Strategies in Trauma and Limb Reconstruction最新文献

{"title":"Comparison of Mechanical Performance between Circular Frames and Biplanar Distraction Devices for Knee Joint Distraction.","authors":"James My Chowdhury,&nbsp;Beth Lineham,&nbsp;Matthew Pallett,&nbsp;Hemant G Pandit,&nbsp;Todd D Stewart,&nbsp;Paul J Harwood","doi":"10.5005/jp-journals-10080-1530","DOIUrl":"https://doi.org/10.5005/jp-journals-10080-1530","url":null,"abstract":"<p><strong>Aim and objective: </strong>This study was designed to test and compare the mechanical performance of the biplanar ArthroSave KneeReviver and a circular frame construct with the intended use of providing a mechanically favourable environment for cartilage regeneration across a knee joint.</p><p><strong>Materials and methods: </strong>Three similar constructs of the two devices were applied to biomechanical testing sawbones, with the knee distracted by 8 mm. The constructs were vertically loaded to 800 N in an Instron testing machine at 20 mm/minute. Tests were conducted in neutral hip flexion and at 12° of hip flexion and extension, to mimic leg position in gait. Displacement measurements were taken from the Instron machine, and three-dimensional joint motion was recorded using an Optotrak Certus motion capture system.</p><p><strong>Results: </strong>Overall axial rigidity was similar between the two devices (circular frame, 81.6 N/mm ± 5.9; and KneeReviver, 79.5 N/mm ± 25.1 with hip neutral) and similar in different hip positions. At the point of joint contact, the overall rigidity of the circular frame increased significantly more than the KneeReviver (491 N/mm ± 27 and 93 N/mm ± 32, respectively, <i>p</i> <0.001). There was more variability between models in the KneeReviver. There was more off-axis motion in the KneeReviver, mainly due to increasing knee flexion on loading. This was exacerbated with the hip in flexion and extension but remained small, with the maximal off-axis displacement being 7 mm/3°.</p><p><strong>Conclusion: </strong>The circular frame provides a similar mechanical environment to the novel KneeReviver device, for which most clinical data are available. These findings suggest that both devices appear a viable option for knee joint distraction (KJD). Further clinical data will help inform mode of application.</p><p><strong>Clinical significance: </strong>KJD is a relatively novel technique for use in osteoarthritis (OA), and it remains unclear which distraction devices provide appropriate mechanics. Our testing gives evidence to support either option for further use.</p><p><strong>How to cite this article: </strong>Chowdhury JMY, Lineham B, Pallett M, <i>et al</i>. Comparison of Mechanical Performance between Circular Frames and Biplanar Distraction Devices for Knee Joint Distraction. Strategies Trauma Limb Reconstr 2021;16(2):71-77.</p>","PeriodicalId":21979,"journal":{"name":"Strategies in Trauma and Limb Reconstruction","volume":"16 2","pages":"71-77"},"PeriodicalIF":0.8,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/b3/3d/stlr-16-71.PMC8578248.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39644058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Complications in Elective Removal of 271 Bone Lengthening Nails (FITBONE, PRECICE and STRYDE).","authors":"Markus W Frost,&nbsp;Søren Kold,&nbsp;Ole Rahbek,&nbsp;Anirejuoritse Bafor,&nbsp;Molly Duncan,&nbsp;Christopher A Iobst","doi":"10.5005/jp-journals-10080-1529","DOIUrl":"https://doi.org/10.5005/jp-journals-10080-1529","url":null,"abstract":"<p><strong>Background: </strong>Intramedullary lengthening nails have shown excellent short-term results. The FITBONE and the PRECICE nail are the two most commonly used intramedullary lengthening nails. The manufacturer of each nail recommends the removal of the implant after the completion of the treatment. Despite the need for removal of each nail, the authors are not aware of any prior publications documenting the results of standard intramedullary lengthening nail removal. Therefore, the aim of this study was to examine the intraoperative and postoperative complications of elective intramedullary lengthening nail removals.</p><p><strong>Materials and methods: </strong>We performed a retrospective chart review of patients operated with intramedullary lengthening nails at two limb reconstruction centres (one in the United States, and the second in Denmark). Data retrieved from the patient charts included patient demographics, nail information and any complications occurring at or after nail removal. Only lower limb lengthening with FITBONE and PRECICE or STRYDE nails that had an elective nail removal was included.