Strategies in Trauma and Limb Reconstruction最新文献

{"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}

{"title":"Intrarater Reliability of Digital Thermography in Detecting Pin Site Infection: A Proof of Concept Study.","authors":"Ole Rahbek,&nbsp;Hans-Christen Husum,&nbsp;Marie Fridberg,&nbsp;Arash Ghaffari,&nbsp;Søren Kold","doi":"10.5005/jp-journals-10080-1522","DOIUrl":"https://doi.org/10.5005/jp-journals-10080-1522","url":null,"abstract":"<p><strong>Aim and objective: </strong>The purpose of this study was to explore the capability and Intrarater reliability of thermography in detecting pin site infection.</p><p><strong>Materials and methods: </strong>This is an explorative proof of concept study. Clinical assessment of pin sites was performed by one examiner with the Modified Gordon Pin Infection Classification from grade 0 to 6. Thermography of the pin sites was performed with a FLIR C3 camera. The analysis of the thermographic images was done in the software FLIR Tools. The maximum skin temperature around the pin site and the maximum temperature for the whole thermographic picture were measured. An Intrarater agreement was established and test-retests were performed with different camera angles.</p><p><strong>Results: </strong>Thirteen (four females, nine males) patients (age 9-72 years) were included. Indications for frames: Fracture (<i>n</i>=4), two deformity correction, one lengthening and six bone transport. Days from surgery to thermography ranged from 27 to 385 days. Overall, 231 pin sites were included. Eleven pin sites were diagnosed with early signs of infection: five grade 1, five grade 2 and one grade 3. Mean pin site temperature for each patient was calculated, varied between patients from 29.0°C to 35.4°C (mean 33.9°C). With 34°C as cut-off value for infection, sensitivity was 73%; specificity, 67%; positive predictive value, 10%; and negative predictive value, 98%. Intrarater agreement for thermography was ICC 0.85 (0.77-0.92). The temperature measured was influenced by the camera positioning in relation to the pin site with a variance of 0.2.</p><p><strong>Conclusions: </strong>Measurements of pin site temperature using the hand-held FLIR C3 infrared camera was a reliable method and the temperature was related to infection grading.</p><p><strong>Clinical significance: </strong>This study demonstrated that digital thermography with a hand-held camera might be used for monitoring the pin sites after operations to detect early infection.</p><p><strong>How to cite this article: </strong>Rahbek O, Husum HC, Fridberg M, <i>et al.</i> Intrarater Reliability of Digital Thermography in Detecting Pin Site Infection: A Proof of Concept Study. Strategies Trauma Limb Reconstr 2021;16(1):1-7.</p>","PeriodicalId":21979,"journal":{"name":"Strategies in Trauma and Limb Reconstruction","volume":"16 1","pages":"1-7"},"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/d9/b6/stlr-16-1.PMC8311748.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39258512","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":"Cost Comparison of Tibial Distraction Osteogenesis Using External Lengthening and Then Nailing vs Internal Magnetic Lengthening Nails.","authors":"Aleksey Dvorzhinskiy,&nbsp;David T Zhang,&nbsp;Austin T Fragomen,&nbsp;S Robert Rozbruch","doi":"10.5005/jp-journals-10080-1513","DOIUrl":"https://doi.org/10.5005/jp-journals-10080-1513","url":null,"abstract":"<p><strong>Aim and objective: </strong>Tibial lengthening can be performed by distraction osteogenesis via lengthening and then nailing (LATN) or by using a magnetic lengthening nail (MLN). MLN avoids the complications of external fixation while providing accurate and easily controlled lengthening. Concerns exist still regarding the high upfront cost of the magnetic nail, which serves to limit its use in resource-poor areas and decrease adoption among cost-conscious surgeons. The purpose of this study was to compare the hospital, surgeon, and total cost between LATN and MLN when used for tibial lengthening.</p><p><strong>Materials and methods: </strong>A retrospective review was performed comparing consecutive tibial lengthening using either LATN (n = 17) or MLN (n = 15). The number of surgical procedures and time to union were compared. Surgeon and hospital payments were used to perform cost analysis after adjusting for inflation using the consumer price index (CPI).</p><p><strong>Results: </strong>Patients treated with MLN underwent fewer surgeries (3.6 vs 2.8; p < 0.001) but had a longer time to union as compared with patients treated with LATN (19.79 vs 27.84 weeks; p = 0.006). Total costs were similar ($50,345 vs $46,162; p = 0.249) although surgeon fees were lower for MLN as compared with LATN ($6,426 vs $4,428; p < 0.001).</p><p><strong>Conclusion: </strong>LATN and MLN had similar overall costs in patients undergoing tibial lengthening. MLN was associated with fewer procedures but a longer time to union as compared with LATN.