One-year results of cemented bipolar radial head prostheses for comminuted radial head fractures

Introduction: Comminuted radial head fractures (Mason type III) continue to pose a challenge to orthopedic surgeons. When internal fixation is not possible, radial head arthroplasty has been advocated as the treatment of choice. The purpose of this retrospective study was to evaluate clinical and radiological short-term results of patients with Mason type III radial head fractures treated with a cemented bipolar radial prosthesis. Methods: Twelve patients received cemented bipolar radial head hemiarthroplasty for comminuted radial head fractures. In all patients a CT scan was obtained prior to surgical treatment to assess all associated injuries. Postoperatively an early motion protocol was applied. All patients were evaluated clinically and radiologically at an average of 12.7 months.Results: According to the Mayo Modified Wrist Score, the Mayo Elbow Performance Score, the functional rating index of Broberg and Morrey, and the DASH Score good to excellent results were obtained. Grip strength and range of motion were almost at the level of the unaffected contralateral side. Patient satisfaction was high, no instability or signs of loosening of the implant, and only mild signs of osteoarthritis were seen.Conclusion: Overall good to excellent short-term results for primary arthroplasty for comminuted radial head fractures were observed. These encouraging results warrant the conduction of further studies with long-term follow-up and more cases to see if these short-term results can be maintained over time

Monteggia-like lesions – treatment strategies and one-year results

Introduction: The eponym “Monteggia fracture” includes various patterns of complex fracture-dislocations of the proximal ulna and radius, which are not well defined yet. They are frequently described as Monteggia-like lesions or Monteggia equivalent injuries. Until today, these injury patterns have been reported rarely. The objective of this retrospective study was to better define patterns of injury and to document the short-term results of treatment with current fixation techniques.Methods: Ten patients with a Monteggia-like lesion were included in this study and clinical and radiological follow-up examinations at an average of 12.3 months after the trauma were performed. For clinical follow-up the Mayo Modified Wrist Score, the Mayo Elbow Performance Score, the functional rating index of Broberg and Morrey, and the DASH score were utilized.Results: Osteosynthesis of the ulna was performed using a proximally contoured or precontoured LCP (locking compression plate) in all patients. All patients had a fracture of the radial head. All patients with a Mason type III radial head fracture received a cemented bipolar radial head prosthesis. All Mason type II fractures were treated with open reduction and internal fixation using mini screws. In all Mason type I fractures the treatment of the radial head dislocation was by closed reduction. Associated coronoid fractures were stabilized with lag screws through the ulnar plate or with independent lag screws after reduction of the fracture. According to the aforementioned scoring systems good to excellent results could be achieved.Conclusions: Our findings demonstrate that good or excellent short-term results can be obtained if the injury is classified correctly and a standardized surgical treatment of all components of the injury is achieved. Further studies with larger patient populations and longer follow up periods are needed to evaluate long-term effectiveness of this treatment concept

Evaluation of a novel spine and surface topography system for dynamic spinal curvature analysis during gait.

INTRODUCTION: The assessment of spinal deformities with rasterstereography can enhance the understanding, as well as can reduce the number of x-rays needed. However, to date this technique only allows measurements under static conditions. Since it would be of great value to be able to also analyze the spine in dynamic conditions, the present study evaluated a novel rasterstereographic system. MATERIALS AND METHODS: A new rasterstereographic device was evaluated in a comparison with the gold standard in motion analysis, the VICON system. After initial testing using 12 flat infrared markers adhered to a solid plate, the two systems were evaluated with the markers adhered onto the backs of 8 test subjects. Four triangles were defined using the markers, and the sides of each triangle were measured under static and dynamic conditions. RESULTS: On the solid plate, the sides of the 4 triangles were measured with a measuring tape and then by the two optical systems. Rasterstereography showed a high accuracy in marker detection on the solid plate. Under dynamic conditions, with the subjects walking on a treadmill, the rasterstereographically-measured side lengths were compared with the lengths measured by the VICON system as an assessment of marker detection. No significant differences (p>0.05) were found between the systems, differing only 0.07-1.1% for all sides of the four triangles with both systems. DISCUSSION: A novel rasterstereographic measurement device that allows surface and spine topography under dynamic conditions was assessed. The accuracy of this system was with one millimeter on a solid plate and during dynamic measurements, to the gold standard for motion detection. The advantage of rasterstereography is that it can be used to determine a three-dimensional surface map and also allows the analysis of the underlying spine

Bone marrow aspiration concentrate and platelet rich plasma for osteochondral repair in a porcine osteochondral defect model.

