Digital virtual reduction combined with individualized guide plate of lateral tibial condyle osteotomy for the treatment of tibial plateau fracture.

BACKGROUND: Current treatments do not support direct exposure of fracture fragments, resulting in the inability to directly observe the articular surface during surgery for accurate reduction and firm fixation. OBJECTIVE: The aim of the study was to explore the treatment effect of digital virtual reduction combined with individualized guide plate of lateral tibial condyle osteotomy on tibial plateau fracture involving the lateral posterior condyle collapse. METHODS: 41 patients with tibial plateau fracture involving the lateral posterior condyle collapse were recruited in the trial. All patients underwent Computed Tomography (CT) scanning before operation. After operation, fracture reduction was evaluated using Rasmussen score and function of knee joint was assessed using hospital for special surgery (HSS) score. RESULTS: 41 patients were followed-up 6-26 months (mean, 15.2 months). Fracture reduction was good after operation, with an average of 13.3 weeks of fracture healing without serious complications. The excellent and good rate was 97.6%. The joint movement degree was -5∘∼0∘∼135∘ with an average of 125.5∘. CONCLUSIONS: Digital virtual reduction combined with individualized guide plate of lateral tibial condyle osteotomy was effectively for treating tibial plateau fracture involving the lateral posterior condyle collapse.

A biomechanical study of a polymer material bundled rib fracture fixator.

BACKGROUND: Rib fractures are one of the most common blunt injuries, accounting for approximately 10% of all trauma patients and 60% of thoracic injuries. Multiple rib fractures, especially flail chest, can cause local chest wall softening due to the loss of rib support, leading to paradoxical breathing, severe pain, and a high likelihood of accompanying lung contusions. OBJECTIVE: This study investigates the mechanical properties of a new polymer material rib internal fixator to provide theoretical data for its clinical use. METHODS: We conducted in vitro mechanical tests on 20 fresh caudal fin sheep ribs, using different fracture models across four randomly assigned groups (five ribs per group). The fixators were assessed using non-destructive three-point bending, torsion, and unilateral compression tests, with results averaged. Additionally, finite element analysis compared stress and strain in the polymer fixators and titanium alloy rib plates during bending and torsion tests. RESULTS: In vitro tests showed that the polymer fixators handled loads effectively up to a maximum without increase beyond a certain displacement. Bending and torsion tests via finite element analysis showed the polymer material sustained lower maximum equivalent stresses (84.455 MPa and 14.426 MPa) compared to titanium alloy plates (219.88 MPa and 46.47 MPa). CONCLUSION: The polymer rib fixator demonstrated sufficient strength for rib fracture fixation and was superior in stress management compared to titanium alloy plates in both bending and torsion tests, supporting its potential clinical application.

Clinical Outcomes of Dental Implant Fractures: A Case Series and Analysis of Influencing Factors.

OBJECTIVE: To observe and analyse patients with dental implant fracture and explore the factors influencing the fracture with the aim of providing reference for physicians' clinical work. METHODS: The clinical data of 19 patients with dental implant fracture who visited the Department of Implantology of our hospital between 2007 and 2019 were retrospectively observed and analysed, and the fracture's influencing factors (e.g. the fracted implant site, implant diameter and connection mode, upper prosthetic method and fracture site) were analysed and investigated. RESULTS: The fractured implants comprised 12 Straumann implants (5 fractured at the smooth dental neck and 7 atop the central screws), 5 Bego implants (4 fractured at the smooth dental neck and 1 atop the central screw), 3 Lifecore implants fractured atop the central screws and 1 Anthogyr implant fractured atop the central screw. Of the 19 patients, 6 had anterior dental implant fracture, and 13 had posterior dental implant fracture (21 fractured implants in total). Maxillary anterior dental implant fracture was observed in 6 patients (8 implants), maxillary posterior implant fracture was observed in 3 patients (3 implants), and mandibular posterior dental implant fracture was observed in 10 patients (10 implants). CONCLUSIONS: A good implant system design, appropriate implant diameter and reasonable upper prosthetic method are key to maintaining long-term stability of a dental implant.

