Does the Nonunion Rate of Atypical Femoral Fractures Differ According to Fracture Site?: A Meta-Analysis.

Background: The nonunion rate for atypical femoral fractures (AFF) is known to be higher than that for typical fractures of the femur. We performed a meta-analysis to determine the incidence of nonunion necessitating reoperation following fixation for AFF and compare the rates according to the fracture site (subtrochanter or midshaft). Methods: A total of 742 AFFs from 29 studies were included. A proportion meta-analysis utilizing a random-effects model was conducted to estimate the prevalence of nonunion. The outcomes were the incidence of reoperations that included osteosynthesis. To determine the association of nonunion with patient mean age or average duration of bisphosphonate use, meta-regression analysis was done. Results: In proportion meta-analysis, the estimated pooled prevalence of nonunion was 7% (95% confidence interval [CI], 5%-10%) from all studies. There was a significant difference in nonunion rate between the 2 groups (I2 = 34.4%, p = 0.02); the estimated prevalence of nonunion was 15% (95% CI, 10%-20%) in subtrochanteric AFFs and 4% (95% CI, 2%-6%) in midshaft AFFs. From meta-regression analysis, significant correlations were identified between nonunion rate and patient mean age (coefficient: -0.0071, p = 0.010), but not in the average duration of bisphosphonate use (coefficient: -0.0024, p = 0.744). Conclusions: A notable disparity existed in the nonunion rate among subtrochanteric AFFs and midshaft AFFs group. Therefore, it is critical for orthopedic surgeons to consider the complexity and challenges associated with AFF and to estimate the proper possibility of nonunion according to the fracture site.

Factors Associated With Episode of Care Adverse Events After Humerus Nonunion Repair.

BACKGROUND: Humeral nonunions have devastating negative effects on patients' upper extremity function and health-related quality of life. The objective of this study was to identify factors independently associated with 30-day complication, hospital readmission, and reoperation after surgical treatment of humeral nonunions. MATERIALS AND METHODS: A retrospective case-control study was performed using the American College of Surgeons National Surgical Quality Improvement Program database by querying the Current Procedural Terminology codes for patients who underwent humeral nonunion repair from 2011 to 2020. The study outcomes were 30-day complication, hospital readmission, and reoperation. RESULTS: Of the 1306 patients in our cohort, 135 patients (10%) developed a complication, 66 patients (5%) were readmitted to the hospital, and 44 patients (3%) underwent reoperation during the 30-day postoperative period. Multivariable logistic regression analysis showed that older age, longer operative time, partially dependent functional status, congestive heart failure, bleeding disorder, and contaminated wound classification were associated with 30-day complication after humeral nonunion repair. Older age and disseminated cancer were associated with 30-day reoperation after humeral nonunion repair. Disseminated cancer was associated with 30-day readmission after humeral nonunion repair. CONCLUSION: Using a large database over a recent 10-year period, we identified demographic and comorbid factors independently associated with episode of care adverse events after humeral nonunion repair. Patients 50 years or older had approximately three times the incidence of complications, readmissions, and reoperations in the first month after humeral nonunion repair compared with patients younger than 50 years. Our findings are relevant for preoperative risk stratification and counseling. [Orthopedics. 2024;47(4):e181-e187.].

A morphological review of medial malleolar fractures - A large single centre series.

BACKGROUND: Many approaches to management of medial malleolar fractures are described in the literature however, their morphology is under investigated. The aim of this study was to analyse the morphology of medial malleolar fractures to identify any association with medial malleolar fracture non-union or malunion. METHODS: Patients who had undergone surgical fixation of their MMF were identified from 2012 to 2022, using electronic patient records. Retrospective analysis of their preoperative, intraoperative, and postoperative radiographs was performed to determine their morphology and prevalence of non-union and malunion. Lauge-Hansen classification was used to characterise ankle fracture morphology and Herscovici classification to characterise MMF morphology. RESULTS: A total of 650 patients were identified across a 10-year period which could be included in the study. The overall non-union rate for our cohort was 18.77% (122/650). The overall malunion rate was 6.92% (45/650). Herscovici type A fractures were significantly more frequently mal-reduced at time of surgery as compared to other fracture types (p = .003). Medial wall blowout combined with Hercovici type B fractures showed a significant increase in malunion rate. There is a higher rate of bone union in patients who had been anatomically reduced. CONCLUSION: The morphology of medial malleolar fractures does have an impact of the radiological outcome following surgical management. Medial wall blowout fractures were most prevalent in adduction-type injuries; however, it should not be ruled out in rotational injuries with medial wall blowouts combined with and Herscovici type B fractures showing a significant increase in malunions. Herscovici type A fractures had significantly higher malreductions. LEVEL OF EVIDENCE: Level 3 - Retrospective Cohort Study.

