Minimally invasive reconstruction of lateral tibial plateau fractures using the jail technique: a biomechanical study

BACKGROUND: This study described a novel, minimally invasive reconstruction technique of lateral tibial plateau fractures using a three-screw jail technique and compared it to a conventional two-screw osteosynthesis technique. The benefit of an additional screw implanted in the proximal tibia from the anterior at an angle of 90° below the conventional two-screw reconstruction after lateral tibial plateau fracture was evaluated. This new method was called the jail technique. METHODS: The two reconstruction techniques were tested using a porcine model (n = 40). Fracture was simulated using a defined osteotomy of the lateral tibial plateau. Load-to-failure and multiple cyclic loading tests were conducted using a material testing machine. Twenty tibias were used for each reconstruction technique, ten of which were loaded in a load-to-failure protocol and ten cyclically loaded (5000 times) between 200 and 1000 N using a ramp protocol. Displacement, stiffness and yield load were determined from the resulting load displacement curve. Failure was macroscopically documented. RESULTS: In the load-to-failure testing, the jail technique showed a significantly higher mean maximum load (2275.9 N) in comparison to the conventional reconstruction (1796.5 N, p < 0.001). The trend for better outcomes for the novel technique in terms of stiffness and yield load did not reach statistical significance (p > 0.05). In cyclic testing, the jail technique also showed better trends in displacement that were not statistically significant. Failure modes showed a tendency of screws cutting through the bone (cut-out) in the conventional reconstruction. No cut-out but a bending of the lag screws at the site of the additional third screw was observed in the jail technique. CONCLUSIONS: The results of this study indicate that the jail and the conventional technique have seemingly similar biomechanical properties. This suggests that the jail technique may be a feasible alternative to conventional screw osteosynthesis in the minimally invasive reconstruction of lateral tibial plateau fractures. A potential advantage of the jail technique is the prevention of screw cut-outs through the cancellous bone

RECOVERY OF DAILY ACTIVITY PATTERNS IN PATIENTS AFTER ACL RECONSTRUCTION

Injuries of the anterior cruciate ligament are one of the most often occurring injuries during sports activities. For young active patients, surgical treatment with repair, augmentation or replacement of the involved structure(s) is advised. The present study compared the outcome after Ligamys repair and Semitendinosus reconstruction during the first six postoperative weeks with objective measurements of the activity/inactivity behavior in daily life

Minimally invasive reconstruction of lateral tibial plateau fractures using the jail technique: a biomechanical study

Background: This study described a novel, minimally invasive reconstruction technique of lateral tibial plateau fractures using a three-screw jail technique and compared it to a conventional two-screw osteosynthesis technique. The benefit of an additional screw implanted in the proximal tibia from the anterior at an angle of 90° below the conventional two-screw reconstruction after lateral tibial plateau fracture was evaluated. This new method was called the jail technique. Methods: The two reconstruction techniques were tested using a porcine model (n = 40). Fracture was simulated using a defined osteotomy of the lateral tibial plateau. Load-to-failure and multiple cyclic loading tests were conducted using a material testing machine. Twenty tibias were used for each reconstruction technique, ten of which were loaded in a load-to-failure protocol and ten cyclically loaded (5000 times) between 200 and 1000 N using a ramp protocol. Displacement, stiffness and yield load were determined from the resulting load displacement curve. Failure was macroscopically documented. Results: In the load-to-failure testing, the jail technique showed a significantly higher mean maximum load (2275.9 N) in comparison to the conventional reconstruction (1796.5 N, p  0.05). In cyclic testing, the jail technique also showed better trends in displacement that were not statistically significant. Failure modes showed a tendency of screws cutting through the bone (cut-out) in the conventional reconstruction. No cut-out but a bending of the lag screws at the site of the additional third screw was observed in the jail technique. Conclusions: The results of this study indicate that the jail and the conventional technique have seemingly similar biomechanical properties. This suggests that the jail technique may be a feasible alternative to conventional screw osteosynthesis in the minimally invasive reconstruction of lateral tibial plateau fractures. A potential advantage of the jail technique is the prevention of screw cut-outs through the cancellous bone.<br

