Is the occurrence of extra-articular calcaneal fractures of the joint depression type related to osteoporosis and aging?

PURPOSE: The authors experienced several cases of extra-articular calcaneal fracture accompanied by joint depression involving the entire posterior facet without joint involvement. This type of fracture and its characteristics and treatment outcomes have not been previously reported. The study was performed to analyze the characteristics of extra-articular calcaneal fractures of the joint depression type and their postoperative clinical and radiographic results and complications. METHODS: Between February 2013 and March 2021, 23 extra-articular calcaneal fractures of the joint depression type were consecutively treated by a single surgeon. Relationships between fracture characteristics and patient demographics were assessed. Clinical results were quantified using visual analog scale, American Orthopaedic Foot and Ankle Society ankle-hindfoot scale, and Foot Function Index, radiographic results were evaluated using Böhler's angles, and calcaneal widths were determined using calcaneal axial and lateral radiographs obtained preoperatively and at last follow-up. RESULTS: Twenty (87%) of the 23 cases occurred in women, and the mean age of all patients was 65.8 years (43-90). The three men were older than 65. Five (21.7%) patients had osteopenia, and 12 (52.2%) had osteoporosis. Bone mineral density testing could not be performed in the other six patients. Clinical and radiographic results were significantly improved after surgery. CONCLUSION: Extra-articular calcaneal fractures of the joint depression type are much more common in women and occur at an older age than calcaneal fractures commonly occur. These fractures are also more common in patients with a low bone mineral density. LEVEL OF EVIDENCE: Level IV.

The efficacy of physeal bar resection with guided growth in the treatment of physeal arrest with angular limb deformity.

Premature physeal arrest can cause progressive deformities and functional disabilities of the lower limbs. This study addressed the outcomes after physeal bar resection with or without guided growth (temporary hemiepiphysiodesis) for the treatment of angular limb deformities. We retrospectively analyzed 27 patients (mean 9 years; range, 3-12 years) who underwent physeal bar resection of the distal femur (15 patients), proximal tibia (3 patients), and distal tibia (9 patients) between 2002 and 2020. Fifteen patients underwent physeal bar resection only (Group A), and the other twelve underwent simultaneous guided growth (Group B). The correction angle (angle change between the preoperative and last follow-up values) was compared and analyzed. The overall mean correction angle was 2.9° (range, - 9 to 18.3°). A total of 12 (45%) patients had a > 5° angular deformity improvement (mean, 9.6°; range, 5-18.3°), 9 (33%) had a < 5° angular change; and 6 (22%) had a > 5° worsening of the angular deformity (mean, 6.7°; range, 5.2-9°). The correction angle in Group B (mean 7.6° ± 6.2) was significantly higher than that in Group A (mean - 0.77° ± 6.3) (P = 0.01). We found six (40%) and zero patients with a > 5° angular deformity increase in Groups A and B, respectively (P < 0.047). The group that underwent physeal bar resection with guided growth showed significantly higher correction angles than the group that underwent physeal bar resection alone. Additionally, none of the patients in the guided growth group experienced an increased angular deformity. Therefore, combining guided growth with physeal bar resection may lead to better outcomes in the treatment of growth arrest with angular deformities.

Comparative biomechanical analysis of reconstruction and cephalomedullary nails in the treatment of osteoporotic subtrochanteric fractures.

INTRODUCTION: This study aimed to compare the biomechanical properties of two types of intramedullary nails - reconstruction nails (RCN) and cephalomedullary nails (CMN) - each with different proximal fixations, in a model of an osteoporotic subtrochanteric femoral fracture. This study focused on assessing stiffness and load to failure of RCN and CMN nails to provide insight into their clinical applications in osteoporotic fracture treatments. MATERIALS AND METHODS: Ten synthetic osteoporotic femoral models were used to generate a comminuted subtrochanteric fracture model. Five femurs were fixed using an RCN, and the remaining five were fixed using a CMN. The constructs were subjected to axial compression to measure their structural stiffness, load to failure, and failure modes. RESULTS: The CMN group demonstrated a slightly higher load to failure (mean, 2250 N) than the RCN group (mean, 2100 N), which was statistically significant (p = 0.008). However, the stiffness in both groups was statistically similar (RCN, 250 N/mm; CMN, 255 N/mm; p = 0.69). Both groups showed a load to failure exceeding 1500 N, a typically exerted load on the femoral head by a 75 kg individual. The failure patterns differed, with CMN failures starting at the nail insertion area and RCN failures starting at the reconstruction screw area. CONCLUSION: The RCN offers stiffness comparable to that of the CMN; although its load to failure is slightly lower than that of the CMN, it still exceeds the physiological tolerance limit. These findings suggest that the RCN is a viable alternative for treating osteoporotic subtrochanteric fractures.

Induced membrane technique with plate fixation has a lower complication rate than bone transport over a plate for segmental tibial defects larger than 5 cm.

INTRODUCTION: The treatment of segmental tibial bone defects remains a surgical challenge. While Bone Transport (BT) and Induced Membrane Technique (IMT) are effective strategies for regenerating bone, there are few comparative studies between them. This investigation undertakes a comparative analysis of BT and IMT for large segmental tibial defects stabilised through plate fixation. MATERIALS AND METHODS: Patients with segmental tibial defects exceeding 5 cm were prospectively enrolled from 2008 to 2021 in a single institution, with a minimum follow-up duration of two years. All patients underwent either BT or IMT with plate fixation of the tibia. Procedural success, primary union as well as bone and functional outcome scores were compared. Complications, including non-unions, joint contractures and deep infections requiring surgical intervention, were also compared. RESULTS: 41 patients were recruited in total. 28 patients underwent Bone Transport Over a Plate (BTOP), while 13 patients underwent IMT with Plate fixation (IMTP). The procedural success rate trended higher in IMTP compared to BTOP (100% vs. 85.7%). The primary union rate also trended higher in IMTP compared to BTOP (92.3% vs. 79.2%). BTOP and IMTP achieved similar rates of satisfactory bone outcome scores (78.6% vs. 84.6%) and functional outcome scores (75% vs. 76.5%). There was no statistical difference between procedural success, primary union, bone and functional outcome scores. The complication rate in BTOP was 78.6% (22 of 28), including five docking site or regenerate non-unions, eight deep infections and nine joint contractures. IMTP had a 38.5% (5 of 13) complication rate, including one non-union, two deep infections and two joint contractures. The complication rate was 2.04 times higher in BTOP compared to IMTP (p = 0.0117). CONCLUSIONS: BTOP and IMTP are both equally effective techniques for regenerating bone in large tibial bone defects. However, IMTP may be a safer procedure than BTOP, with a lower probability of requiring additional procedures to address complications.