</p><p><strong>Result: </strong>A total of 271 elective nail removals were included in the study. Complications occurred during 3% of the nail removals and in 13% after nail removal. There were 18 reported cases with postoperative knee pain. All these patients had nail removal through the knee joint, representing 8% of the retrograde femur nail removals and 7% of the tibia nail removals. Four postoperative fractures occurred, of which two needed surgery. Eleven percent of femur removals and 26% of tibial removals sustained a complication.</p><p><strong>Conclusion and clinical significance: </strong>This study emphasises the importance of adequate follow-up of the bone lengthening patient even after the nail has been removed. It also shows that the recommended removal of the intramedullary nail (IMN) lengthening nails must be included in studies reporting on the overall risks of complications using bone lengthening nails.</p><p><strong>How to cite this article: </strong>Frost MW, Kold S, Rahbek O, <i>et al</i>. Complications in Elective Removal of 271 Bone Lengthening Nails (FITBONE, PRECICE and STRYDE). Strategies Trauma Limb Reconstr 2021;16(2):110-115.</p>","PeriodicalId":21979,"journal":{"name":"Strategies in Trauma and Limb Reconstruction","volume":"16 2","pages":"110-115"},"PeriodicalIF":0.8,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/37/6c/stlr-16-110.PMC8578244.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39644062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient-reported Outcome and Quality of Life after Treatment with External Fixation: A Questionnaire-based Survey.","authors":"Shuhei Ugaji,&nbsp;Hidenori Matsubara,&nbsp;Satoshi Kato,&nbsp;Yasuhisa Yoshida,&nbsp;Tomo Hamada,&nbsp;Hiroyuki Tsuchiya","doi":"10.5005/jp-journals-10080-1519","DOIUrl":"https://doi.org/10.5005/jp-journals-10080-1519","url":null,"abstract":"Abstract Background This survey aims to assess the satisfaction of patients who have had treatment using external fixation (EF). Materials and methods An original questionnaire and a Short Form 36 (SF-36) were distributed to 121 patients who underwent treatment using EF for deformity correction and lengthening between 2006 and 2016. A multivariate analysis was performed on the factors associated with satisfaction. Results Sixty patients returned a response. The average satisfaction score was 83.6 points. In the 5-point satisfaction survey, 43 of 60 patients (71.7%) responded “very satisfied” or “satisfied” and 27 patients (45.0%) responded “yes” to the question as to whether they would request EF treatment again if presenting with the original preoperative condition. In addition, the subjectively expressed tolerance for having an external fixator device on the limb was 92.1 days on average. A correlation was established with the ISOLS score. Conclusion The top three factors that determined subjective inconvenience with EF are pain, walking, and heaviness. Although EF treatment was stressful, the satisfaction scores were high. Furthermore, the satisfaction with EF treatment was improved by (1) pain control, (2) shortening the EF period, and (3) psychological support. How to cite this article Ugaji S, Matsubara H, Kato S, et al. Patient-reported Outcome and Quality of Life after Treatment with External Fixation: A Questionnaire-based Survey. Strategies Trauma Limb Reconstr 2021;16(1):27–31.","PeriodicalId":21979,"journal":{"name":"Strategies in Trauma and Limb Reconstruction","volume":"16 1","pages":"27-31"},"PeriodicalIF":0.8,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/50/0e/stlr-16-27.PMC8311749.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39258460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Deformity Correction, Surgical Stabilisation and Limb Length Equalisation in Patients with Fibrous Dysplasia: A 20-year Experience.","authors":"Matthew J Hampton,&nbsp;Samuel Weston-Simmons,&nbsp;Stephen N Giles,&nbsp;James A Fernandes","doi":"10.5005/jp-journals-10080-1523","DOIUrl":"https://doi.org/10.5005/jp-journals-10080-1523","url":null,"abstract":"<p><strong>Introduction: </strong>Fibrous dysplasia (FD) of bone can be present with pain, deformity and pathological fractures. Management is both medical and surgical. Little literature exists on the surgical management of both monostotic and polyostotic FD. We present our experience of limb reconstruction surgery in this pathological group of bone disease.