Radiographic outcomes and non-union factor analysis in fragmentary segmental femoral shaft fractures (AO/OTA 32C3) treated with reamed antegrade nailing.

This study retrospectively assessed radiographic outcomes and risk factors associated with non-union in femoral shaft fragmentary segmental fractures (AO/OTA 32C3) treated with reamed antegrade intra-medullary nailing. Radiological outcomes, including union and alignment, were evaluated. The risk factors for non-union were investigated, including demographics and treatment-related characteristics, such as the number of interlocking screws, segmentation length, main third fragment length, distance of the main third fragment, width ratio and exposed nail length in one cortex from immediate post-operative radiographs. Multivariate logistic regression was used for statistical analysis. Among 2295 femoral shaft fracture patients from three level-1 trauma centers, 51 met the inclusion criteria. The radiological union was achieved in 37 patients (73%) with a mean union time of 10.7 ± 4.8 months. The acceptable axial alignment was observed in 30 patients (59%). Multiple logistic regression analysis identified only exposed nail length as a significant risk factor for non-union (odds ratio: 1.599, p = 0.003) and the cut-off value was 19.1 mm (sensitivity, 0.786; specificity, 0.811). The study revealed high rates of non-union (27%) and malalignment (41%). Therefore, patients who underwent intramedullary nailing with an exposed nail length greater than 19.1 mm or about twice the nail diameter should be cautioned of the potential non-union.

[Treatment of open fracture bone defect of distal femur with antibiotic cement column and bone graft].

OBJECTIVE: To investigate the efficacy of antibiotic cement column combined with iliac bone graft in the treatment of open fracture with bone defect of distal femur. METHODS: From October 2014 to March 2021, 16 patients of open fracture bone defect of distal femur were treated with antibiotic bone cement column and iliac bone graft, including 12 males and 4 females. The age ranged from 28 to 68 years old. There were 11 cases of traffic accident injury, 5 cases of falling injury, 3 cases as Gustilo type Ⅰ, 5 cases as type Ⅱ and 8 cases as type ⅢA. AO classification was used:9 cases of C2 type and 7 cases of C3 type. The time from injury to final bone grafting ranged from 4 to 119 days. The length of bone defect ranged from 2 to10 cm. Fractures healing time, complications and knee function Merchan score were recorded. RESULTS: All the 16 patients were followed up from 9 to 29 months. The incisions of 16 patients healed in one stage without postoperative infection, plate fracture, limb shortening and valgus and varus deformity. The healing time randed from 4 to 10 months . Knee joint function according to the Merchant scoring standard, showed that 8 cases were excellent, 4 cases were good, 3 cases were fair, and 1 case was poor. CONCLUSION: The use of antibiotic bone cement column combined with iliac bone graft in the treatment of open and complex bone defects of distal femur is an effective surgical method to prevent infection, assist fracture reduction, increase fixation strength and significantly reduce the amount of bone grafting.

Derotational distal femur osteotomy with medial patellofemoral ligament reconstruction can get good outcomes in the treatment of recurrent patellar dislocation with excessive TT-TG and increased femoral anteversion.