Real-world efficacy of a teriparatide biosimilar (RGB-10) compared with reference teriparatide on bone mineral density, trabecular bone score, and bone parameters assessed using quantitative ultrasound, 3D-SHAPER® and high-resolution peripheral computer tomography in postmenopausal women with osteoporosis and very high fracture risk.

A retrospective analysis comparing a teriparatide biosimilar (RGB-10) with reference teriparatide for osteoporosis treatment in postmenopausal women at high fracture risk found them to be therapeutically equivalent. Both provided significant improvements in lumber spine BMD, TBS, and other parameters of bone health, assessed using multiple diagnostic methods. PURPOSE: To compare the therapeutic efficacy of a teriparatide biosimilar (RGB-10) with reference teriparatide for the treatment of osteoporosis in postmenopausal women at very high fracture risk. METHODS: A retrospective analysis of 25 postmenopausal female patients treated for osteoporosis with RGB-10 for 24 months and a matched cohort of 25 patients treated with reference teriparatide. The following outcomes were assessed at baseline, 12 and 24 months: bone mineral density (BMD) at the lumbar spine, femoral neck and total hip using dual-energy x-ray absorptiometry (DXA) and integral, trabecular and cortical volumetric and surface BMD using 3D-SHAPER® imaging, trabecular bone score (TBS), quantitative ultrasound (QUS) measurements, and high-resolution peripheral quantitative computed tomography (HRpQCT) imaging of the radius and tibia. RESULTS: No significant differences were observed between treatment groups in any of the measured parameters of BMD or bone health at baseline as well as in any timepoint when assessed using these various diagnostic methods. Both compounds provided equivalent significant improvements from baseline in measures of osteoporosis and fracture risk. CONCLUSION: The results of the analysis demonstrate the therapeutic equivalence of the teriparatide biosimilar (RGB-10) to reference teriparatide for the treatment of osteoporosis in postmenopausal women at very high risk of fracture.

The management of critical bone defects: outcomes of a systematic approach.

BACKGROUND: The reconstruction of segmental long bone defects remains one of 'The holy grails of orthopaedics'. The optimal treatment of which remains a topic of great debate. This study aimed to evaluate the outcomes following the management of critical-sized bone defects using a classification-based treatment algorithm. METHODS: A retrospective review of all patients undergoing treatment for segmental diaphyseal defects of long bones at a tertiary-level limb reconstruction unit between January 2016 and December 2021, was performed. The management of the bone defect was standardised as per the classification by Ferreira and Tanwar (2020). RESULTS: A total of 96 patients (mean age 39.8, SD 15.2) with a minimum six months follow-up were included. Most bone defects were the result of open fractures (75/96) with 67% associated with Gustilo-Anderson IIIB injuries. There was a statistical difference in the likelihood of union between treatment strategies with more than 90% of cases undergoing acute shortening and bone transport achieving union and only 72% of cases undergoing the induced membrane technique consolidating (p = 0.049). Of those defects that consolidated, there was no difference in the time to bone union between strategies (p = 0.308) with an overall median time to union 8.33 months (95% CI 7.4 - 9.2 months). The induced membrane technique was associated with a 40% risk of sepsis. CONCLUSION: This study reported the outcomes of a standardised approach to the management of critical-sized bone defects. Whilst overall results were supportive of this approach, the outcomes associated with the induced membrane technique require further refinement of its indications in the management of critical-sized bone defects.

Sex differences and predictors of anti-osteoporosis medication use in the 12 months after hip fracture surgery in adults 65 or older.