</p><p><strong>Materials and methods: </strong>A retrospective cohort of children who underwent limb reconstruction surgery at a single high-volume paediatric centre was identified from a prospective database. Case notes and radiographs were reviewed. Surgical techniques, outcomes and difficulties were explored.</p><p><strong>Results: </strong>Twenty-one patients were identified aged between 7 and 13 at presentation to the limb reconstruction unit. Eleven were female, nine had McCune-Albright syndrome, seven had polyostotic FD and five had monostotic. Proximal femoral varus procurvatum deformity was the most common site requiring surgical intervention. The distal femur, tibia, humerus and forearm were also treated.Methods include deformity correction with intramedullary fixation including endo-exo-endo techniques, elastic nailing, guided growth, circular fixator technique and fixator-assisted plating. Correction of deformity and leg length discrepancies was common.The osteotomies went on to heal with no nonunions or delayed healing. We encountered secondary deformity at distal end of nails as the children grew as expected. These were managed with revision nailing techniques and in some cases external fixation. There was one implant failure, which did not require revision surgery.</p><p><strong>Conclusion: </strong>The surgical management of pathological bone disease is challenging. Corrective osteotomies with intramedullary fixation can be very successful if appropriate limb reconstruction principles are adhered to. Deformity correction, guided growth and lengthening can all be successfully achieved in bone affected by FD. Polyostotic FD can be present with secondary deformities, and these can be difficult to manage.</p><p><strong>How to cite this article: </strong>Hampton MJ, Weston-Simmons S, Giles SN, <i>et al. Deformity Correction, Surgical Stabilisation and Limb Length Equalisation in Patients with Fibrous Dysplasia: A 20-year Experience</i>. Strategies Trauma Limb Reconstr 2021;16(1):41-45.</p>","PeriodicalId":21979,"journal":{"name":"Strategies in Trauma and Limb Reconstruction","volume":"16 1","pages":"41-45"},"PeriodicalIF":0.8,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/66/75/stlr-16-41.PMC8311743.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39258462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ilizarov Method for Acute Paediatric Tibial Fractures.","authors":"Juergen Messner, Christopher P Prior, Bethan Pincher, Simon Britten, Paul J Harwood, Patrick Al Foster","doi":"10.5005/jp-journals-10080-1517","DOIUrl":"10.5005/jp-journals-10080-1517","url":null,"abstract":"<p><strong>Aim and background: </strong>A systemic method for the application of Ilizarov fixators and on-table fracture reduction is described in this instructional article. This technique has been developed from the unit's practice in adult patients. The indications, underlying principles and rationale for the method are also discussed.</p><p><strong>Technique: </strong>The basic concept involves the construction of a series of concentric, colinear rings aligned with the mechanical axis of the limb. An orthogonal ring block is initially placed on the proximal segment and extended distally. Wire to ring reduction techniques are used resulting in the contact, alignment and stability required for early full weight-bearing, free movement of knee and ankle, and subsequent healing.</p><p><strong>Conclusion and clinical significance: </strong>Our step-by-step guide takes the reader through a systematic approach to surgery along with tips and tricks on how to achieve reduction and avoid the common pitfalls. With this method, it is possible to achieve an on-table reduction and correction of a multiplanar deformity without the use of expensive hexapod technology. This may allow less experienced users reproduce the technique with a shorter learning curve.</p><p><strong>How to cite this article: </strong>Messner J, Prior CP, Pincher B <i>et al</i>. Ilizarov Method for Acute Paediatric Tibial Fractures. Strategies Trauma Limb Reconstr 2021;16(1):46-52.</p>","PeriodicalId":21979,"journal":{"name":"Strategies in Trauma and Limb Reconstruction","volume":"16 1","pages":"46-52"},"PeriodicalIF":0.8,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/3f/1d/stlr-16-46.PMC8311752.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39258463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Huge Intraosseous Tibial Haemangioma Managed with Embolisation, Excision and Fibular Ilizarov Reconstruction: A Case Report.","authors":"Ken Ad Barsales,&nbsp;Juanito Javier,&nbsp;Jolly J Catibog,&nbsp;Ariel Vergel de Dios,&nbsp;Edward Hm Wang","doi":"10.5005/jp-journals-10080-1518","DOIUrl":"https://doi.org/10.5005/jp-journals-10080-1518","url":null,"abstract":"<p><strong>Aim: </strong>Our aim is to report the successful treatment of an intraosseous haemangioma of tibia with an atypical presentation through a multidisciplinary approach of preoperative embolisation, a subtotal resection of the tibia and subsequent reconstruction with the Ilizarov medial fibular translation technique.