Background: Surgery is the main treatment for recurrent patellar dislocation (PD). However, due to the complexity of anatomical factors, there is still a lack of consensus on the choice of combined surgical methods. This study aimed to compare the clinical and radiological outcomes of medial patellofemoral ligament reconstruction combined with derotational distal femur osteotomies (MPFLR + DDFO) and combined with tibial tubercle osteotomies (MPFLR + TTO) for recurrent PD with increased femoral anteversion angles (FAA) and excessive tibial tubercle-trochlear groove (TT-TG) distance. Methods: In this retrospective analysis, MPFLR + DDFO and MPFLR + TTO patients from 2015 to 2020 were included. Group A (MPFLR + DDFO, n = 42) and B (MPFLR + TTO, n = 46) were formed. Clinical outcomes included physical examinations, functional outcomes (Kujala, Lysholm, International Knee Documentation Committee (IKDC), visual analog scale (VAS) and intermittent and persistent osteoarthritis pain scale (ICOAP), Tegner scores), and complications. The Caton-Deschamps index (CD-I), patellar title angle, patellar congruence angle, patella-trochlear groove distance, TT-TG distance, and FAA were used to assess radiological outcomes. Results: All clinical outcomes improved significantly in both groups, but Group A had significantly better postoperative scores than Group B (Kujala: 89.8 ± 6.4 vs. 82.9 ± 7.4, P < 0.01; Lysholm: 90.9 ± 5.1 vs. 81.3 ± 6.3, P = 0.02; IKDC: 87.3 ± 9.0 vs. 82.7 ± 8.0, P < 0.01; Tegner: 6.0 (5.0, 9.0) vs. 5.0 (4.0, 8.0), P = 0.01). However, there was no significant difference in the VAS and ICOAP scores between the two groups. No dislocation recurrences occurred. Radiological outcomes improved significantly in both groups, but Group A had better outcomes. After surgery, the patellar height of 88.5% (23/26) patients in Group A and 82.8% (24/29) patients in Group B was restored to normal (the Caton-Deschamps index <1.2). Conclusions: Both MPFLR + TTO and MPFLR + DDFO obtained satisfactory clinical and radiological outcomes in the treatment of recurrent PD with increased FAA and excessive TT-TG. However, the outcomes of MPFLR + DDFO were better and should be considered a priority. MPFLR + TTO may be not necessary for such patients.

The Epidemiology of Lower Limb Fractures: A Major United Kingdom (UK) Trauma Centre Study.

INTRODUCTION: Understanding the epidemiology and incidence of fractures can help inform policymakers and clinicians about the needs of the population and highlight trends over time, allowing for tailoring of healthcare delivery to the population. This study reports on the lower limb fractures treated at a major trauma centre over a seven-year period. METHODS: We collected data on fracture locations, age, gender, BMI, hospital admission length, and treatment options of all lower limb fractures treated at a level I trauma centre from January 2015 to December 2021. We included data on the femur, tibia, and fibula, which were each split up into distinct regions. Fractures were subdivided by location and graphed, separated by gender, over age group. Finally, each location area's frequency was graphed over the entire study period. RESULTS: A total of 8,511 patients sustained 8,613 fractures, given an overall incidence of 215.9 fractures per 100,000 patients per year. The mean age was 62.3 years, and 56.3% of patients were female. Fractures of the peri trochanteric region of the femur had the highest mean average age (79.9 years), which was closely followed by fractures of the head and neck of the femur (78.2 years). Fractures of the head and neck of the femur and the peri trochanteric region of the femur also had the highest proportion of females suffering from these fractures (67 and 66% female, respectively). Femur shaft fractures had the lowest average age (36.5 years) and the lowest proportion of female patients (29%). On graphing by location, separated by gender, over age group, overall fractures showed a bi-peak distribution of younger males and older, post-menopausal females having their respective peaks. Three further distinct distributions were observed in individual location fractures. CONCLUSION: Identifying the relative incidence and demographic associations with lower limb fractures helps highlight a changing population's needs. There is an absence of such study in literature in the United Kingdom (UK) since 2006. Our study's insights and results aid clinicians and policymakers in the creation of guidelines and the distribution of resources based on the most recent information and elucidate changing healthcare service needs for the population.

Effects of Erythropoietin-Promoted Fracture Healing on Bone Turnover Markers in Cats.