PURPOSE: This study evaluates sex differences and predictors of anti-osteoporosis medication (AOM) use following a hip fracture, with a focus on older men who exhibit higher mortality rates post-fracture compared to women over the age of 65. METHODS: Participants included 151 men and 161 women aged 65 and older with hip fractures. The outcome, AOM use, was assessed at baseline (≤ 22 days of hospitalization) and at 2, 6, and 12 months post-hip fracture. Generalized estimating equations (GEE) modeled sex differences and predictors of AOM use during the year post-fracture in 255 participants with complete baseline data and ≥ 1 follow-up observation. RESULTS: Of the 312 participants, only 53 used AOM at baseline, and 35 initiated use during follow-up. In the unadjusted GEE model, AOM use was significantly less likely in men (OR = 0.42; 95% CI, 0.22-0.78) compared to women. For both men and women, baseline use of AOM was a significant predictor (OR = 28.3; 95% CI, 5.4-148.0 vs. 41.6; 95% CI, 14.0-123.0). The other significant predictors by sex were osteoporosis diagnosis (OR = 3.19; 95% CI, 1.16-8.77) and minimal alcohol use (OR = 3.26; 95% CI, 1.34-7.94) for women versus age (OR = 1.09; 95% CI, 1.01-1.18) for men. CONCLUSION: In older adults with hip fractures, AOM use is low over the year post-fracture and men are less likely to report AOM use compared to women which has implications for important sex differences in predictors of use. Further research is needed to address overall disparities and sex differences in AOM use.

Is clinician reported practice in Western Australian emergency departments aligned with direct discharge pathway protocols for minor self-limiting fractures? A multi-centre professional survey.

OBJECTIVE: To determine ED clinician's current management for five common minor self-limiting fractures (MSLF) and evaluate practice against evidence-informed direct discharge pathway (DD) protocols. METHODS: A survey was provided to doctors, nurse practitioners and advanced scope physiotherapists working in seven metropolitan, public health EDs in Perth, Australia. The relative odds of ED location (e.g. which facility) and clinician level factors (e.g. country of initial training, years of ED experience, profession) on recommending care completely consistent with evidence informed direct discharge pathway protocols were estimated. RESULTS: Two hundred sixty-two clinicians completed the survey. There was variability in practice across all sites, with most reported care assessed at 60%-76% consistency with individual elements of DD care provision. Highest consistency was seen in lower limb immobilisation and DVT prophylaxis. Lowest consistency was seen in weight bearing advice, pain management and (boxer's) fracture reduction and immobilisation. There were very low levels of complete consistency, ranging from 9% (boxer's fracture) to 25% (radial head fracture). Two factors were associated with increased odds of completely consistent care: (i) clinician experience working in ED, with greater duration of practice associated with increased odds ratios (OR range, 1.6-3.3); and (ii) profession, where advanced scope physiotherapy was associated with increased odds ratios (OR range, 3.2-25.0). CONCLUSIONS: Survey results suggested system wide variation in ED fracture management practice and target areas for service improvement. Avenues for service improvement could include hospital wide agreed management plans for specific fractures and support for less experienced clinicians.

Post-traumatic Total Hip Arthroplasty After Acetabular Fractures: Benefits of the Hardinge Approach.

Post-traumatic arthritis is a common sequelae after undergoing open reduction and internal fixation (ORIF) of acetabular fractures. This often necessitates conversion to total hip arthroplasty (THA) to help alleviate pain and improve function for these patients. Unfortunately, dislocation rates for post-traumatic THA have been alarmingly high especially when the posterior approach has been used. In the setting of prior soft tissue disruption, the theoretical risk of dislocation is even greater. Conversely, the lateral or the abductor-split approach (Hardinge) is associated with decreased dislocation rates. In this retrospective case series, we evaluated the dislocation rate of the Hardinge approach on patients who underwent THA after developing post-traumatic arthritis after acetabulum ORIF. All patients who matched CPT code 27132 (Repair, Revision, and/or Reconstruction Procedures on the Pelvis and Hip Joint), from January 2009 to December 2019, and treated by the senior author, were pulled from the electronic medical record at the University of Pittsburgh Medical Center. Thirty-one of the resultant 110 were treated with THA for post-traumatic arthrosis through a lateral, abductor-splitting Hardinge approach and met the inclusion criteria for further study. Our case series involves 31 patients who underwent post-traumatic THA through a Hardinge approach: the mean age at the time of index acetabular ORIF is 48.5 years, the mean age at the time of THA is 53.5 years, and the mean interval between ORIF and ultimate THA was five years. The mean length of follow-up after THA was 22.4 months. Overall, patients did well with an all-cause revision rate of 9.7%, with no revision performed for loosening of either the acetabular or femoral component. One patient developed an infection. No patient in our group sustained a dislocation, and all implants were stable without evidence of radiographic loosening at the final follow-up. This study found satisfactory results with patients undergoing THA via lateral or abductor split approach (Hardinge) for post-traumatic arthritis after acetabular ORIF. The use of a Hardinge approach for post-traumatic reconstruction of the hip may be protective against dislocation without increasing baseline risks in this difficult patient population.