</p><p><strong>Background: </strong>En bloc excision is the treatment of choice for large tumours of the tibia. However, there is no single recommended method for the reconstruction of the resulting bony defect.</p><p><strong>Case: </strong>A 22-year-old female presented with a massive intraosseous haemangioma of the entire tibia. Sequential, multimodal treatment consisted of (1) preembolisation, (2) en bloc resection and (3) reconstruction of the extensive skeletal defect via the Ilizarov method of fibular medialisation. Radiologic union occurred at 6 months and graft hypertrophy at 22 months. At 45 months, the patient was fully weight-bearing without need for an assistive device.</p><p><strong>Conclusion: </strong>Resection and reconstruction of a large intraosseous haemangioma of the tibia can be treated successfully using a well-planned sequential management of embolisation, resection and Ilizarov fibular grafting.</p><p><strong>Significance: </strong>This report highlights the successful management of an unusually extensive and difficult tumour through appropriate and meticulous perioperative multidisciplinary planning, execution and follow-up.</p><p><strong>How to cite this article: </strong>Barsales KAD, Javier J, Catibog JJ, <i>et al.</i> Huge Intraosseous Tibial Haemangioma Managed with Embolisation, Excision and Fibular Ilizarov Reconstruction: A Case Report. Strategies Trauma Limb Reconstr 2021;16(1):60-63.</p>","PeriodicalId":21979,"journal":{"name":"Strategies in Trauma and Limb Reconstruction","volume":"16 1","pages":"60-63"},"PeriodicalIF":0.8,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/6d/28/stlr-16-60.PMC8311747.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39258466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of Arm Length as a New Upper Limb Anthropometric Method for Preoperative Estimation of Tibial Intramedullary Nail Length.","authors":"Amit Sharma,&nbsp;Siddhartha Sinha,&nbsp;Sumit Gupta,&nbsp;Anand Gupta,&nbsp;Amit Narang,&nbsp;Parul Sharma,&nbsp;Rajesh K Kanojia","doi":"10.5005/jp-journals-10080-1520","DOIUrl":"https://doi.org/10.5005/jp-journals-10080-1520","url":null,"abstract":"<p><strong>Aim and objective: </strong>To assess the use of arm length (AL) for the estimation of tibial nail length preoperatively and compare its accuracy to various established upper and lower limb anthropometric parameters.</p><p><strong>Material and methods: </strong>This prospective study of 54 patients assessed upper limb parameters as a possible alternative for intraoperatively measured tibial nail length. The anthropometric parameters measured independently by two observers were AL, olecranon to fifth metacarpal head (OMD), tibial tuberosity to medial malleolus (TT-MM), tibial tuberosity to medial malleolus minus 20 mm (TT-MM-20 mm) and knee joint line to medial malleolus minus 40 mm (KJL-MM-40) and compared to final nail size used intraoperatively. Two observers were used. Bland-Altman plots were constructed to assess the limits of agreement to intraoperative estimates of optimum nail length. A repeatability assessment was also assessed by both observers.</p><p><strong>Results: </strong>None of the anthropometric parameters showed limits of agreement within ±10 mm of nail length. AL showed the least average difference and best limits of agreement among all the anthropometric parameters. Among the lower limb parameters, the KJL-MM showed the least average difference but poorer limits of agreement to nail length. The OMD measurement showed a greater average difference than the AL indicating it is a poorer upper limb parameter for predicting nail length.</p><p><strong>Conclusion: </strong>AL as measured between the angle of the acromion to the lateral epicondyle can be used as a preoperative upper limb anthropometric estimate of nail length to one nail size of the optimum length. Further studies with a larger sample size may reduce the confidence intervals and help justify its wider use.</p><p><strong>How to cite this article: </strong>Sharma A, Sinha S, Gupta S, <i>et al.</i> Evaluation of Arm Length as a New Upper Limb Anthropometric Method for Preoperative Estimation of Tibial Intramedullary Nail Length. Strategies Trauma Limb Reconstr 2021;16(1):20-26.