- Acromial stress fracture following reverse total shoulder arthroplasty: incidence and predictors. [Journal Article]J Shoulder Elbow Surg 2019JS
- CONCLUSIONS: Acromion-related symptoms are common following RTSA. Female patients with increased preoperative center-of-rotation medialization had an increased incidence of ASFs. Although this study establishes which patients are at risk of ASFs, methods for prevention of ASFs in these patients remain unclear.
- Diagnostic value of intraoperative tap test for acute deltoid ligament injury. [Journal Article]Eur J Trauma Emerg Surg 2019EJ
- CONCLUSIONS: The tap test has the advantages of high sensitivity, simple operation, and less radiation exposure, suggesting that it is of high diagnostic value for assessing the integrity of the acute deltoid ligament.
- Mid-term outcomes of arthroscopic-assisted Core decompression of Precollapse osteonecrosis of femoral head-minimum of 5 year follow-up. [Journal Article]BMC Musculoskelet Disord 2019; 20(1):448BM
- CONCLUSIONS: To our knowledge, this is the longest reported follow-up of arthroscopic-assisted management of ONFH. Arthroscopic-assisted management is a promising surgical approach that provides safe, accurate, and minimally invasive decompression, resulting in reliable results with an acceptable conversion rate to THA.
- StatPearls: External Fixation Principles and Overview [BOOK]StatPearls Publishing: Treasure Island (FL)BOOK
- Physicians have been using external fixation to treat fractures for more than 2000 years after being first described by Hippocrates as a way to immobilize the fracture while preserving soft tissue integrity. The fixator design and biomechanics have changed dramatically over the years, but the principles remain the same. The primary goal of external fixation is to maintain the length, alignment, a…
Physicians have been using external fixation to treat fractures for more than 2000 years after being first described by Hippocrates as a way to immobilize the fracture while preserving soft tissue integrity. The fixator design and biomechanics have changed dramatically over the years, but the principles remain the same. The primary goal of external fixation is to maintain the length, alignment, and rotation of the fracture. External fixation can serve as provisional fixation or definitive fixation purposes. Both methods can be performed in conjunction with partial internal fixation if necessary. It is important for orthopedic surgeons at a trauma center to be familiar with the techniques and principles of external fixation for various fractures of the upper extremity, lower extremity, and pelvis. Fracture healing physiology largely depends on the mode of fixation and level of stability. With absolute fracture stability such as compression plating, the bone will undergo primary intramembranous bone healing. On the other hand, relative fracture stability, such as external fixation, results in secondary enchondral bone healing. There are also several ways to alter the external fixation construct to make the fracture more or less stable. Influential factors and variables for construct stiffness and stability One method of changing the stability is to alter the pin configuration. Placing pins closer to the fracture site, adding more pins and increasing the spread of the pins will all add to the stiffness of the construct. However, one must also place the pins out of the field of future surgical approaches during definitive fixation. Any increases in pin diameter will strengthen the construct to the fourth power and reduce the stress at the bone-pin interface. Increasing pin diameter has the greatest influence on the stability of unilateral frames. That said, larger pins increase the risk of a potential stress riser and can ultimately lead to fracture. For example; a 5 mm pin is 144% stiffer than a 4 mm pin. Other variations in pin morphology include self-drilling pins, trocar tip pins, and hydroxyapatite-coated pins. Another way to change the strength of the construct is to increase the diameter of the rods or secure it closer in proximity to the bone. One can also add multiple bars to the same pins to enhance stability. Bars get secured to the pins by clamps. The most common material for bars today is carbon fiber, which is 15 % stiffer than stainless steel bars. External fixator types External fixator types divide into several different subcategories, including uniplanar, multiplanar, unilateral, bilateral, and circular fixators. By adding pins in different planes (i.e., placed perpendicular to each other), one can create a multiplanar construct. Uniplanar fixation devices are fast and easy to apply but are not as sturdy as multiplanar fixation. Bilateral frames are created when the pins are on both sides of the bone and can also add additional stability. Circular fixators have gained popularity with limb lengthening procedures but are especially effective at allowing the patient to weight bear and maintain some joint motion during the treatment. They are more difficult to apply and use smaller gauge pins and more of them to distribute the weight. There are many different ways to change and enhance the external fixation construct. To complicate things further, there are also hybrid frames which are a combination of any of the previous constructs described. The surgeon must create a level of stability that is appropriate for optimal healing. It is essential also to have a good understanding of basic fracture principals because stiffer is not always better when it comes to external fixation.
- Cartilage damage at the time of anterior cruciate ligament reconstruction is associated with weaker quadriceps function and lower risk of future ACL injury. [Journal Article]Knee Surg Sports Traumatol Arthrosc 2019KS
- CONCLUSIONS: Cartilage damage seen at time of ACL reconstruction is common and associated with lower likelihood of achieving ≥ 90% symmetry for isokinetic extension strength at 6 months after surgery. However, lower recurrent ACL injury rates are seen in patients with concurrent cartilage damage. These data may inform future clinical decisions regarding operative managment of recurrent ACL injuries.