In orthopaedics, erythropoietin (EPO) is applied in the preoperative management of anaemic patients, but also as a stimulating factor to assist bone regeneration due to its angiogenic and osteoinductive potential. Since orthopaedists mainly rely on their clinical experience to assess bone healing, additional and more objective methods such as studying the dynamics of bone markers are needed. Therefore, the aim of this study was to investigate the plasma activity of bone-specific alkaline phosphatase (BALP), the N-terminal propeptide of type I collagen (PINP), the C-terminal telopeptide of type I collagen (CTX), and deoxypyridinoline (DPD) during the first 2 months of healing of comminuted fractures in cats, either non-stimulated or locally stimulated with recombinant human erythropoietin (rhEPO). The study included twelve cats of mixed breeds, aged 7.2 ± 4 months, weighing 2.11 ± 1.1 kg, with comminuted diaphyseal fractures of the femur. Surgical treatment with plate osteosynthesis was performed in all animals. The cats were randomly divided into two groups-a control (n = 6) and an EPO group (n = 6). The locally applied EPO leads to the increased activity of bone formation markers (BALP and PINP) during the second week after the osteosynthesis, preceding the peaks in the control group by two weeks. The studied bone resorption markers (DPD, CTX) varied insignificantly during the studied period. In conclusion, erythropoietin could serve as a promoter of bone healing in comminuted fractures in cats.

A novel design of hip-stem with reduced strain-shielding.

The use of uncemented stems in hip arthroplasty has been increasing, even in osteoporotic patients. The major concerns of uncemented hip-stems, however, are peri-prosthetic fracture, thigh pain, and proximal femoral stress-/strain-shielding. In this study, a novel design of uncemented hip-stem is proposed that will reduce such concerns, improve osseointegration, and benefit both osteoporotic and arthritic patients. The stem has a central titanium alloy core surrounded by a set of radial buttresses that are partly porous titanium, as is the stem tip. The aim of the study was to investigate the mechanical behaviour of the proposed partly-porous design, examining load transfer in the short-term, and comparing its strain-shielding behaviour with a solid metal implant. The long-term effect of implant-induced bone remodelling was also simulated. Computed tomography based three-dimensional finite element models of an intact proximal femur, and the same femur implanted with the proposed design, were developed. Peak hip contact and major muscle forces corresponding to level-walking and stair climbing were applied. The proposed partly-porous design had approximately 50% lower strain-shielding than the solid-metal counterpart. Results of bone remodelling simulation indicated that only 16% of the total bone volume is subjected to reduction of bone density. Strain concentrations were observed in the bone around the stem-tip for both solid and porous implants; however, it was less prominent for the porous design. Lower strain-shielding and reduced bone resorption are advantageous for long-term fixation, and the reduced strain concentration around the stem-tip indicates a lower risk of peri-prosthetic fracture.

Feasibility study of femur bone with continuum model.

It is known that the geometric structures of bones are very complex. This has made researchers unable to model them with the continuum approach and suffice to model them with simulation or experimental tests. Undoubtedly, provide a simple and accurate continuum model for studying bones is always desirable. In this article, as the first serious endeavour, a suggested beam model is investigated to see whether it is suitable for modelling femur bones or not. If this model gives an acceptable answer, it can be a link to the continuum theories for beams. In other words, the approximated beam model can be formulated with continuum approach to study femur bone. For feasibility study of the approximated model for femur bones, both static and dynamic analysis of them are investigated and compared. It is found that in most cases for vibration analysis, the suggested model has acceptable results but in static analysis, the mean difference between the results is about 16%. This research is hoped to be the first serious step in this category.

Fetal Biometric Parameter Reference Charts of a Central Anatolian Turkish Population.

