but not parallel, a cellular network featuring a few fibroblasts and adipocytes, and several capillaries. No between-attachment histologic differences were apparent; both tissues shared a site of attachment to the posterior horn of the medial meniscus. We did not detect the meniscotibial ligament, macroscopically or microscopically. CONCLUSIONS: A ramp lesion may not be a ligamentous injury because the meniscotibial ligament was not detected. Rather, it appears that a ramp lesion is a tear in the common attachment point between the posterior horn of the medial meniscus and meniscocapsular and meniscotibial junctions. This structure is vascularized, and contains nonoriented low cellularity collagen of moderate density. CLINICAL RELEVANCE: Based on our results, a better rationale for the recommendation of surgical repair of a ramp appears to be needed, given the absence of a meniscotibial ligament, and the presence of capillaries in the meniscocapsular and meniscotibial attachments.

The first use of laparoscopy to treat pelvic ring fractures: A case report.

INTRODUCTION: Pelvic ring injuries pose major challenges for the trauma surgeon. Given the complications of open surgeries, percutaneous techniques have become increasingly popular, but laparoscopy has never been employed for internal osteosynthesis of the pelvic ring. PRESENTATION OF CASE: We describe a 34-year-old male with a pelvic ring fracture (grade AO/OTA 61B2.1b). The anterior pelvic arch was successfully plate-fixed using a laparoscopic technique. This is the first report of such an approach to treat pelvic ring fractures. DISCUSSION: Our principal point is that "laparoscopic internal fixation" delivered an in situ result as good as that of open surgery, but we required only four trocar portals. CONCLUSION: We describe a novel laparoscopic approach to treatment of pelvic ring fractures.

A rare case of an irreducible Pipkin II fracture-dislocation of the femoral head in a young patient following low-energy trauma.

INTRODUCTION: Fractures-dislocations of the femoral head are rare, and irreducible dislocations are even rarer. The functional prognosis is poor. PRESENTATION OF CASE: We report the case of a 23-year-old male brought to the emergency room following low-energy trauma. X-rays and a computed tomography scan revealed a Pipkin II fracture-dislocation of the right femoral head. We attempted reduction with the patient under general anesthesia; this failed, so we proceeded to total hip arthroplasty (THA). DISCUSSION: A femoral head fracture has a poor prognosis; the principal complications are osteonecrosis, osteoarthritis, and heterotopic ossifications. No surgical treatment algorithm for a femoral head fracture (for fragment excision, followed by internal fixation or THA) is available, given the rarity of the injury and the lack of sufficient cases. CONCLUSIONS: We describe the mechanism of low-energy injury, as well as the controversial THA treatment chosen by this young patient.

Advantages of expulsion-proof pins in the treatment of olecranon fractures with tension band wiring: Comparison with a control group.

INTRODUCTION: Tension band wiring is considered the standard treatment for transverse olecranon fractures. Its main complications are pin migration and discomfort caused by the hardware. We have designed and used "expulsion-proof" pins (EPP) that are shaped to prevent migration and reduce discomfort. This study compared the complication rate between our device and Kirschner pins (controls). HYPOTHESIS: We hypothesised that EPP would have lower migration rates and fewer complications than standard Kirschner pins. MATERIALS AND METHODS: This retrospective, single-center, multi-operator, observational, study examined data from January 1996 to December 2014. The primary outcome was the occurrence of pin migration. Secondary outcomes were the occurrence of one or more additional complications and the hardware removal rate. RESULTS: The study enrolled 101 patients: 53 (52.4%) with expulsion-proof pins and 48 (47.6%) controls. The mean follow-up was 240.6days in the EPP group and 268.9days in the control group. No cases of migration (0%) were found in the EPP group versus 21 (43.7%) cases in the controls (p<0.05). One or more complications occurred in 18 (33.9%) patients in the EPP group versus 46 (95.8%) controls (p<0.05). There was material discomfort in 13 (24.5%) cases and 1 (1.9%) case of secondary displacement in the EPP group, compared with 38 (79.2%) and 7 (14.6%) cases, respectively, in the controls (p<0.05). The rate of delayed consolidation was statistically identical in the two groups (p=0.103). The hardware was removed in 13 (24.5%) cases in the EPP group compared with 36 (75%) controls (p<0.05). CONCLUSION: EPPs are useful for management of olecranon fractures treated via TBW: the pins do not migrate and can reduce complications, discomfort, secondary displacement, and the hardware removal rate. LEVEL OF EVIDENCE: Level III, retrospective comparative study.