</p><p><strong>Clinical significance: </strong>Despite an increased upfront cost in MLN, there was no difference in total cost between LATN and MLN when used for tibial lengthening. Thus, in cases where either method is feasible, cost may not be a deciding factor when selecting the appropriate treatment.</p><p><strong>How to cite this article: </strong>Dvorzhinskiy A, Zhang DT, Fragomen AT, <i>et al.</i> Cost Comparison of Tibial Distraction Osteogenesis Using External Lengthening and Then Nailing vs Internal Magnetic Lengthening Nails. Strategies Trauma Limb Reconstr 2021;16(1):14-19.</p>","PeriodicalId":21979,"journal":{"name":"Strategies in Trauma and Limb Reconstruction","volume":"16 1","pages":"14-19"},"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/1f/3d/stlr-16-14.PMC8311750.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39258514","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":"The Joint Angle Tool for Intraoperative Assessment of Coronal Alignment of the Lower Limb.","authors":"Ahmed A-H Abood,&nbsp;Juozas Petruskevicius,&nbsp;Björn Vogt,&nbsp;Adrien Frommer,&nbsp;Robert Rödl,&nbsp;Jan Duedal Rölfing","doi":"10.5005/jp-journals-10080-1511","DOIUrl":"https://doi.org/10.5005/jp-journals-10080-1511","url":null,"abstract":"<p><strong>Aim: </strong>Presentation of the joint angle tool (JAT), a low-cost goniometer for intraoperative assessment of the lower limb alignment.</p><p><strong>Background: </strong>Intraoperative assessment of coronal alignment is important when performing corrective osteotomies around the knee and ankle, limb lengthening, and trauma surgery. JAT provides surgeons with information about the anatomic and mechanical axes intraoperatively based on true anteroposterior radiographs.</p><p><strong>Technique: </strong>JAT consists of pre-printed joint orientation angles of the anatomic and mechanical axis including normal variations on a plastic sheet. It is placed on the screen of the image intensifier after obtaining a true anteroposterior image. The pre-printed joint orientation angles can assist the surgeons intraoperatively in achieving the pre-planned axis correction. Here, its feasibility is demonstrated in four cases.</p><p><strong>Conclusion and clinical significance: </strong>JAT is a modified goniometer that allows intraoperative assessment of the mechanical and anatomic axis. JAT is applicable throughout the entire surgical procedure irrespective of the method of internal fixation and may provide additional reassurance of correct alignment. JAT consists of a plastic sheet with printed joint orientation angles and their normal variation. JAT is freely available from profeedback.dk/JAT/JAT.pdf for use and modification according to the Creative Commons license (CC BY-SA 4.0) if this paper is attributed.</p><p><strong>How to cite this article: </strong>Abood AA-H, Petruskevicius J, Vogt B, <i>et al.</i> The Joint Angle Tool for Intraoperative Assessment of Coronal Alignment of the Lower Limb. Strategies Trauma Limb Reconstr 2020;15(3):169-173.</p>","PeriodicalId":21979,"journal":{"name":"Strategies in Trauma and Limb Reconstruction","volume":"15 3","pages":"169-173"},"PeriodicalIF":0.8,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/35/5f/stlr-15-169.PMC8121113.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39023799","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":"Thromboprophylaxis in Intramedullary Limb Lengthening Surgery.","authors":"Alexios D Iliadis,&nbsp;Anna Timms,&nbsp;Sharron Fugazzotto,&nbsp;Penina Edel,&nbsp;Simon Britten,&nbsp;Jonathan Wright,&nbsp;David Goodier,&nbsp;Peter Calder","doi":"10.5005/jp-journals-10080-1505","DOIUrl":"https://doi.org/10.5005/jp-journals-10080-1505","url":null,"abstract":"Abstract Aim The use of intramedullary lengthening devices is becoming increasingly popular. There are limited data regarding the incidence of venous thromboembolism following intramedullary lengthening surgery and no reports or guidance for current practice on use of thromboprophylaxis. Following a case of post-operative deep vein thrombosis in our institution, we felt that it is important to assess best practice. We conducted a national survey to collect data that would describe current practice and help develop consensus for treatment. Materials and methods We identified surgeons across the UK that perform adult intramedullary limb lengthening through the British Limb Reconstruction Society membership and a Precise Users database. Surgeons were contacted and asked to respond to an online survey. Responses to thromboprophylaxis regimes employed in their practice and cases of venous thromboembolism were collated. Results 24 out of 54 surgeons identified responded with a total of 454 cases of adult intramedullary lengthening (352 femoral and 102 tibial nails) performed over a five year period (January 2015–January 2020). Only one case of deep venous thrombosis (DVT) following femoral lengthening was reported. There is wide variability in practice both in terms of thromboprophylaxis risk assessment, choice of medications and duration of treatment. The vast majority of surgeons (85%) felt that there was insufficient evidence available to guide their practice. Conclusions Intramedullary lengthening is a surgical treatment