</p>","PeriodicalId":21979,"journal":{"name":"Strategies in Trauma and Limb Reconstruction","volume":"16 1","pages":"20-26"},"PeriodicalIF":0.8,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/9e/61/stlr-16-20.PMC8311751.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39258459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does Retrograde Femoral Nailing through a Normal Physis Impair Growth? An Experimental Porcine Model.","authors":"Ahmed A Abood,&nbsp;Ole Rahbek,&nbsp;Morten L Olesen,&nbsp;Bjørn B Christensen,&nbsp;Bjarne Møller-Madsen,&nbsp;Søren Kold","doi":"10.5005/jp-journals-10080-1515","DOIUrl":"https://doi.org/10.5005/jp-journals-10080-1515","url":null,"abstract":"<p><strong>Materials and methods: </strong>The study was carried out using an experimental porcine model. Eleven juvenile female porcines were randomized for insertion of a retrograde femoral nail in one limb. The other limb acted as a control. The animals were housed for 8 weeks before the nail was removed and housed for 8 additional weeks, that is, 16 weeks in total. Growth was assessed by interphyseal distance on 3D magnetic resonance imaging (MRI) after 16 weeks and the operated limb was compared to the non-operated limb. Histomorphometric analysis of the physeal canal was performed.</p><p><strong>Results: </strong>No difference in longitudinal growth was observed when comparing the operated femur to the non-operated femur using MRI after 16 weeks. No osseous tissue crossing the physis was observed on MRI or histology. The empty canal in the physis after nail removal was filled with fibrous tissue 16 weeks after primary surgery.</p><p><strong>Conclusion: </strong>Growth was not impaired and no bone bridges were seen on MRI or histology 16 weeks after insertion and later removal of the retrograde femoral nail.</p><p><strong>Clinical significance: </strong>The insertion of a retrograde intramedullary femoral nail centrally through the physis and later removal might be safe, however, long-term follow-up is needed.</p><p><strong>Aim and objective: </strong>The insertion of an intramedullary nail may be beneficial in certain cases of leg length discrepancy (LLD) in children. However, it is unknown if the physeal injury due to the surgery may cause bone bridge formation and thereby growth arrest after removal. This study aimed to assess longitudinal interphyseal growth 16 weeks after insertion and later removal of a retrograde femoral nail passing through the physis. Moreover, to analyse the tissue forming in the empty physeal canal after removal of the nail.</p><p><strong>How to cite this article: </strong>Abood AA, Rahbek O, Olesen ML, <i>et al</i>. Does Retrograde Femoral Nailing through a Normal Physis Impair Growth? An Experimental Porcine Model. Strategies Trauma Limb Reconstr 2021;16(1):8-13.</p>","PeriodicalId":21979,"journal":{"name":"Strategies in Trauma and Limb Reconstruction","volume":"16 1","pages":"8-13"},"PeriodicalIF":0.8,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/f9/4c/stlr-16-8.PMC8311745.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39258513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Peculiar Case of Open Complex Elbow Injury with Critical Bone Loss, Triceps Reinsertion, and Scar Tissue might Provide for Elbow Stability?","authors":"Giulia Facco,&nbsp;Rocco Politano,&nbsp;Andrea Marchesini,&nbsp;Letizia Senesi,&nbsp;Pasquale Gravina,&nbsp;Pier Paolo Pangrazi,&nbsp;Antonio P Gigante,&nbsp;Michele Riccio","doi":"10.5005/jp-journals-10080-1504","DOIUrl":"https://doi.org/10.5005/jp-journals-10080-1504","url":null,"abstract":"<p><strong>Background: </strong>Complex elbow injuries (CEIs) are severe and rare lesions, difficult to treat correctly due to the different patterns of clinical presentations. Standard methods cannot often be applied. The main goals of the treatment are performing a stable osteosynthesis of all fractures, obtaining a concentric and stable reduction of the elbow by repairing the soft tissue constraint lesions, and allowing early motion. Since the introduction of virtual reality (VR) approaches in clinical practice, three-dimensional (3D) computed tomography (CT) and 3D printing have revolutionised orthopaedic surgeries, thus helping to understand the anatomy and the pathology of complex cases.</p><p><strong>Case description: </strong>We discussed a case of CEI, characterised by an extended soft tissue (IIIB Gustilo classification) and neurovascular lesions associated with bone loss in a young female patient. Olecranon fracture was type IIIB according to Mayo classification. We outlined the steps of a pluri-tissue reconstructive approach and stressed the importance of 3D printing in the preoperative planning for such cases. Finally, peculiar final functional patient outcomes were reported.