Ruhigstellung der Schulter in Außenrotation nach traumatischer Erstluxation

$\bf Problem$: Die Rezidivrate nach Schulterluxation wird mit bis zu 98% angegeben. Itoi schlug eine Immobilisation in Außenrotation vor. Ziel dieser Arbeit ist es, die Reposition des Labrum-Ligament-Komplexes (LLK) an den Glenoidrand nachzuweisen. $\bf Methode$: 30 Patienten wurden drei Wochen in einer Außenrotationschiene behandelt. Vor Ruhigstellung erfolgte eine MRT-Diagnostik, um die Dislokation des LLK zu ermitteln. Eine weitere MRT-Untersuchung erfolgte drei Wochen nach Immobilisation zur Stellungskontrolle des LLK. Ein Jahr nach Trauma erfolgte eine Follow-up-Untersuchung. $\bf Ergebnisse$: Bei allen Patienten konnte eine signifikant verbesserte Stellung des LLK in Außenrotation nachgewiesen werden. In der MRT-Untersuchung drei Wochen nach Ruhigstellung zeigte sich die Position des LLK konsolidiert. Innerhalb des ersten Jahres erlitten drei Patienten (11,3%) ein Rezidiv. $\bf Schlußfolgerung$: Die Ruhigstellung in Außenrotation führt zu einer stabilen Einheilung des LLK an den Glenoidrand

Cost-utility analysis of dynamic intraligamentary stabilization versus early reconstruction after rupture of the anterior cruciate ligament

Objectives The aim of this study was to evaluate the cost-effectiveness of the dynamic intraligamentary stabilization (DIS) technique in comparison with reconstructive surgery (ACLR) in the treatment of isolated anterior cruciate ligament (ACL) ruptures from the perspective of the community of insured citizens in Germany. Methods Because of the specific decision problem at hand, namely that with DIS the procedure has to take place within 21 days after the initial trauma, a decision tree was developed. The time horizon of the model was set to 3 years. Input data was taken from official tariffs, payer data, the literature and assumptions based on expert opinion when necessary. Results The decision tree analysis identified the DIS strategy as the superior one with 2.34 QALY versus 2.26 QALY for the ACLR branch. The higher QALY also came with higher costs of 5,398.05 € for the DIS branch versus 4,632.68 € for the ACLR branch respectively, leading to an ICER of 9,092.66 € per QALY. Results were robust after sensitivity analysis. Uncertainty was examined via probabilistic sensitivity analysis resulting in a slightly higher ICER of 9,567.13 € per QALY gained. Conclusion The DIS technology delivers an effective treatment for the ACL rupture at a favorable incremental cost-effectiveness ratio

Labral lesions in first-time traumatic anterior shoulder dislocation: it’s more than just Bankart …

&lt;jats:title&gt;Abstract&lt;/jats:title&gt;&lt;jats:sec&gt;&lt;jats:title&gt;Introduction&lt;/jats:title&gt;&lt;jats:p&gt;Traumatic anterior shoulder dislocation occurs frequently and usually affects young, active male patients. Detachment of the anteroinferior labrum, known as the Bankart lesion, is a common result. However, more extensive entities including bony lesions and disruptions of the labral ring can also be found. The aim of the present work was to analyze all cases of first-time traumatic anterior shoulder dislocation at a level‑1 trauma center with regard to the type of labral lesion. Focus was placed on the frequency and distribution of complex lesions and the extent of the surgical repair.&lt;/jats:p&gt;&lt;/jats:sec&gt;&lt;jats:sec&gt;&lt;jats:title&gt;Patients and methods&lt;/jats:title&gt;&lt;jats:p&gt;The clinical database of a level‑1 trauma center with a specialized shoulder unit was searched to identify all patients with first-time anterior shoulder dislocation treated between 2015 and 2019. Of 224 patients, 110 underwent primary surgical repair after first-time dislocation (mean age 40 years).&lt;/jats:p&gt;&lt;/jats:sec&gt;&lt;jats:sec&gt;&lt;jats:title&gt;Results&lt;/jats:title&gt;&lt;jats:p&gt;A total of 62% of patients had only a soft tissue injury, while 38% (&lt;jats:italic&gt;n&lt;/jats:italic&gt; = 40) showed a bony Bankart lesion/fracture of the glenoid fossa with a mean defect size of 26%. In only 31% of patients (&lt;jats:italic&gt;n&lt;/jats:italic&gt; = 34), a &lt;jats:italic&gt;classic&lt;/jats:italic&gt;Bankart repair was performed, whereas the remaining 69% underwent additional procedures.&lt;/jats:p&gt;&lt;/jats:sec&gt;&lt;jats:sec&gt;&lt;jats:title&gt;Conclusion&lt;/jats:title&gt;&lt;jats:p&gt;In this series of surgically treated first-time traumatic anterior shoulder dislocations, the majority of cases presented with more complex lesions than an isolated classic Bankart lesion. The risk for bony involvement and associated pathologies, such as cuff tears and greater tuberosity fracture, increases with age and requires a more extensive surgical approach. Disruption of the labral ring was frequently found in both soft tissue and bony lesions and directly affected the surgical procedure.&lt;/jats:p&gt;&lt;/jats:sec&gt