growing in popularity. There are limited data available to guide decision-making regarding aspects of treatment such as thromboprophylaxis. This is reflected in the wide variation in practice reported in this study. There are both a need and a desire to gather data that will allow us to come to a consensus and to guide safe practice. Clinical significance Venous thromboembolism is a potential complication of lower limb lengthening surgery. We report on national incidence and current practices of thromboprophylaxis to allow for informed decision-making and help develop consensus for best practice. How to cite this article Iliadis AD, Timms A, Fugazzotto S, et al. Thromboprophylaxis in Intramedullary Limb Lengthening Surgery. Strategies Trauma Limb Reconstr 2020;15(3):151-156.","PeriodicalId":21979,"journal":{"name":"Strategies in Trauma and Limb Reconstruction","volume":"15 3","pages":"151-156"},"PeriodicalIF":0.8,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/e8/05/stlr-15-151.PMC8121112.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39011370","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":"Closed-wedge Patelloplasty for the Treatment of Distal Patellofemoral Maltracking and Instability due to Severe Patellar Dysplasia: Case Report and Surgical Technique.","authors":"Jannik Frings,&nbsp;Fabian Freudenthaler,&nbsp;Matthias Krause,&nbsp;Karl-Heinz Frosch","doi":"10.5005/jp-journals-10080-1501","DOIUrl":"https://doi.org/10.5005/jp-journals-10080-1501","url":null,"abstract":"<p><strong>Background: </strong>Patellofemoral maltracking is caused by different anatomical factors. Most of them are associated with a proximal maltracking, which alters the patella's engagement into the trochlear groove and predisposes the patellofemoral joint for instability. Different surgical techniques have been described to realign patellar tracking, however, most of which address proximal patellar maltracking.</p><p><strong>Aim: </strong>The aim of this article is to demonstrate the influence of patella-related deformities on patellar tracking and to present a novel surgical technique for the treatment of distal patellar maltracking, caused by a severe patellar dyplasia.</p><p><strong>Case description: </strong>We report the case of a 23-year-old patient with a severe patellar dysplasia, presenting a distal patellar maltracking with recurring dislocations in deep flexion. Due to her instability, the patient was immobilised and dependent on the constant use of walking aids. Radiological images showed a concavely shaped patellar, which articulated exclusively with the lateral epicondyle and caused the patella to dislocate laterally, starting at a flexion angle of 60°. An anterior closing-wedge osteotomy was used to reshape and recenter the patella, which was complemented by a medial patellofemoral ligament reconstruction. At the 18-month follow-up, the patient presented pain free and fully remobilised, without the use of walking aids. Patellar tracking was reestablished, with a possible knee flexion until 140°. No redislocation of the patella had occurred.</p><p><strong>Conclusion: </strong>Distal patellofemoral maltracking, caused by a severe patellar dysplasia, can successfully be treated with an anterior closed-wedge osteotomy of the patella. In combination with a medial patellofemoral ligament reconstruction, patellofemoral stability can be reestablished, to prevent further dislocations.</p><p><strong>Clinical significance: </strong>There are multiple factors, which may cause patellar maltracking. A thorough clinical and radiological preoperative analysis is mandatory, in order to clearly identify the underlying pathologies, as these may affect patellar tracking proximally or distally.</p><p><strong>How to cite this article: </strong>Frings J, Freudenthaler F, Krause M, et al. Closed-wedge Patelloplasty for the Treatment of Distal Patellofemoral Maltracking and Instability due to Severe Patellar Dysplasia: Case Report and Surgical Technique. Strategies Trauma Limb Reconstr 2020;15(3):184-192.</p>","PeriodicalId":21979,"journal":{"name":"Strategies in Trauma and Limb Reconstruction","volume":"15 3","pages":"184-192"},"PeriodicalIF":0.8,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/fe/c6/stlr-15-184.PMC8121114.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39024231","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":"Short-term Results of Magnetic Resonance Imaging after Ankle Distraction Arthroplasty.","authors":"Amgad M Haleem,&nbsp;Sherif Galal,&nbsp;Ogonna K Nwawka,&nbsp;Angela Balagadde,&nbsp;Eugene W Borst,&nbsp;Huong T Do,&nbsp;Douglas N Mintz,&nbsp;Austin T Fragomen,&nbsp;S Robert Rozbruch","doi":"10.5005/jp-journals-10080-1512","DOIUrl":"https://doi.org/10.5005/jp-journals-10080-1512","url":null,"abstract":"<p><strong>Background: </strong>Ankle distraction arthroplasty has emerged as an alternative treatment for ankle arthritis. There are few reports on the magnetic resonance imaging (MRI) findings after distraction arthroplasty. This study sought to determine whether there are positive changes on MRI after ankle distraction and improvements on X-ray. Additionally, patient-reported outcomes and joint range of motion (ROM) after ankle distraction are described.