PURPOSE: The assessment of fetal biometry using ultrasound provides accurate pregnancy dating and also screening of fetal growth. Fetal biometry, which is common practice in the second and third trimesters of pregnancy, is fetal morphometry, which involves taking measurements of the different anatomical body parts. These fetal dimensions vary on ethnicity. The aim of this study is to demonstrate fetal biometric parameters measurement results of the Central Anatolia Turkish population with detailed percentile tables and graphs to screen fetal growth more accurately. METHODS: This cross-sectional study was performed on a total of 1132 fetuses (47% girl, and 53% boy) between 15 and 40 weeks of gestation. Biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), and femur length (FL) measurements are performed in a standardized manner every gestational week. BPD and HC were measured at the level of the thalami on the horizontal plane of the fetal head. HC was measured using the ellipse method. AC measurement was taken at the circular cross-section of the upper fetal abdomen. FL was measured along with the ossified diaphysis of the femur. All measurements were taken in millimeters. RESULTS: Pregnant women's mean age was 27.58 (17-43), and the mean body mass index was 27.68 (15.06-50.78) as demographic data. 38.13% of women had their first, 29.74% had their second, and 32.13% had three or more gestations within our study. Percentile data of fetuses for each parameter (BPD, HC, AC, and FL) and for each week were shown as tables and percentile graphics. Fetal 50th percentile measurements were compared between our study and other studies from different countries. The Kruskal-Wallis test results showed that BPD (p = 0.827), HC (p = 0.808), AC (p = 0.846), and FL (p = 0.725) values have a statistically similar mean in all studies. Hierarchical cluster analysis results showed that our results for BPD, HC, AC, and FL percentile curves have been found closer to Italian population results. However, our results were statistically different from Asian, Nigerian, non-Hispanic American, and Brazilian populations for each of the different parameters. CONCLUSION: The specialization of fetal biometric charts for a particular population can ensure a more accurate assessment of fetal growth rate. We showed fetal biometric percentile tables and graphics of the Central Anatolian Turkish population in this study. These results may provide a valuable contribution to obstetrical practice. Further studies can be conducted in different regions of Turkiye, thus comparisons could be possible over the country.

Outcomes of Distal Third Femur Fractures in Patients 18 Years and Older: A Pilot Study.

INTRODUCTION: The selection of the most optimal fixation method for fractures of the distal femur, whether intramedullary nail (NL), lateral locking plate (PL), or nail/plate (NP) is not always clear. This study retrospectively evaluates surgical patients with distal femur fractures and introduces a pilot study using cluster analysis to identify the most optimal fracture fixation method for a given fracture type. METHODS: This is a retrospective cohort study of patients 18 years and older with an isolated distal femur fracture who presented to our Level-1 trauma center between January 1, 2012, and December 31, 2022, and obtained NL, PL, or NP implants. Patients with polytrauma and those without at least six months of follow-up were excluded. A chart review was used to obtain demographics, fracture classification, fixation method, and postoperative complications. A cluster analysis was performed. The following factors were used to determine a successful outcome: ambulatory status pre-injury and 6-12 months postoperatively, infection, non-union, mortality, and implant failure. RESULTS: A total of 169 patients met inclusion criteria. No statistically significant association between the fracture classification and fixation type with overall outcome was found. However, patients treated with an NP (n = 14) had a success rate of 92.9% vs only a 68.1% success rate in those treated with a PL (n = 116) (p = 0.106). The most notable findings in the cluster analysis (15 total clusters) included transverse extraarticular fractures demonstrating 100% success if treated with NP (n = 6), 50% success with NL (n=2), and 78.57% success with PL fixation (n=14). NP constructs in complete articular fractures demonstrated success in 100% of patients (n = 5), whereas 77.78% of patients treated with NL (n = 9) and 61.36% of those treated with PL (n = 44). CONCLUSIONS: Plate fixation was the predominant fixation method used for distal third femur fractures regardless of fracture classification. However, NP constructs trended towards improved success rates, especially in complete intraarticular and transverse extraarticular fractures, suggesting the potential benefit of additional fixation with these fractures. Cluster analysis provided a heuristic way of creating patient profiles in patients with distal third femur fractures. However, a larger cohort study is needed to corroborate these findings to ultimately develop a clinical decision-making tool that also accounts for patient specific characteristics.

X-Sens Inertial Sensor Technology-Based Rehabilitation on a Patient With Posterior Cruciate Ligament Avulsion Fracture and Shaft of Femur Fracture: A Case Report.

