Fracture healing following high energy tibial trauma: Ilizarov versus Taylor Spatial Frame

Introduction: The optimal treatment of high energy tibial fractures remains controversial and a challenging orthopaedic problem. The role of external fi xators for all these tibial fractures has been shown to be crucial. Methods: A fi ve-year consecutive series was reviewed retrospectively, identifying two treatment groups: Ilizarov and Taylor Spatial Frame (TSF; Smith & Nephew, Memphis, TN, US). Fracture healing time was the primary outcome measure. Results: A total of 112 patients (85 Ilizarov, 37 TSF) were identifi ed for the review with a mean age of 45 years. This was higher in women (57 years) than in men (41 years). There was no signifi cant difference between frame types (p=0.83). The median healing time was 163 days in both groups. There was no signifi cant difference in healing time between smokers and non-smokers (180 vs 165 days respectively, p=0.07), open or closed fractures (p=0.13) or age and healing time (Spearman's r=0.12, p=0.18). There was no incidence of non-union or re-fracture following frame removal in either group. Conclusions: Despite the assumption of the rigid construct of the TSF, the median time to union was similar to that of the Ilizarov frame and the TSF therefore can play a signifi cant role in complex tibial fractures

Case Report: Ischial Stress Fracture Non-Union in a College Football Player

Stress fractures are common injuries associated with repetitive high-impact activities, often in high-level athletes and military recruits. Although predominantly occurring in the lower extremities, stress fractures may occur wherever there is a sudden increase in frequency or intensity of activity, thereby overloading the yield point of the local bone environment. Ischial stress fractures are a rarely diagnosed cause of pain around the hip and pelvis. Often, patients present with buttock pain with activity, which can be misdiagnosed as proximal hamstring tendonitis or avulsion. Here, we report a case of a college football player who was diagnosed with an ischial stress fracture which went on to symptomatic non-union after extensive conservative management. We treated his ischial non-union with open reduction internal fixation utilizing a tension band plate and screws. This interesting case highlights an uncommon cause of the relatively common presentation of posterior hip pain and describes our technique for addressing a stress fracture non-union in the ischium

Computed tomography versus plain radiography assessment of acetabular fracture reduction is more predictive for native hip survivorship

ntroduction Computed tomography (CT) is more accurate than plain pelvic radiography (PXR) for evaluating acetabular fracture reduction. As yet unknown is whether CT-based assessment is more predictive for clinical outcome. We determined the independent association between reduction quality according to both methods and native hip survivorship following acetabular fracture fxation. Materials and methods Retrospectively, 220 acetabular fracture patients were reviewed. Reductions on PXR were graded as adequate or inadequate (0–1 mm or >1 mm displacement) (Matta’s criteria). For CT-based assessment, adequate reductions were defned as <1 mm step and <5 mm gap, and inadequate reductions as ≥1 mm step and/or ≥5 mm gap displacement. Predictive values and Kaplan–Meier hip survivorship curves were compared and risk factors for conversion to total hip arthroplasty (THA) were identifed. Results Mean follow-up was 8.9 years (SD 5.6, range 0.5–23.3 years), and 52 patients converted to THA (24%). Adequate reductions according to CT versus PXR assessment were associated with higher predictive values for native hip survivorship (92% vs. 82%; p=0.043). Inadequate reductions were equally predictive for conversion to THA (33% for CT and 30% for PXR; p=0.623). For both methods, survivorship curves of

Osteochondral impaction of the posterior acetabular surface without cortical fracture of any wall or column: an undescribed pattern of acetabular injury

Surgical treatment of a unusual acetabular fracture is described. This fracture was characterized by impaction and breaking down of the posterior articular surface and comminution of lamina quadrilatera lower portion, without cortical fracture of both columns. The fracture was treated surgically through the Kocher–Langenbeck approach. A small hole was created in the acetabulum posterior wall, the impacted fragment was reduced, and the bone defect was filled with autologous bone from the greater trochanter. A plate was shaped in order to fix both bone graft and fractured fragment

Endosteal biologic augmentation for surgical fixation of displaced femoral neck fractures

Objectives: To report outcomes of a cohort with displaced Femoral Neck Fractures (FNF) treated with a length/angle-stable construct augmented with an endosteal fibular allograft serving as a biologic dowel. Design: Prospective Setting: Level I Trauma Center Patients: The study group consists of twenty-seven patients with isolated FNF surgically treated by a single surgeon. Intervention: Open reduction of the femoral neck, fixed with a length- and angle stable-construct of two fully threated cannulated screws augmented with an endosteal fibular allograft serving as a biologic dowel. Main Outcome Measurements: Clinical and radiographic outcomes of the fixation construct and the viability of both the femoral head and the fibular allograft, host response to the allograft and osseous union was evaluated using a specialized sequence of contrast-enhanced MRI obtained at 3 and 12 months postoperatively. Results: This construct resulted in high union rates (89%; 24/27). Two patients suffered early catastrophic failure and one patient developed fracture non-union, all of wish underwent uneventful conversion to total hip arthroplasty. Three (11%) additional patients had removal of symptomatic implants. The clinical and radiographic outcomes were excellent. Twelve months MRIs revealed either partial or complete osseous incorporation of 86% the fibular allografts without signs of adverse reaction of the host to the allograft. Femoral head osteonecrosis segments were noted in 76% of patients on MRI, however radiographically there were no sign of osteonecrosis or segmental collapse. Conclusion: The fibular allograft reconstructs the comminuted femoral neck, and the osteointegration overtime increases the strength of the host-bone-graft interface. This added strength seems to provide the stability needed to better preserve the intra-operative reduction, obtain good outcomes and reduce the complications associated with FNF. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence

Heterologous mesenchymal stem cells successfully treat femoral pseudarthrosis in rats

<p>Abstract</p> <p>Background</p> <p>This study evaluated the effectiveness of treating pseudarthrosis in rats by using bone marrow cell suspensions or cultures of bone marrow mesenchymal stromal cells</p> <p>Methods</p> <p>Thirty-eight specific pathogen-free (SPF) animals were randomly assigned to four groups: Group 1, Control, without surgical intervention; Group 2 (Placebo), experimental model of femoral pseudarthrosis treated only with saline solution; Group 3, experimental model of femoral pseudarthrosis treated with heterologous bone marrow cells suspension; Group 4, experimental model of femoral pseudarthrosis treated with cultures of heterologous mesenchymal stromal cells from bone marrow. When pseudarthrosis was confirmed by simple radiological studies, digital radiography and histopathology after a 120-day postoperative period, Groups 2, 3 and 4 were treated as above. At 30, 60 and 90 days after the treatment, all animals were evaluated by simple radiological studies, and at the end of the experiment, the animals were assessed by computed axial tomography and anatomopathological and histomorphometric examinations.</p> <p>Results</p> <p>Injected cells were detected in the areas affected by pseudarthrosis using scintigraphy within the first 24 hours after their administration. After 60 days, the animals of Group 3 showed callus formation while the animals of Group 4 presented periosteal reaction and had some consolidated areas. In contrast, Group 2 showed a predominance of fibro-osteoid tissue. After 90 days, bone consolidation and remodeling was observed in all animals from Group 3 whereas animals from Group 4 exhibited partial consolidation and those ones from Group 2 persisted with pseudarthrosis.</p> <p>Conclusion</p> <p>The treatment with heterologous bone marrow cells suspension proved to be effective in the treatment of pseudarthrosis whereas cultures of heterologous bone marrow mesenchymal stromal cells did not show the same potential to aid bone healing.</p