</p><p><strong>Materials and methods: </strong>Thirty-two patients (mean age 49 years) who underwent ankle distraction had pre-operative and one-year postoperative MRIs, which were graded using a modified whole-organ magnetic resonance imaging score (WORMS). Ankle joint space and ROM were measured. A non-validated three-item questionnaire was administered to assess functional outcomes.</p><p><strong>Results: </strong>Although the anterior quadrant of the ankle showed a trend to improvement in cartilage morphology on the postoperative MRI, the WORMS did not demonstrate a significant difference in any of its subcategories. While reduction in joint osteophytes was observed and maintained short term, this was mainly due to resection intraoperatively. X-rays revealed a significant increase in joint space, and there was a significant increase in ankle dorsiflexion. Eight-seven percent of the patients were satisfied with their functional outcome.</p><p><strong>Conclusion: </strong>At short-term follow-up, MRI scores after ankle distraction arthroplasty did not demonstrate significant improvement despite positive changes on X-ray and improved clinical outcomes and ankle ROM. Further study on larger patient numbers with longer follow-up is required.</p><p><strong>Level of evidence: </strong>IV, Case Series.</p><p><strong>How to cite this article: </strong>Haleem AM, Galal S, Nwawka OK, <i>et al</i>. Short-term Results of Magnetic Resonance Imaging after Ankle Distraction Arthroplasty. Strategies Trauma Limb Reconstr 2020;15(3):157-162.</p>","PeriodicalId":21979,"journal":{"name":"Strategies in Trauma and Limb Reconstruction","volume":"15 3","pages":"157-162"},"PeriodicalIF":0.8,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ab/13/stlr-15-157.PMC8121115.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39011371","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":"Biomechanical Analysis of the Behaviour at the Metaphyseal-Diaphyseal Junction of Complex Tibial Plateau Fractures Using Two Circular Fixator Configurations.","authors":"Gracielle S Cardoso,&nbsp;Renato Amorim,&nbsp;Francisco M Penha,&nbsp;Françoá J Horn,&nbsp;Carlos Rm Roesler,&nbsp;Jefferson Lb Marques","doi":"10.5005/jp-journals-10080-1507","DOIUrl":"https://doi.org/10.5005/jp-journals-10080-1507","url":null,"abstract":"<p><strong>Background: </strong>High-energy tibial plateau fractures are challenges in treatment with controversy over operative stabilisation, especially for fractures with metaphyseal-diaphyseal dissociation. Treatment with percutaneous or minimally invasive direct reduction techniques, usually associated with circular external fixation, has generated interest although there is no consensus regarding the type of external fixation to be used.</p><p><strong>Aim: </strong>This study aims to compare the two hybrid circular external fixation mountings used to treat the high-energy tibial plateau fractures.</p><p><strong>Methods: </strong>Two different groups of hybrid circular external fixation frame mountings were assembled using composite tibiae with proximal metaphyseal osteotomies simulating tibial plateau fractures with metaphyseal-diaphyseal dissociation. The standard all-wire frame mounting was assembled, and the comparison frame mounting had the distal K-wires replaced with half-pins. Both groups were tested through cyclic loading between 300 and 1000 N for 10,000 cycles. Interfragmentary linear and rotational displacements were analysed.</p><p><strong>Results: </strong>The standard frame mounting behaved similarly to a classic Ilizarov frame, allowing greater axial movement (mean, 3.76 ± 0.26 mm in the standard group and 3.02 ± 0.23 mm in the test group) and smaller mediolateral displacement compared with the test frame (mean, 0.17 ± 0.16 mm compared to 0.56 ± 0.12 mm). The test frame behaved more similarly to a linear external fixator and provided greater axial stability, similar anteroposterior displacement, and lower mediolateral stability. Despite these differences, in both groups the axial displacement was greater than the prejudicial nonaxial movements.</p><p><strong>Conclusion: </strong>Increasing the number of half-pins and decreasing the number of K-wires in hybrid circular external fixation generate frames that tend to behave more similarly to the linear external fixators.</p><p><strong>How to cite this article: </strong>Cardoso GS, Amorim R, Penha FM, <i>et al</i>. Biomechanical Analysis of the Behaviour at the Metaphyseal-Diaphyseal Junction of Complex Tibial Plateau Fractures Using Two Circular Fixator Configurations. Strategies Trauma Limb Reconstr 2020;15(3):138-145.</p>","PeriodicalId":21979,"journal":{"name":"Strategies in Trauma and Limb Reconstruction","volume":"15 3","pages":"138-145"},"PeriodicalIF":0.8,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/8d/a3/stlr-15-138.PMC8121107.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39011368","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}