The posterior cruciate ligament (PCL), one of the key ligaments in the knee, serves to prevent backward movement of the tibia relative to the femur. A simultaneous occurrence of a PCL avulsion fracture and a femur shaft fracture in a pediatric patient suggests a complex orthopedic injury resulting from significant trauma to the knee and thigh area. This study describes the rehabilitation process of a 12-year-old female involved in a road traffic accident, who suffered both a midshaft femur fracture and a PCL avulsion fracture. Following surgical procedures, the patient underwent a comprehensive physiotherapy regimen utilizing X-Sens inertial sensor technology. The rehabilitation plan comprised multiple stages targeting pain alleviation, muscle strengthening, flexibility exercises, gait retraining, and balance improvement. Various interventions including contrast baths, cryotherapy, patellar mobilization, isotonic and resistance exercises, and progressive gait training were integrated across different phases of the rehabilitation program. Over subsequent follow-up periods, the patient demonstrated significant enhancements in pain management, range of motion, muscle strength, functional capabilities, and gait metrics. This case report underscores the efficacy of a systematic physiotherapy strategy incorporating advanced technology in the successful recovery from intricate lower limb fractures, underscoring the importance of prompt intervention and multidisciplinary collaboration for optimal patient outcomes.

Computer Navigation-assisted Bilateral Total Knee Arthroplasty with Osteosynthesis in Single Sitting in Patients Presenting with Distal Femur Fracture with Pre-existing Knee Arthritis: A Case Series.

Background: Intra-articular and periarticular distal femur fractures with pre-existing osteoporosis (OP) and osteoarthritis (OA) pose a significant challenge to ambulatory patients because of the higher chances of implant failure and severe disability of OA. To reduce OA-related morbidity, we advocate simultaneous total knee arthroplasty (TKA) with fracture fixation instead of fracture fixation alone using computer-assisted navigation to achieve proper ligament balance, restoration of the mechanical axis, and component alignment. Case Report: A case series of four patients (male - 2 and females - 2) with periarticular fractures of the distal femur with severe OA and OP were primarily fixed with different modalities such as distal femur locking plates, cannulated-cancellous screw, and Herbert screw followed by computer navigation-assisted cruciate retaining TKA. All patients had Kellgren Lawrence grade ≥3 OA and underwent bilateral TKA. All patients were aggressively treated for OP using pulsed PTH therapy. Patients were found to have a faster recovery with the initiation of early partial weight bearing with crutches postoperatively in all patients, followed by unassisted weight bearing once radiological union was seen. Conclusion: Based on satisfactory quality evidence and navigation-assisted cruciate-retaining TKA appears to be a useful treatment option for distal femoral fractures with pre-existing OA and OP. This is cost-effective and is associated with the least morbidity and excellent patient satisfaction.

Limitations and Complications in Treating Femoral Neck Fractures with the Femoral Neck System: A Case Report.

Introduction: The femoral neck system (FNS) represents an emerging fixation system designed for the management of femoral neck fractures. This innovative system combines the mechanical benefits of compression and anti-rotation properties in internal fixation. Biomechanical studies have demonstrated the superior axial and rotational stability of the FNS implant when compared to traditional cannulated screws and dynamic hip screw. Despite these promising mechanical advantages, there is currently a limited body of literature addressing the factors contributing to FNS failure. A thorough assessment of the safety and outcomes associated with this novel implant is essential. Case Report: In this context, we present three cases wherein FNS failure occurred, aiming to elucidate the potential causes behind these failures, and had to undergo either an implant removal or bipolar hemiarthroplasty. Conclusion: While considering the femoral neck system as the implant of choice, we should consider the age, injury to surgery time, and the location of the fracture line. However, we cannot conclusively ascertain whether age contributes independently to the risk of failure.

Two Cases of Ipsilateral Posterior Hip Dislocation and Shaft Femur Fracture and Management.

Introduction: The incidence of ipsilateral fracture of the shaft of the femur and dislocation of the hip are extremely rare injuries. However, the incidence of complex fractures is increasing day by day due to an increasing variety of traumatic mechanisms. This type of injury constitutes various diagnostic and treatment difficulties for the surgeon. Such injuries should be managed on an urgent basis for better functional outcomes. Case Report: We hereby describe two such cases: First case hip was reduced using external fixator pins, stabilization of the shaft femur fracture was done with an external fixator and the second case hip was reduced with bone holding clamps and the shaft femur fracture was fixed with interlocking nail. Conclusion: Fixator-assisted closed reductions are the first line of treatment in the management of posterior dislocation hip complicated with ipsilateral femoral shaft fractures. If closed reduction fails, fracture site can be opened and direct forces can be applied to the proximal femur to aid hip reduction with minimum complications.

