Augmentation of tibial plateau fractures with Trabecular Metal™: a biomechanical study

<p>Abstract</p> <p>Background</p> <p>Restoration and maintenance of the plateau surface are the key points in the treatment of tibial plateau fractures. Any deformity of the articular surface jeopardizes the future of the knee by causing osteoarthritis and axis deviation. The purpose of this study is to evaluate the effect of Trabecular Metal (porous tantalum metal) on stability and strength of fracture repair in the central depression tibial plateau fracture.</p> <p>Method</p> <p>Six matched pairs of fresh frozen human cadaveric tibias were fractured and randomly assigned to be treated with either the standard of treatment (impacted cancellous bone graft stabilized by two 4.5 mm screws under the comminuted articular surface) or the experimental method (the same screws supporting a 2 cm diameter Trabecular Metal (TM) disc placed under the comminuted articular surface). Each tibia was tested on a MTS machine simulating immediate postoperative load transmission with 500 Newton for 10,000 cycles and then loaded to failure to determine the ultimate strength of the construct.</p> <p>Results</p> <p>The trabecular metal construct showed 40% less caudad displacement of the articular surface (1, 32 ± 0.1 mm vs. 0, 80 ± 0.1 mm) in cyclic loading (p < 0.05). Its mechanical failure occurred at a mean of 3275 N compared to 2650 N for the standard of care construct (p < 0, 05).</p> <p>Conclusion</p> <p>The current study shows the biomechanical superiority of the trabecular metal construct compared to the current standard of treatment with regards to both its resistance to caudad displacement of the articular surface in cyclic loading and its strength at load to failure.</p

Bias towards dementia: Are hip fracture trials excluding too many patients?: A systematic review

Patients with hip fractures are older and often present many co-morbidities, including dementia. These patients cannot answer quality of life questionnaires and are generally excluded from trials. We hypothesized that a significant number of patients are being excluded from these studies and this may impact outcomes. This was a two part study; the first analyzing databases of two ongoing large- scale multi-centred hip fracture trials and the second being a systematic review. The FAITH and HEALTH studies were analyzed for exclusion incidence directly related to dementia. The second part consisted of a systematic search of all relevant studies within the last 20 years. In the FAITH study, a total of 1690 subjects were excluded, 375 (22.2%) of which were due to dementia or cognitive impairment. In the HEALTH study, 575 were excluded with dementia/cognitive impairment representing 207 patients (36%). Following the systematic review, 251 articles were identified 17 of which were retained. The overall prevalence of dementia was 27.9% (range 2–51%). Only two studies compared demented and non-demented groups. In these studies significant increases in both mortality and complications were found. In summary, when investigating hip fractures, choosing appropriate objective endpoints is essential to ensure results are also applicable to patients with dementia