Effect of Comprehensive Rehabilitation Training Based on Balance Function on Postoperative Recovery and Function of Hip Fracture in the Elderly: A Systematic Review and Meta-Analysis.

Introduction: In China, the proportion of the elderly population is gradually increasing, followed by the increasing medical demands of elderly patients. Hip fracture is a common fracture in the elderly. The elderly are prone to serious postoperative complications, resulting in failure to restore normal hip function, which seriously affects patients' quality of life and further increases their mortality rate. Thus, hip fracture represents a remarkable public health issue within the realm of geriatric medical care. Significance: This study systematically evaluated the impact of comprehensive rehabilitation training, with a focus on balance function, on elderly individuals with hip fractures' postoperative recovery and functional outcomes. Result: Results showed a significant difference in BBS scores favoring comprehensive rehabilitation training based on balance function over conventional intervention. Similarly, AM-PAC scores favored the balance-focused training. TUTG meta-analysis indicated its adoption in comprehensive rehabilitation training. FIM scores showed improvement with balance-focused training. Harris score meta-analysis also favored this approach. A funnel plot analysis revealed potential publication bias, likely due to study heterogeneity and limited publications. Conclusions: In conclusion, comprehensive rehabilitation training centered around balance function displayed clinical efficacy in enhancing postoperative hip joint function in elderly hip fracture patients. This approach improved balance, coordination, and posture control, facilitating lower limb function recovery and overall prognosis. It holds promise as a valuable treatment approach.

Calcaneal distraction vs. cast immobilization for the preoperative treatment of patients with Danis-Weber type C ankle fractures: a case-control study.

Introduction: Ankle fractures require temporary fixation to allow swelling to subside prior to surgery; this is typically achieved using calcaneal distraction or cast immobilization. We compared the results of these methods in the treatment of Danis-Weber type C ankle fractures. Methods: This retrospective study analyzed the data of 86 patients with Danis-Weber type C ankle fractures, of whom 40 underwent calcaneal distraction and 46 underwent cast immobilization. Clinical measures including preoperative detumescence time, daily swelling value, skin condition, and pain, SF-36 Health Survey (SF-36) score and ankle scores were compared between the two groups. Results: Baseline characteristics did not differ significantly between the groups. Calcaneal distraction resulted in a lower preoperative detumescence time (6.22 ± 0.64 vs. 8.94 ± 0.82 days) and lower daily swelling values compared with cast immobilization, leading to a lower skin necrosis rate. Resting pain scores were significantly lower in the calcaneal distraction group than in the cast immobilization group at various postoperative time points (P < 0.05). Ankle function scores were higher in the calcaneal distraction group than in the cast immobilization group at 12 months postoperatively (P < 0.05), indicating improved outcomes. Additionally, the SF-36 quality of life scores of patients undergoing calcaneal distraction were notably superior to those in the cast immobilization group. Discussion: Calcaneal distraction is superior to cast immobilization in reducing soft tissue swelling, alleviating pain, and enhancing ankle function recovery in patients with Danis-Weber type C ankle fractures. Early calcaneal distraction upon hospital admission is recommended to optimize surgical outcomes.

Extra Medullary Fixation in Unstable Proximal Femoral Fractures by PF-LCP.