Retrospective cohort study analyzing outcomes of the SIGN Fin Nail in adult femoral fractures using the retrograde approach.

Purpose: There is high burden of long bone fractures in low- and middle-income countries (LMICs). Given a limited availability of fluoroscopy in LMICs, the Surgical Implant Generation Network (SIGN) developed two types of intramedullary nails: the SIGN standard nail and the SIGN Fin Nail. A limited number of studies have analyzed healing outcomes with the SIGN Fin Nail and the current study is the largest one to date. The purpose of this study is to compare outcomes between the SIGN standard nail and SIGN Fin Nails in adult femoral shaft fractures treated with a retrograde approach. Method: A retrospective cohort study of adults with femoral shaft fractures was performed using the Sign Online Surgical Database (SOSD). The primary outcome was achieving full painless weight bearing and the secondary outcomes assessed were radiographic healing and infection. A propensity-score adjustment was performed for potential confounders and effect modification due to fracture location was tested using a Mantel-Haenszel test for heterogeneity. Results: Of 19,928 adults with femoral shaft fractures, 2,912 (14.7%) had the required 6-month follow-up to be included. The overall propensity score weighted relative risk between the Fin and Standard Nail for achieving painless weight-bearing was 0.99, 95% CI [0.96-1.03] and for radiographical healing was 0.99, 95%CI [0.97-1.02]. The propensity score weighted relative risk for infection was 1.30, 95% [0.85-1.97]. Use of the Fin nail was also significantly associated with shorter surgery times (p < 0.005, effect size = 24 min). Sub-group analysis based on fracture location and injury cause demonstrated no change in relative risk. Conclusion: The Fin nail showed no change in relative risk in terms of achieving full painless weightbearing or radiographic healing compared to the standard nail for retrograde nailing of femoral shaft fractures in adults. The heterogeneous nature of the cohort and large sample size allow for generalizability and add to a growing base of literature supporting use of the Fin Nail for retrograde femoral nailing. However, there are limitations as we could not correct for comminution at the fracture site or measure radiographic alignment or shortening.

Clinical Algorithm for the Management of Ipsilateral Proximal and Shaft Femur Fractures Using Single or Dual Implants.

Purpose of the study The current study had two goals: first, it compared the radiological and functional results of the ipsilateral shaft and proximal femur fractures treated by using two different methods, i.e., single implant vs dual implants. The second goal was to devise a clinical algorithm for guiding and managing such fractures. Methods This study was conducted in a level 1 trauma center and included 34 patients with concomitant ipsilateral fractures of the proximal femur and shaft of the femur. The patients were divided into two groups as per our clinical algorithm. Group I, comprising of 16 patients, were treated with a single implant like the proximal femoral nail (PFN) or proximal femoral nail antirotation (PFNA2). Group II of dual implants, comprising of 18 patients, were treated with two types of implants separately for proximal and shaft fracture. Results All patients were followed at monthly intervals up to six months, then at three monthly intervals up to one year, with a minimal follow-up of one year of every patient. On clinical evaluation by Friedman-Wyman criteria, in group I, seven patients had a fair outcome, eight patients had a good outcome, and one patient had a poor outcome, while in group II, eight patients had a fair outcome, nine patients had a good outcome, and one patient had a poor outcome. No patient developed non-union or avascular necrosis of the femoral head in any of the groups. Conclusion For concurrent ipsilateral diaphyseal and proximal femur fractures, both dual and single implants are equally effective alternatives if properly applied as per our clinical algorithm. Implant selection primarily depends on the pattern of injury, and our clinical algorithm can be a suitable guide for guiding the selection of implants.

