A novel pyrolytic carbon implant for hallux rigidus: a cadaveric study

BACKGROUND: The aim of this cadaveric study was to assess the technical feasibility of inserting a novel interpositional pyrolytic carbon coated implant in the first MTP joint, determine the best surgical procedure for the implantation, and evaluate the dynamic behavior of the joint after surgery. METHODS: The marble implant was inserted in the first metatarsophalangeal joint of five pairs of cadaveric feet using two different surgical approaches, dorsal and medial, for each pair. The stability and mobility of the feet before and after implantation, as well as the relationship between the implant and the sesamoids, were assessed by static and dynamic fluoroscopy. RESULTS: After implantation, the stability was perfect in all positions and the mobility was conserved. There were no conflicts between the sesamoids and the implant during the movement of the first metatarsophalangeal joint. Both the dorsal and the medial surgical approaches led to similar findings. CONCLUSION: To our knowledge, this is the first anatomic evaluation of this type of implant. Whereas the results of the technique obtained on cadaveric feet were satisfactory, caution has to be applied to trying to apply this procedure to the living patient

Isolated interfragmentary compression for nonunion of humeral shaft fractures initially treated by nailing: A preliminary report of seven cases

Introduction Plating with bone grafting is considered the gold standard treatment for nonunion of humeral shaft fractures. However, this complex procedure involves multiple risks. The aim of this study is to evaluate an alternative treatment using isolated axial interfragmentary compression for the dynamisation of humeral shaft nonunion after retrograde locked nailing. Materials and methods Between January 2000 and May 2009, 124 humeral shaft fractures were treated in our trauma department with retrograde locked nailing using the unreamed humeral nail (UHN®, Synthes, Paoli, PA, USA). Nonunion occurred in seven patients (5.6%) – five females and two males, mean age 44 years (range: 17–73 years). The nonunion was treated by applying isolated secondary interfragmentary compression. Mean follow-up was 43 months (range: 8–74 months). The Rommens score and the disabilities of the arm, shoulder and hand (DASH) score were used to evaluate the global functioning of the upper limb. Results The compression procedure was successful in all seven cases. In each case, the union occurred without any complications in 3–5 months. The mean DASH score was 25/100 (range: 8.3–60.8/100). The Rommens score was judged excellent for five of the seven patients but two were rated moderate. One of these suffered from complex regional pain syndrome type II since the fracture, and another developed a stiff shoulder 6 months after trauma. Conclusion Isolated secondary interfragmentary compression appears to be a simple and successful procedure in cases of humeral nonunion

Two-stage reconstruction of post-traumatic segmental tibia bone loss with nailing

Introduction Treatment of lower extremity segmental bone loss is difficult. Masquelet et al. proposed a two-stage technique: first, debridement and filling of bone loss with an acrylic spacer; second, bone reconstruction by filling with cancellous bone in the space left free (following cement removal) inside the so-called self-induced periosteal membrane. In the originally described technique, the fracture site is stabilized by an external fixator, which remains in place throughout the bone healing process, i.e., often longer than 9 months with all the known disadvantages of this type of assembly. Following the principle of two-stage reconstruction, we modified the technique by reconstructing around an intramedullary-locking nail placed in the first stage. Hypothesis This technique prevents the mechanical complications related to external fixator use and provides faster resumption of weight-bearing. Patients and methods Twelve patients were operated for segmental tibial bone loss greater than 6 cm resulting from injury (four cases) or aseptic necrosis (one case) or septic necrosis (seven cases). All the patients were operated on in an emergency setting and the first stage was performed before the 2nd week. A free muscle flap (ten patients) or a pediculated fasciocutaneous flap (two patients) was necessary during this first step to cover the site and provide good conditions for secondary bone growth. The follow-up was 39.5 months (range, 12–94 months). Results Complete weight-bearing was resumed at a mean 4 months. After the second step, all the patients except one had apparently healed (complete weight-bearing with no pain). Five septic complications occurred after the second step, in one case leading to reconstruction failure. Four other patients had infectious complications successfully treated (as of the last follow-up) either by changing the nail in two cases or by prolonged antibiotic therapy in two other cases, with no graft loss. Discussion The use of the intramedullary nail facilitates the Masquelet technique by allowing the patient to resume weight-bearing more quickly and avoiding secondary fractures. However, the risk of sepsis remains high but can be controlled without compromising the final bone union in four cases out of five. Level of evidence Level IV. Retrospective study