Purpose: Perception that extra-medullary fixation of these fractures are fraught with difficulties and deficiencies is becoming inappropriate. This device provides angular stable fixation retaining fracture biology with minimum interference to osseous and soft-tissue vascularity and it does not require reaming which destroys 80% of endosteal vasculature for 6-12 weeks. PFLCP averts iatrogenic fracture in lateral trochanteric wall (LTW) which is frequent with DHS, protects LTW from secondary fracture in post-operative period. Aim is to assess outcome of unstable proximal femur fracture fixation by PFLCP. Methods: Study included 64 from 2016 to 2020, divided in two groups. (A) Unstable intertrochanteric fracture and (B) subtrochanteric fracture (Seinsheimer types II-V). All fractures fixed by MIPO with PFLCP. Loss of reduction, infection, cut-out, cut-through, backing of screws, bending or breaking of plate and screw, malunion, non-union and revision were evaluated. Fracture healing and functional recovery assessed by Reborne Score and Parker Mobility Score (PMS) respectively. Results: Out of 64, 24 achieved pre-injury PMS, 32 declined by 1 point, 6 declined by 2 points and 1 by 3 points, one required revision. Using various parameters 37.5% patients had excellent results and 50% had good results, 9.38% had average and 3.12% had poor result. None reported non-union or breakage of plate. Conclusions: PFLCP provides angular stable fixation, torsional stability with high biomechanical strength to resist deforming stresses. MIPO avoids soft-tissue stripping reducing blood-loss, retains periosteal blood supply to inter-fragmentary bone fragments, enhancing fracture healing, reducing complications, such as delayed healing, nonunion, infection and implant failure.

Investigation of Novel Radiological Parameters to Predict Treatment Failure and Ideal Surgical Interventions in Young Femoral Neck Fractures Treated with Triple Cannulated Screw: A Retrospective Analysis.

Introduction: Treatment failure remains a challenge in young femoral neck fractures treated with triple cannulated screws (TCS). This study aims to identify novel radiological parameters that can predict treatment failure and propose surgical techniques to enhance the success of TCS or aid in selecting alternative methods. Patients and methods: We conducted a retrospective analysis of 87 patients who underwent surgery for femoral neck fractures between February 2014 and June 2022, meeting the inclusion criteria. Patients achieving union were categorized as Non-Fail (Group 1), while those experiencing nonunion were categorized as Fail (Group 2). Various demographic and clinical factors were assessed, including age, gender, fracture side, and fracture classification (Garden and Pauwels). Radiological parameters such as fragmentation in the medial cortex, postoperative fracture displacement in the calcar region, collo-diaphyseal angle (CDA) difference (varus/valgus alignment), and several newly defined parameters (modified tip apex distance (m-TAD), tip cortex distance (TCD), upper-lower screw-cortex distance/neck diameter, the calcar screw-cortex distance/neck diameter (Buyukdogan index), and sub-capital area/basocervical area (Dogan index) were evaluated. Patients developing nonunion were studied to establish potential cut-off values based on radiological parameters. Results: Of the patients, 61 were classified as Non-Fail (Group 1) and 26 as Fail (Group 2). Both groups exhibited similar distributions in terms of gender, fracture side, Pauwels classification, and follow-up times (p > 0.05). However, Group 2 had a higher mean age than Group 1 (p = 0.006). There was a significant difference between the two groups in terms of Garden classification (p = 0.0003). Furthermore, postoperative calcar displacement, varus alignment, m-TAD, TCD, upper-lower screw-cortex distance/neck diameter ratio, Buyukdogan index, and Dogan index showed significant differences between the groups (p < 0.05). Conversely, medial calcar fragmentation did not differ significantly between the groups (p > 0.05). Conclusions: The Dogan index (≤ 0.5) can serve as an independent preoperative predictor of treatment failure, aiding in the selection of more effective surgical interventions than TCS. Varus alignment (> 10 degrees), the upper-lower screw-cortex distance to the neck diameter (> 0.45) and Buyukdogan index (> 0.2) are influenced by the surgical technique of TCS application and should be considered to decrease the success of TCS.

Management of oblique root fracture in the middle third of two maxillary immature central incisors with severe caries in mixed dentitions: a case report.

Mid-root fractures are rare injuries in young permanent teeth and tend to have poor prognoses. This study presents a case of oblique root fracture of both maxillary immature central incisors in the middle third accompanied by delayed dental visit and severe caries of all primary teeth. After restoring all the primary and permanent teeth that needed stabilization, the coronal fragments were repositioned and stabilized with a flexible splint consisting of orthodontic wire and composite resin. A comprehensive and sequential dental treatment for other oral diseases and oral hygiene instructions were provided. A 16-month follow-up revealed that the two injured young permanent incisors were healed, surrounded by hard tissues and continued to grow both in length of the root and thickness of the root canal wall, with significant improvement in oral hygiene. Based on the outcome of this case, initial stabilization without endodontic therapy could be considered a successful treatment modality for young permanent teeth with oblique root fracture due to the growth of fractured teeth with vital pulp and the maintenance of natural dentition.