The Müller acetabular reinforcement ring - still an option in acetabular revision of Paprosky 2 defects? Longterm results after 10 years

Aim of this study was to measure the clinical and radiological longterm outcome after acetabular revision arthroplasty using the Müller acetabular reinforcement ring. 96 patients with 103 revision arthroplasties and a mean age of 69 years (41 to 84) were included. The mean follow-up was 10 years (range 7 – 12). The radiologic analysis reports no signs of loosening in 76 %, 17 % showed possibly loosening and 7 % probable loosening. Definite radiologic loosening has not been detected. The mean center of rotation of the hip moved 0.15 cm (SD 0.74 cm) laterally and 0.1 cm (SD 0.97 cm) cranially based on the geometrically reconstructed center of rotation. A mean score of 58 points for the Harris Hip Score (range 14 – 93) indicated a poor functional outcome, while a mean value of 96 points (range 0 – 223) for the WOMAC Index indicated good results for functional outcome in daily living. The revision arthroplasty in cases with acetabular defects using the Müller acetabular reinforcement ring shows acceptable longterm results

Shoulder injuries in polytraumatized patients: an analysis of the TraumaRegister DGU®

Background!#!The aim of the present study was to analyze the prevalence, epidemiology and relevance of shoulder injuries in polytraumatized patients in a large national trauma database. We hypothesize a high prevalence of shoulder injuries in traffic accidents and a high prevalence of concomitant injuries of the thorax leading to an aggravated clinical course and higher Injury Severity Score (ISS). Furthermore, we hypothesize an increased rate of surgical treatment with the severity of the injury.!##!Materials and methods!#!The retrospective analysis is based on the database (2002-2013) of the TraumaRegister DGU® and includes statistical data from 608 hospitals. The severity of injuries and trauma were scaled using the Abbreviated Injury Scale (AIS), and the Injury Severity Score (ISS), respectively. Patients with an ISS ≥ 16 were included in the study, and injuries were subdivided according to their anatomical involvement and analyzed with respect to the trauma mechanism and the resulting injuries.!##!Results!#!In this study, 54,076 cases of patients with an ISS ≥ 16 were analyzed. Shoulder injuries occurred in 15,115 patients (27.9%). Of these, 68.5% were caused by traffic accidents, especially in motorbike, bicycle, and pedestrian accidents. We found more shoulder injuries in blunt trauma mechanisms. Moreover, patients with shoulder injuries spent on average 1.7 more days on the intensive care unit (ICU), or intermediate care unit (IMCU), according to the severity of the injury, and had longer overall hospital stays (26.2 vs. 24.1 days) than patients without shoulder injuries. The overall ISS was increased in patients with shoulder injuries, whereas an increase of mortality could not be identified. Concomitant thoracic injuries occurred significantly more often in patients with shoulder injuries (82.9% vs. 69.6%). Injuries of the abdomen, pelvis, and lower extremity showed no correlation with shoulder injuries, whereas head and spine injuries showed a significant correlation.!##!Conclusion!#!Shoulder injuries are very common in polytraumatized patients. Together with their distinctive concomitant injuries, they have an aggravating impact on the clinical progress. Our data confirm the correlation with thoracic injuries. Furthermore, we identified an increased risk of shoulder injuries in motorbike, bicycle, and pedestrian accidents. An increase in mortality could not be identified

Treatment strategies for scapular spine fractures: a scoping review

Fractures of the scapular spine are relatively rare and can occur without (1) or with (2) association to a reverse shoulder arthroplasty (RSA). To date there are only limited data on the topic. The aim of this scoping review was to identify all available literature and report current treatment concepts. A scoping review was conducted by searching PubMed for relevant studies between 2000 and October 2020. All studies were included which gave detailed descriptions of the treatment strategy. A total of 21 studies with 81 patients were included for the analysis. The mean age over all patients was 62 years (range: 24 to 89 years) and 77% of the patients were female. In 19.8% of cases, the fracture occurred after a traumatic fall from standing height. Eighty-six per cent of the patients had an RSA-associated scapular spine fracture (2). These patients were older compared to group (1) (47 ± 19.6 vs. 76 ± 5.6 years, p = 0.0001) and the majority were female (85%). The majority from group (1) underwent operative treatment with plate fixation. Most patients regained full function and range of motion. RSA-associated fractures (2) were mainly treated non-operatively, with moderate clinical outcome. A high rate of nonunions was reported. Scapular spine fractures without RSA are mainly treated operatively with good clinical results. In association with RSA, scapular spine fractures are mainly treated non-operatively and lead to inferior clinical and radiological results. This scenario seems to be problematic and further research is required to sharpen treatment concepts in this group