Morphology and transverse alignment of the patella have no effect on knee gait characteristics in healthy Chinese adults over the age of 40 years.

Background: The influence of patella morphology and horizontal alignment on knee joint kinematics and kinetics remains uncertain. This study aimed to assess patella morphology and transverse alignment in relation to knee kinetics and kinematics in individuals without knee conditions. A secondary objective was to investigate the impact of femur and tibia alignment and shape on knee gait within this population. Patients and methods: We conducted a prospective collection of data, including full-leg anteroposterior and skyline X-ray views and three-dimensional gait data, from a cohort comprising 54 healthy individuals aged 40 years and older. Our study involved correlation and logistic regression analyses to examine the influence of patella, femur, and tibia morphology and alignment on knee gait. Results: The patellar tilt angle or the patella index did not show any significant relationships with different aspects of gait in the knee joint, such as velocity, angle, or moment (p > 0.05, respectively). Using multivariate logistic regression analysis, we found that the tibiofemoral angle and the Q angle both had a significant effect on the adduction angle (OR = 1.330, 95%CI 1.033-1.711, p = 0.027; OR = 0.475, 95%CI 0.285-0.792, p = 0.04; respectively). The primary variable influencing the knee adduction moment was the tibiofemoral angle (OR = 1.526, 95% CI 1.125-2.069, p = 0.007). Conclusion: In healthy Chinese individuals aged over 40, patella morphology and transverse alignment do not impact knee gait. However, the femoral-tibial angle has a big impact on the knee adduction moment.

Experimental assessment of pelvis slipping during postless traction for orthopaedic applications.

BACKGROUND: The application of lower limb traction during hip arthroscopy and femur fractures osteosynthesis is commonplace in orthopaedic surgeries. Traditional methods utilize a perineal post on a traction table, leading to soft tissue damage and nerve neuropraxia. A postless technique, using high-friction pads, has been considered as a potential damage-free alternative. However, whether these pads sufficiently prevent patient displacement remains unknown. Thus, this study systematically assesses the efficacy of commercial high-friction pads (PinkPad and CarePad) in restraining subject displacement, for progressively increasing traction loads and different Trendelenburg angles. METHODS: Three healthy male subjects were recruited and tested in supine and Trendelenburg positions (5° and 10°), using a customized boot-pulley system. Ten load disks (5 kg) were dropped at 15s intervals, increasing gradually the traction load up to 50 kg. Pelvis displacement along the traction direction was measured with a motion capture system. The displacement at 50 kg of traction load was analyzed and compared across various pads and bed inclinations. Response to varying traction loads was statistically assessed with a quadratic function model. RESULTS: Pelvis displacement at 50 kg traction load was below 60 mm for all conditions. Comparing PinkPad and CarePad, no significant differences in displacement were observed. Finally, similar displacements were observed for the supine and Trendelenburg positions. CONCLUSIONS: Both PinkPad and CarePad exhibited nearly linear behavior under increasing traction loads, limiting displacement to 60 mm at most for 50 kg loads. Contrary to expectations, placing subjects in the Trendelenburg position did not increase adhesion.

Antegrade femoral lengthening and simultaneous hemiepiphysiodesis for congenital femoral deficiency.

Purpose: Congenital femoral deficiency is characterized by limb length discrepancy and genu valgum. Lengthening of the femur along its anatomic axis increases valgus alignment by medial knee translation. Pairing limb lengthening with simultaneous medial distal femoral hemiepiphysiodesis can simultaneously correct two limb deformities. Methods: All skeletally immature patients with congenital femoral deficiency who underwent antegrade femoral lengthening and concomitant guided growth over a 4-year period were reviewed. Length and alignment data were quantified during lengthening, consolidation, and for 1 year after guided growth implants were removed or the patient reached skeletal maturity. Digital simulation was performed for all lengthenings to assess the mechanical alignment that would have been achieved had lengthening been performed without medial distal femoral hemiepiphysiodesis. Results: Nine patients (five males, four females, mean age = 12.3 ± 1.9 years) underwent 10 antegrade intramedullary femoral lengthenings with simultaneous medial distal femoral hemiepiphysiodesis. All had improvement in valgus alignment (average improvement in mechanical axis deviation was 18 ± 11 mm, average change in limb alignment was 6 ± 5°). In simulated lengthenings without guided growth, all limbs would have experienced increased lateral mechanical axis deviation of 5 ± 3 mm. The hemiepiphysiodesis implant and lengthening device were explanted simultaneously in 7 of 10 lengthenings. Conclusion: Simultaneous medial distal femoral hemiepiphysiodesis with antegrade femoral lengthening for ongenital femoral deficiency can minimize the number of surgical episodes for the skeletally immature patient. The lengthening device and guided growth construct can be removed simultaneously in a majority of cases, saving children one or two additional surgical treatments.

