Management of Open Fracture

Open fractures are common and their prevalence is increasing in elderly people. The burden of open fractures is high because of economic and social costs. Most open fractures occur in lower limbs. The use of validated protocols, will optimize our outcomes when treating open fractures. The first step began with the proper identification of the fracture characteristics and the hidden soft tissue injury. The use of an adequate and early antibiotic prophylaxis is mandatory and then, we have to perform adequate irrigation and debridement. Finally, we have to decide to temporally fix the fracture or proceed with the definitive fixation method. Recently, the creation of dedicated “orthoplastic” units has increased the outcomes in high-energy tibial fractures. These fractures should be managed in adequate trauma centers that should be used to face all the complications that will appear during the reconstruction procedure because complications can be as high as 50% in high-energy open fractures

Distal Femoral Fractures

Distal femur fractures are increasing injuries in our environment, due to their close relationship with the aging of the population. The diagnosis and treatment of these injuries have evolved in recent years, and the availability of new tools allows us to improve the results of our patients. Techniques such as dual nail-plate or plate-plate fixation emerge as an option in complications and complex fractures, and augmentation with PMMA may be an option in very low-density bones. To use these new techniques, anatomical knowledge, especially of the medial aspect of the femur, is essential. Many recent publications have studied the use of minimally invasive techniques with safe pathways. Throughout the following pages, we give a glimpse of the novelties in the treatment of these fractures, and we review the classic concepts

The use of passive seismological imaging in speleogenetic studies: an example from Kanaan Cave, Lebanon

Among many parameters that control the evolution of caves stands the volume of unconsolidated clay sediments generally produced by the alteration of the calcareous rocks. Here we introduce the use of a passive seismological imaging technique to investigate the clay deposits and estimate its total volume in a cave. Applied for the first time for speleogenesis studies, the HVSR (Horizontal / Vertical Spectral Ration) is a geophysical technique that can help better interpret cave geomorphology. We apply seismological spectral techniques (H/V ratio) on ambient noise vibrations to derive the clay volume, as well as its shape. This technique applied on the clay volume reveals some internal details, such as fallen blocks prior to the deposit accumulation and helps to understand deposit evacuation dynamics. The study focuses on the Kanaan Cave, located in Metn District, Lebanon, and reveals new stages related to the cave speleogenesis. This technique could be applied on ‘paragenetic’ caves where clay volume is frequently present in order to constrain the clay volume and reconstruct the buried floor shape of the cave, underneath the clay deposit

Estudio de la trayectoria de los tornillos en las masas laterales en el raquis cervical bajo

Estudio de la trayectoria, siguiendo las indicaciones de los autores clásicos, y descripción de una nueva trayectoria para la implantación de tornillos de instrumentación posterior en las masas laterales del raquis cervical subaxial o bajo. El estudio se desarrolla en tres fases: En la primera fase se realiza una comparación en vértebras humanas secas de C3 a C6 utilizando las trayectorias clásicas de Magerl, Anderson y An (ya que son aquellas que se dirigen al ángulo superoexterno del muro anterior de la masa lateral). También se realiza una descripción de una nueva trayectoria basada en referencias tridimensionales locales (del posible campo quirúrgico) y no en ángulos como se venía realizando con las técnicas clásicas. Se realizó un estudio estadístico comparativo señalando la frecuencia de complicaciones como lesiones de la arteria vertebral y de la raíz nerviosa. También se evaluó la longitud de cara a establecer las propiedades mecánicas de resistencia al arrancamiento y la estabilidad. En la segunda fase se realizó lo mismo en cadáveres formolizados (estudiándose los mismos parámetros que en la primera fase). Finalmente se realizó una aplicación de la técnica en la práctica clínica habitual aunque sin estudio de las variables por motivos de ética

Early outcomes of locked noncemented stems for the management of proximal humeral fractures: a comparative study

Proximal humeral fractures are common and a major concern in public health resources utilization. There is an increase in the use of reverse total shoulder arthroplasty (RTSA) as an option for complex fractures in the elderly. The complexity of the technique in RTSA is increased because of the fracture. To find an advantage of locking stems in RTSA for the treatment of proximal humeral fractures, we designed a comparative study between fracture-dedicated locking stems vs. cemented stems. We retrospectively studied 58 patients treated with an RTSA after a fracture. We compared how the implant design and the tuberosity consolidation affects patient outcome through measuring range of motion and the Constant score. The groups were similar in age, sex, time to surgery, and Constant score in the uninjured side. Patients treated with a dedicated locking noncemented stem performed better, with an increased Constant score (P > .05) and reached more mobility with no statistical significance. We found that 13 of the 24 fractures (54%) treated with a cemented stem consolidated, and 26 of 34 tuberosities (76%) healed in the noncemented locked stems. Patients with tuberosity consolidation acquired better range of motion and Constant scores (P < .05). A dedicated stem improves tuberosity healing and increases outcomes seen in Constant scores. Tuberosity consolidation is a main goal when treating proximal humeral fractures with RTSA

Commercially available antibiotic-laden PMMA-covered locking nails for the treatment of fracture-related infections - A retrospective case analysis of 10 cases

Introduction: Fracture-related infections (FRIs) are a devastating complication. FRIs are challenging and should be addressed with a multidisciplinary approach. An FRI should be addressed surgically by non-viable bone debridement, local antibiotic deposition, minimization of dead space and fracture stabilization. Antibiotic-laden PMMA-covered nails are a viable option to face these complications. To demonstrate the safety and utility of commercially available antibiotic-laden PMMA-covered nails, we performed a review of the cases operated in our institution and a cost analysis to compare the cost of a commercial nail to other available alternatives. Material and methods: We designed a retrospective study of consecutive cases to demonstrate the safety and efficacy of antibiotic-laden PMMA-covered commercial nails and designed a cost analysis of commercial coated nails compared to other custom-made alternatives. Results: We treated seven tibias and three femurs. Nine patients fully fit the criteria for FRI. There was one case of reintervention because of persistent drainage. All fractures healed, and in the first year post-intervention, there were no signs or symptoms of infection. There were no complications related to the commercially available nail that was used. There is a small increase in the direct quantifiable cost in commercially available nails, but non-quantifiable cost should be assessed individually. Conclusions: Commercially available antibiotic-laden PMMA-covered nails are a safe and useful treatment option for complicated cases of lower limb long bone reconstruction. The low complication rate and the straightforward technique compensate for the direct cost increase in most situations

The use of passive seismological imaging in speleogenetic studies; an example from Kanaan Cave, Lebanon

Among many parameters that control the evolution of caves stands the volume of unconsolidated clay sediments generally produced by the alteration of the calcareous rocks. Here we introduce the use of a passive seismological imaging technique to investigate the clay deposits and estimate its total volume in a cave. Applied for the first time for speleogenesis studies, the HVSR (Horizontal / Vertical Spectral Ration) is a geophysical technique that can help better interpret cave geomorphology. We apply seismological spectral techniques (H/V ratio) on ambient noise vibrations to derive the clay volume, as well as its shape. This technique applied on the clay volume reveals some internal details, such as fallen blocks prior to the deposit accumulation and helps to understand deposit evacuation dynamics. The study focuses on the Kanaan Cave, located in Metn District, Lebanon, and reveals new stages related to the cave speleogenesis. This technique could be applied on ‘paragenetic’ caves where clay volume is frequently present in order to constrain the clay volume and reconstruct the buried floor shape of the cave, underneath the clay deposit