Do we need another screw? Sacroiliac screw fixation in open-book pelvic ring injuries (APC type II).

Purpose: To compare anterior plate fixation (SP fixation) both alone and in combination with an additional posterior sacroiliac screw (SP+SIS fixation) as a treatment for pelvic ring injuries with widening of the pubic symphysis and disruption to the anterior sacroiliac ligaments. Methods: To find studies with pelvic ring injuries (APC II; B2.3d) and SP or SP+SIS fixation, a systematic literature review was conducted by searching four databases. A protocol was published a priori at Open Science Framework (https://doi.org/10.17605/OSF.IO/3YHAV). Exclusion criteria included perineal injuries, chronic instability of the symphysis, complete sacroiliac separation, and pediatric patients (age <18 years). Primary outcomes of interest were defined as implant failure, health-related quality of life, and revision rate. Results: Altogether, 1861 studies were screened, and 40 studies qualified for full-text analysis. In total, 14 studies (two surveys, six biomechanical studies, and six retrospective clinical studies) were included. The surveys revealed that surgeons who had more recently begun practicing were more likely to use posterior fixation (SP+ISS). The biomechanical studies were heterogenous and did not yield a uniform pattern. In clinical studies, 117 patients (45%) received SP fixation, and 142 patients (55%) received SP+SIS fixation. Complications occurred in 31 SP patients (30%) and in five SP+SIS patients (3.5%). Conclusion: A high risk of bias was uncovered, and reporting was found to be incomplete. SP+SIS may have the potential to improve outcomes, but the evidence remains too inconclusive to draw reliable recommendations.

Femoral Neck Shaft Angle Measurement for Differentiating Femoral Head Stress Fracture from Avascular Necrosis.

OBJECTIVE: The study aimed to evaluate whether the measurement of Femoral Neck Shaft Angle (FNSA) can be helpful in differentiating femoral head Stress Fracture (SF) from Avascular Necrosis (AVN). METHODS: From September 2019 to April 2022, sixty-four patients [median age 32.0 years, interquartile range (IQR) 23.0-39.0 years] who underwent both hip radiograph and Magnetic Resonance Imaging (MRI) and diagnosed as femoral head SF or AVN were included in our retrospective study. Patients were divided into as having either femoral head SF (n = 34) or AVN (n = 30). The FNSA was measured in anteroposterior hip radiography. Continuous values were compared using the Mann-Whitney U test. The assessment of the predictive value of FNSA for femoral head SF was performed by Receiver Operating Characteristic (ROC) analysis. RESULTS: The FNSA was significantly higher in patients with SF (median 133.5°, IQR 128.0-136.7°) than those with AVN (median 127.5°, IQR 124.0-132.0°) (p = 0.001). In addition, the FNSA was significantly higher in SF femurs (median 134.8°, IQR 129.2-137.4°) than in contralateral normal femurs (median 127.1°, IQR 124.3-132.5°) in patients with unilateral femoral head SF (n = 30) (p < 0.001). In ROC analysis, the sensitivity, specificity, and Area Under the Curve (AUC) for predicting the femoral head SF were 77.3%, 63.3%, and 0.785 (95% confidence interval: 0.666-0.905), respectively, at a cutoff of 130.2°. CONCLUSION: Increased FNSA was associated with femoral head SF; thus, measurement of FNSA could be helpful for differentiating femoral head SF from AVN.

Feasibility of intentional bioprosthetic valve fracture in the tricuspid position.