</p><p><strong>Conclusion: </strong>In this case, we found out that triceps reinsertion and scar process may provide for the joint stability in a low-demanding patient. 3D printing and VR approaches in clinical practice can be useful in the management of CEIs associated with an important bone and soft tissue loss.</p><p><strong>How to cite this article: </strong>Facco G, Politano R, Marchesini A, <i>et al.</i> A Peculiar Case of Open Complex Elbow Injury with Critical Bone Loss, Triceps Reinsertion, and Scar Tissue might Provide for Elbow Stability? Strategies Trauma Limb Reconstr 2021;16(1):53-59.</p>","PeriodicalId":21979,"journal":{"name":"Strategies in Trauma and Limb Reconstruction","volume":"16 1","pages":"53-59"},"PeriodicalIF":0.8,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/16/f6/stlr-16-53.PMC8311746.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39258464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Functional Outcomes and Quality of Life Following Complex Tibial Fractures Treated with Circular External Fixation: A Comparison between Proximal, Midshaft, and Distal Tibial Fractures.","authors":"Jaco J Naude,&nbsp;Muhammad A Manjra,&nbsp;Franz Birkholtz,&nbsp;Annette-Christi Barnard,&nbsp;Kevin Tetsworth,&nbsp;Vaida Glatt,&nbsp;Erik Hohmann","doi":"10.5005/jp-journals-10080-1506","DOIUrl":"https://doi.org/10.5005/jp-journals-10080-1506","url":null,"abstract":"<p><strong>Aim and objective: </strong>The purpose of this study was to compare clinical results following complex proximal, midshaft, and distal tibial fractures and investigate whether there are differences in outcomes between these locations.</p><p><strong>Materials and methods: </strong>Patients between 18 years and 65 years of age and minimum follow-up of 12 months with complex tibial fractures treated with a circular ring fixator were included. Functional outcomes were assessed using the Association for the Study and Application of Methods of Ilizarov (ASAMI) functional and bone scores, Foot Function Index (FFI), Four Step Square Test (FSST), and Timed Up and Go Test (TUG). Quality of life was assessed by the EQ-5D score.</p><p><strong>Results: </strong>A total of 45 patients were included: proximal fractures, <i>n</i> = 11; midshaft fractures, <i>n</i> = 17; and distal fractures, <i>n</i> = 17. ASAMI functional (<i>p</i> = 0.8) and bone scores (<i>p</i> = 0.3) were not different. Excellent and good bone scores were achieved in >90% in all groups. FFI was 30.9 + 24.7 in the proximal group, 33.9 + 27.7 in the midshaft group, and 28.8 + 26.9 in the distal group (<i>p</i> = 0.8). TUG was 9.0 + 2.7 sec in the proximal group, 9.0+3.5 in the midshaft group, and 8.5+2.0 in the distal group (<i>p</i> = 0.67). FSST was 10.7 + 2.5 sec in the proximal, 10.3 + 3.8 in the midshaft, and 8.9 + 1.8 in the distal fracture groups (<i>p</i> = 0.5). EQ-5D index value was highest in the distal (0.72), lowest in the proximal (0.55), and 0.70 in the midshaft fracture groups (<i>p</i> = 0.001). EQ-5D VAS was significantly different between the proximal (65) and midshaft (82.3) (<i>p</i> = 0.001) and between the distal (75) and proximal (65) fracture groups (<i>p</i> = 0.001).</p><p><strong>Conclusions: </strong>The results of this study suggest that the functional outcomes between proximal, midshaft, and distal complex tibial fractures are comparable. Their ability to ambulate afterward is comparable to age-related normative data, but complex tasks are more difficult and better compared to the ambulating ability of a healthy population aged 65 to 80 years. Patients with proximal tibial fractures had significantly more disability by at least one functional level and/or one health dimension.</p><p><strong>How to cite this article: </strong>Naude JJ, Manjra MA, Birkholtz F, <i>et al.</i> Functional Outcomes and Quality of Life Following Complex Tibial Fractures Treated with Circular External Fixation: A Comparison between Proximal, Midshaft, and Distal Tibial Fractures. Strategies Trauma Limb Reconstr 2021;16(1):32-40.</p>","PeriodicalId":21979,"journal":{"name":"Strategies in Trauma and Limb Reconstruction","volume":"16 1","pages":"32-40"},"PeriodicalIF":0.8,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/33/8a/stlr-16-32.PMC8311744.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39258461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}