Proximal femur fracture: Direct medical costs of hospital treatment.

INTRODUCTION: Proximal femur fractures are one of the most common injuries in older adults representing a serious health condition in developed as well as developing countries. AIM: This study aimed to assess the hospitalization costs of the proximal femur fracture. METHODS: We conducted a prospective descriptive study spread over six months about patients hospitalized and operated on for proximal femur fractures. In order to estimate the cost we referred to the nomenclature of professional acts and the prices set by the Ministry of Public Health and the Ministry of Finance. RESULTS: The study included 100 patients, 55 females and 45 males with an average age of 76 years. The average hospital length of stay was 5 days. The preoperative stay was at a mean of three days. The average total hospitalization cost for these fractures was 2877 Tunisian Dinars depending on the type of fracture and surgical treatment. The main components of the costs were hospital stay costs and human resources costs 40%, cost of the implant 25.9%, cost of consumables 12%, operating cost 10%, cost of additional examinations 9% and cost of medications 2%. CONCLUSION: Proximal femur fractures represent an important cause of health resource consumption. To reduce the cost of hospital care, we recommend limiting the length of hospital stay as much as possible, investing in total hip and hemi-arthroplasties and adapting economical behavior taking into account the cost of consumables.

Far cortical locking constructs for fixation of distal femur fractures in an Asian population: A prospective observational study.

BACKGROUND: The stiffness of locked plates suppresses healing process, prompting the introduction of far cortical locking to address this issue. This study aimed to demonstrate the clinical efficacy of far cortical locking constructs in treating distal femoral fractures in an Asian population. METHODS: This multicenter prospective observational study was conducted at four university hospitals between February 2018 and February 2021. Demographic data, the presence of metaphyseal comminution, and surgical fixation details were recorded. Clinical outcomes, including single-leg standing, EQ-5D, and EQ-VAS scores, and radiologic outcomes, including the RUST score of each cortex, were evaluated and compared according to the presence of metaphyseal comminution. RESULTS: There were 37 patients (14 men and 23 women) with a mean age of 67.3 ± 11.8 years. Twenty-two patients had metaphyseal comminution (59%), and 15 presented simple fractures in metaphyseal areas. Four patients (13%) could stand on one leg >10s at 6 weeks, and 24 patients (92%) at 1 year. EQ-5D increased from 0.022 ± 0.388 to 0.692 ± 0.347, and the mean EQ-VAS 51.1 ± 13.1 to 74.1 ± 24.1 between discharge (n = 37) and post-operative 1 year (n = 33), respectively. RUST score presented increment for time, from 6.2 ± 1.8 at 6 week to 11.6 ± 1.1 at 1 year. Radiological healing demonstrated rapid increase from week 6 (16/28, 43%) to month 3 (27/31, 87%), with no obvious increase was observed in 6 months (23/26, 89%) or 12 months (25/28, 89%). Simple metaphyseal fractures presented significantly higher RUST scores at 6 weeks and 3 months, but there was no difference in RUST scores at 6 months or 1 year according to metaphyseal comminution. CONCLUSIONS: Plate constructs with far cortical locking screws provided safe and effective fixation for distal femoral fractures, with consistent radiological and clinical results, regardless of metaphyseal comminution.