BACKGROUND: Bone marrow aspiration concentrate (BMAC) may possess a high potency for cartilage and osseous defect healing because it contains stem cells and multiple growth factors. Alternatively, platelet rich plasma (PRP), which contains a cocktail of multiple growth factors released from enriched activated thrombocytes may potentially stimulate the mesenchymal stem cells (MSCs) in bone marrow to proliferate and differentiate. METHODS: A critical size osteochondral defect (10×6 mm) in both medial femoral condyles was created in 14 Goettinger mini-pigs. All animals were randomized into the following four groups: biphasic scaffold alone (TRUFIT BGS, Smith & Nephew, USA), scaffold with PRP, scaffold with BMAC and scaffold in combination with BMAC and PRP. After 26 weeks all animals were euthanized and histological slides were cut, stained and evaluated using a histological score and immunohistochemistry. RESULTS: The thrombocyte number was significantly increased (p = 0.049) in PRP compared to whole blood. In addition the concentration of the measured growth factors in PRP such as BMP-2, BMP-7, VEGF, TGF-β1 and PDGF were significantly increased when compared to whole blood (p<0.05). In the defects of the therapy groups areas of chondrogenic tissue were present, which stained blue with toluidine blue and positively for collagen type II. Adding BMAC or PRP in a biphasic scaffold led to a significant improvement of the histological score compared to the control group, but the combination of BMAC and PRP did not further enhance the histological score. CONCLUSIONS: The clinical application of BMAC or PRP in osteochondral defect healing is attractive because of their autologous origin and cost-effectiveness. Adding either PRP or BMAC to a biphasic scaffold led to a significantly better healing of osteochondral defects compared with the control group. However, the combination of both therapies did not further enhance healing

Concentration of platelets and growth factors in platelet-rich plasma from Goettingen minipigs

In minipigs little is known about the concentration of growth factors in plasma, despite their major role in several patho-physiological processes such as healing of fractures. This prompted us to study the concentration of platelets and selected growth factors in plasma and platelet-rich plasma (PRP) preparation of sixteen Goettingen minipigs. Platelet concentrations increased significantly in PRP in comparison to native blood plasma. Generally, significant increase in the concentration of all growth factors tested was observed in the PRP in comparison to the corresponding plasma or serum. Five of the plasma samples examined contained detectable levels of bone morphogenic protein 2 (BMP-2) whereas eleven of the plasma or serum samples contained minimal amounts of vascular endothelial growth factor (VEGF) and platelet-derived growth factor (PDGF-bb) respectively. On the other hand variable concentrations of bone morphogenic protein 7 (BMP-7) and transforming growth factor β1 (TGF-β1) were measured in all plasma samples. In contrast, all PRP samples contained significantly increased amounts of growth factors. The level of BMP-2, BMP-7, TGF-β1, VEGF and PDGF-bb increased by 17.6, 1.5, 7.1, 7.2 and 103.3 fold, in comparison to the corresponding non-enriched preparations. Moreover significant positive correlations were found between platelet count and the concentrations of BMP-2 (r=0.62, p<0.001), TGF-β1 (r=0.85, p<0.001), VEGF (r=0.46, p<0.01) and PDGF-bb (r=0.9, p<0.001). Our results demonstrate that selected growth factors are present in the platelet-rich plasma of minipigs which might thus serve as a source of autologous growth factors

The role of erythropoietin and bone marrow concentrate in the treatment of osteochondral defects in mini-pigs.

All available treatment options for osteochondral and chondral defects do not restore hyaline cartilage and are limited to decreasing associated pain, and maintaining or improving joint function. The purpose of this study was to evaluate the potential of erythropoietin (EPO) in combination with bone marrow aspiration concentrate (BMAC) in the treatment of osteochondral defects of mini-pigs.14 Goettinger mini-pigs, in which a 6 × 10 mm osteochondral defect in the medial femoral condyle of both knee joints was created, were randomized into four groups: biphasic scaffold alone, scaffold with EPO, scaffold with BMAC and scaffold in combination with EPO and BMAC. After 26 weeks all animals were euthanized and histological slides were evaluated using a modified ÓDriscoll Score.In the therapy groups, areas of chondrogenic tissue that contained collagen II were present. Adding EPO (p = 0.245) or BMAC (p = 0.099) alone to the scaffold led to a non-significant increase in the score compared to the control group. However, the combination of EPO and BMAC in the implanted scaffold showed a significant improvement (p = 0.02) in the histological score.The results of our study show that in mini-pigs, the combination of EPO and BMAC leads to an enhanced osteochondral healing. However, additional research is necessary to further improve the repair tissue and to define the role of MSCs and EPO in cartilage repair

Treatment of scaphoid waist fractures with the HCS screw

The aim of the study was to evaluate the clinical results of the Headless Compression Screw (HCS, Synthes) when used for treatment of acute scaphoid waist fractures. The new screw design generates interfragmentary compression with use of a compression sleeve. Twenty-one patients were treated for acute scaphoid waist fractures type B2 with HCS screws. The average time to the final follow-up examination was 12.8 months. All 21 fractures united after a mean time of 7.2 weeks. The mean DASH score was 7.1. The average motion of the wrist in extension was 61°, flexion was 46°, radial abduction reached 25° and the ulnar abduction was 31°. The maximally achieved grip strength was 86% compared to the uninjured side. Treatment of type B2 scaphoid fractures with the Headless Compression Screw showed good functional and radiographic results. The results are similar to those identified using other screw fixation systems