BACKGROUND: Transcatheter tricuspid valve-in-valve (ViV) replacement has yielded good hemodynamic outcomes in the treatment of dysfunctional bioprosthetic valves (BPVs). Intentional fracture of certain rigid BPV frames, if feasible, allows a larger implanted valve when compared with implant into an unfractured BPV. There remains limited data on the feasibility of tricuspid valve frame fracture. AIMS: Evaluate the feasibility of transcatheter tricuspid ViV replatement with fracture of the underlying BPV ring. METHODS: An international multicenter registry of tricuspid ViV replacement with intentional tricuspid valve frame fracture was created. Demographic data along with procedural characteristics, outcomes, and follow-up data were collected. Comparison was made to the pre- and post-ViV replacement with fracture of the tricuspid valve frame conditions. RESULTS: Ten patients from six centers were included with a median age and weight of 29 years and 67.3 kg respectively. Tricuspid valve frame fracture was performed using a median balloon diameter 3 mm (IQR 3-5) larger than the true inner diameter (ID). The final ID was a mean of 1.5 mm (95% CI: 0.35, 2.64: p < 0.05), and median 1.1 mm (0.5, 2.1) larger than the reported true ID of the surgical BPV after ViV replacement. The mean tricuspid inflow gradient by echocardiogram decreased by 6.65 mmHg (95% CI: 4.14, 9.15: p < 0.001). All procedures were without complication, specifically there was no heart block, pericardial effusion, or right coronary disruption. CONCLUSION: Intentional tricuspid valve frame fracture with tricuspid ViV replacement is feasible and can increase the valve orifice potentially reducing the risk of ViV patient prosthesis mismatch and is not associated with significant complications.

Determination of the best point of entry of percutaneous insertion of sacroiliac screws depending on patient positioning for surgery: A cadaveric study.

BACKGROUND: The standard starting point for percutaneous sacroiliac screw insertion was initially determined at the intersection of the line posterior to the anterior superior iliac spine and the line continuing the anatomical axis of the femur. The technique was pioneered in patients lying prone in surgery, although it has been used with patients in the supine position. The optimal starting point for patients in both prone and supine positions remains uncertain. OBJECTIVES: This cadaveric study aimed to determine the best entry point for the percutaneous insertion of sacroiliac screws depending on the patient's positioning for surgery. MATERIAL AND METHODS: Kirschner wires (K-wires) were percutaneously inserted into the sacral body of 8th human cadavers. In addition to the so-called standard sacroiliac screw entry point (point A), points located consecutively 1 cm (point B) and 2 cm (point C) cranially from the point along the line, prolonging the femoral axis were also studied. The K-wires were inserted into the studied entry points on the right side in a supine position and on the left side of the same cadaver in a prone position. The placement of the K-wires was assessed using radiographic imaging and cadaver dissection. RESULTS: An analysis of the K-wire placement in the supine position revealed incorrect positioning of 100% of the K-wires inserted at entry point A and 87% at entry point B. All the K-wires inserted in the supine position at entry point C were correctly placed. All K-wires inserted in the prone position were correctly positioned. CONCLUSIONS: All 3 studied entry points enabled the correct placement of orthopedic implants for prone position surgery. The best entry point for surgery performed in the supine position was located 2 cm cranially from the standard entry point, along the line prolonging the femoral axis.

Fascia Iliaca Block Combined with Low-dose Spinal Anesthesia for Hip Fracture Surgery in the Elderly: Effects on Severe Hypotension and Analgesia. A Randomized Controlled Trial.