Paciente con espondilitis anquilopoyética y fractura cervical: retardo de consolidación en un tratamiento conservador resuelto con teriparatida / A patient with spondylitis ankylopoetica and neck fracture: a delay in consolidation in a conservative treatment resolved with teriparatide

Se presenta el caso de un paciente con antecedentes de espondilitis anquilopoyética que sufrió una fractura cervical a nivel C5-C6 sin lesión neurológica. Debido a sus antecedentes personales pluripatológicos, se optó por un tratamiento con halo-chaleco. En la evolución se observó un retardo de consolidación a los dos meses, por lo que se instauró tratamiento con teriparatida a dosis de 20mg/día. La consolidación se obtuvo a los cuatro meses, dos después del comienzo con tratamiento farmacológico. La teriparatida puede ser un tratamiento farmacológico adyuvante como estimulador de la consolidación de fracturas en situaciones comprometidas (AU)

A case is presented on a patient with a history of spondylitis ankylopoetica who suffered a neck fracture at C5-C6 level, with no neurological injury. Due a personal history of multiple illnesses, it was decided to treat with a halo jacket. A delay in consolidation was observed after two months, so treatment with teriparatide was started at a dose of 20mg/day. Consolidation was achieved at four months (two after starting the pharmacological treatment). Teriparatide can be an adjuvant pharmacological treatment as a stimulator of consolidation of fractures in compromised situations (AU)

Tratamiento de las fracturas de la extremidad distal del radio con un cemento óseo remodelable / Treatment of distal radius fractures with remodelable bone cement

Objetivo: Comparar los resultados clínico-radiológicos y complicaciones del tratamiento de las fracturas de radio distal con un cemento óseo remodelable (Norian SRS) frente al tratamiento conservador.Diseño experimental: Estudio prospectivo y aleatorizado de fracturas tipos A3 o C2 de la clasificación AO en pacientes de 50 a 85 años de edad distribuidas en dos grupos de tratamiento: reducción cerrada e inmovilización con yeso 6 semanas (grupo Control) o reducción cerrada, estabilización con Norian SRS e inmovilización con yeso 2 semanas (Grupo SRS).Pacientes: 110, 55 por grupo.Resultados: El grupo SRS presentó menor incidencia de dolor y una recuperación más precoz de movilidad, fuerza de prensión y desarrollo de actividades. A los seis meses, la tasa de resultados satisfactorios fue del 81,5 por ciento en el grupo SRS y del 54,5 por ciento en el Control.Las fracturas estabilizadas con SRS presentaron una incidencia de redesplazamiento significativamente menor. La incidencia de consolidación en mala posición fue del 18,2 por ciento en el grupo SRS y del 41,8 por ciento en el grupo Control. Hubo una relación estadísticamente significativa entre los resultados funcionales y los radiológicos.Un 69,1 por ciento de los casos tratados con SRS tuvieron depósitos extraóseos, que con frecuencia causaron molestias transitorias pero presentaron tendencia a desaparecer.Conclusiones: El relleno del defecto trabecular de las fracturas de radio distal con un cemento óseo remodelable asociado a inmovilización con yeso 2 semanas proporciona mejores resultados clínicos y radiológicos que el tratamiento conservador, siendo su principal complicación los depósitos extraóseos de cemento, que ocasionan molestias locales y tienden a desaparecer (AU)

Pseudoartrosis del húmero: frecuencia en 5 años y resultado de tratamiento en el Hospital ABC / Pseudoarthrosis of the humerus: its frequency in five years and the results of treatment in the ABC hospital

Se revisaron en el Hospital ABC un total de 19 casos de pseudoartrosis de húmero, en un periodo de 5 años. Realizamos un estudio retrospectivo para determinar el tipo, tratamiento y evolución de los pacientes. Observamos una frecuencia de 4.5 por ciento con relación al total de las pseudoartrosis; 7 pacientes fueron tratados inicialmente en otra institución y 12 casos en nuestro hospital. Encontramos que el tratamiento en el 100 por ciento de los casos, fue la resección del foco de pseudoartrosis, estabilización con clavo centromedular bloquedado y aporte óseo autólogo para corregir el defecto. La función de la extremidad fue buena en 17 pacientes, 89.4 por ciento; mientras que un paciente persistió con el defecto y dolor, pero aceptable para la función. El otro paciente falleció por causas ajenas al padecimiento ortopédico