BACKGROUND: Hip fracture surgeries in elderly patients often require spinal or general anesthesia, posing risks of severe hypotension and inadequate pain management. The optimal anesthesia type for minimizing these risks remains undetermined. Preliminary studies suggest that a combination of fascia iliaca block (FIB) and low-dose low-specific-gravity spinal anesthesia (LLSA) might offer a solution, but comprehensive evidence is lacking. OBJECTIVES: This study aimed to assess the efficacy of combining FIB with LLSA for reducing severe hypotension and enhancing analgesia during hip fracture surgery in elderly patients. STUDY DESIGN: A prospective, randomized controlled trial was conducted. SETTING: An operating theatre of a tertiary hospital. METHODS: The study comprised 68 patients. They were separated into 2 equal parallel groups 34 patients each: the FIB+LLSA group and the general anesthesia (GA) group. Patients aged 75-96 undergoing primary hip arthroplasty for hip fracture were randomized to receive either FIB+LLSA or GA. The primary outcome was the incidence of severe hypotension; secondary outcomes included postoperative pain, use of rescue analgesia, vasopressor dosage, and complications. RESULTS: We found a significantly lower incidence of severe hypotension in the FIB+LLSA group compared to the GA group (32.4% vs 67.6%). Additionally, postoperative pain scores were significantly lower, and the need for rescue analgesia was reduced in the FIB+LLSA group. Vasopressor use during surgery was also significantly lower in the FIB+LLSA group. The hospital stay was shorter in the FIB+LLSA group, with an average of 5.9 days compared to 6.7 days in the GA group. LIMITATIONS: The study's limitations include its single-center nature, which may limit the generalizability of the findings. Additionally, the inability to conduct a double-blind study could introduce biases, though measures were taken to minimize this. The sample size might not be sufficient to determine the broader implications of LLSA. CONCLUSIONS: Combining FIB with LLSA for elderly patients undergoing hip fracture surgery significantly reduces the incidence of severe intraoperative hypotension and postoperative pain. It also decreases the need for rescue analgesia and shortens hospital stays, suggesting that FIB+LLSA could be a beneficial regional anesthesia technique for elderly hip fracture surgery patients, aligning with enhanced recovery protocols.

Development of Symptomatic Adjacent and Remote Level Compression Fractures Following Balloon-assisted Kyphoplasty in a Series of 1,318 Patients.

BACKGROUND: Balloon-assisted kyphoplasty (BAK) is a minimally invasive procedure to treat vertebral compression fractures (VCF). BAK not only restores vertebral height and corrects kyphotic deformity by cement augmentation, but it also may alter spinal biomechanics, leading to subsequent adjacent level VCFs. OBJECTIVES: This study aims to investigate the timing, location, and incidence of new VCFs following BAK and identify the risk factors associated with their occurrence. STUDY DESIGN: Single-institution observational study. METHODS: A prospectively collected cohort of 1,318 patients who underwent BAK by a single-surgeon from 2001 through 2022 was analyzed. The patients had pain that was unresponsive to nonsurgical management and a VCF secondary to osteoporosis, trauma, or neoplasm. The time between the index and subsequent fracture, fracture level, number of initial fractures, age, body mass index (BMI), tobacco use, and chronic corticosteroid use were recorded. RESULTS: Of 1,318 patients, 204 (15.5%) patients underwent a second BAK procedure an average of 373 days following BAK (range: 2-3,235 days). Third, fourth, and fifth procedures were less common (45, 12, and 6 patients, respectively). A total of 142 patients (69.6%) developed a subsequent fracture adjacent to the index level; adjacent and remote level fractures developed at different times (mean: 282 vs 581 days, P = 0.001). Patients treated for multiple VCFs in a single surgery were more likely to develop subsequent VCFs (P = 0.024) and at adjacent levels (P = 0.007). Subsequent VCFs were associated with older age (P < 0.001), women (P = 0.045), osteoporosis (P < 0.001), and chronic corticosteroid use (P < 0.001). A subgroup analysis of 812 (61.6%) patients who underwent BAK for degenerative indications revealed that osteoporosis (b = 0.09; 95% CI, 0.03-0.16; P = 0.005) and chronic corticosteroid use (b = 0.06; 95% CI, 0-0.11; P = 0.055) were associated with adjacent level fracture. For the entire cohort, almost every patient treated for both a thoracic and lumbar fracture (92.3%) developed an adjacent level second fracture (P = 0.005). LIMITATIONS: The true incidence of post-BAK fractures may be underestimated as surveillance is not routine in asymptomatic or osteoporotic patients. CONCLUSIONS: Symptomatic post-BAK VCFs are infrequent and may occur long after the initial procedure. Nearly two-thirds of subsequent fractures in our study occurred adjacent to the initially treated level; almost every patient who suffered thoracic and lumbar fractures at the same time developed an adjacent level second fracture. Additionally, osteoporosis and chronic corticosteroid use were associated with adjacent level fractures in patients who underwent surgery for degenerative indications.