- Arthroscopic Microfracture for Osteochondral Lesions of the Talus: Second-Look Arthroscopic and Magnetic Resonance Analysis of Cartilage Repair Tissue Outcomes. [Journal Article]J Bone Joint Surg Am 2019JB
- CONCLUSIONS: Second-look arthroscopic results revealed that 36% of lesions were incompletely healed and had inferior quality of repair tissue compared with that of native cartilage at a mean of 3.6 years, although arthroscopic microfracture provided functional improvements. Magnetic resonance analysis demonstrated some limitations in comparison with arthroscopy for the evaluation of cartilage repair. Therefore, second-look arthroscopy has an important role in accurately assessing the status of the cartilage repair tissue beyond the use of the MOCART score and functional outcomes.
- Adjuvant therapies for the enhancement of microfracture technique in cartilage repair. [Journal Article]Orthop Rev (Pavia) 2019; 11(3):7950OR
- The classic technique of microfracture does not promote hyaline cartilage restoration. Subchondral bone perforations lead to the formation of a clot containing pluripotent progenitor cells and finally the cartilage defect is filled by fibrocartilage tissue. Researchers have focused on enhancing the quality of the newly formed tissue in cartilage defects after microfracture arthroscopic surgery. A…
The classic technique of microfracture does not promote hyaline cartilage restoration. Subchondral bone perforations lead to the formation of a clot containing pluripotent progenitor cells and finally the cartilage defect is filled by fibrocartilage tissue. Researchers have focused on enhancing the quality of the newly formed tissue in cartilage defects after microfracture arthroscopic surgery. Adjuvant treatments are categorized in four main groups: scaffolds, pharmaceutical agents, growth factors and combinations of the aforementioned. Several experimental studies utilize pharmaceutical or biological agents in combination with microfracture, to improve the quality of the regenerated cartilage. The mechanism of action of the agents used is either to exert a chondroprotective effect on the newly formed fibrocartilage tissue, or to induce the recruitment of mesenchymal stem cells towards chondrogenesis instead of osteogenesis during microfracture repair. Additionally, scaffolds have been used for both release of the biological agents and mechanical support of the newly formed blood clot. This review highlights current data regarding the combination of microfracture technique with adjuvant treatments in order to ameliorate the final outcome.
- Autologous costal chondral transplantation and costa-derived chondrocyte implantation: emerging surgical techniques. [Review]Ther Adv Musculoskelet Dis 2019; 11:1759720X19877131TA
- It is a great challenge to cure symptomatic lesions and considerable defects of hyaline cartilage due to its complex structure and poor self-repair capacity. If left untreated, unmatured degeneration will cause significant complications. Surgical intervention to repair cartilage may prevent progressive joint degeneration. A series of surgical techniques, including biological augmentation, microfr…
It is a great challenge to cure symptomatic lesions and considerable defects of hyaline cartilage due to its complex structure and poor self-repair capacity. If left untreated, unmatured degeneration will cause significant complications. Surgical intervention to repair cartilage may prevent progressive joint degeneration. A series of surgical techniques, including biological augmentation, microfracture and bone marrow stimulation, autologous chondrocyte implantation (ACI), and allogenic and autogenic chondral/osteochondral transplantation, have been used for various indications. However, the limited repairing capacity and the potential pitfalls of these techniques cannot be ignored. Increasing evidence has shown promising outcomes from ACI and cartilage transplantation. Nevertheless, the morbidity of autologous donor sites and limited resource of allogeneic bone have considerably restricted the wide application of these surgical techniques. Costal cartilage, which preserves permanent chondrocytes and the natural osteochondral junction, is an ideal candidate for the restoration of cartilage defects. Several in vitro and in vivo studies have shown good performance of costal cartilage transplantation. Although costal cartilage is a classic donor in plastic and cosmetic surgery, it is rarely used in skeletal cartilage restoration. In this review, we introduce the fundamental properties of costal cartilage and summarize costa-derived chondrocyte implantation and costal chondral/osteochondral transplantation. We will also discuss the pitfalls and pearls of costal cartilage transplantation. Costal chondral/osteochondral transplantation and costa-based chondrocytotherapy might be up-and-coming surgical techniques for recalcitrant cartilage lesions.
- Microfracture for cartilage repair in the knee: current concepts and limitations of systematic reviews. [Editorial]Ann Transl Med 2019; 7(Suppl 3):S108AT
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- Biomechanical Comparison of Locking Plate and Cancellous Screw Techniques in Medial Malleolar Fractures: A Finite Element Analysis. [Journal Article]J Foot Ankle Surg 2019JF
- As the commonly used fixation strategy of medial malleolar fractures, cancellous screws (CS) have been challenged for instability, bone destruction, and metal prominence. It is still unclear whether a locking compression plate (LCP) is a better choice in such fractures. Our purpose is to compare the mechanical efficacy of LCP with traditional 4.0-mm CS for transverse, oblique, and vertical medial…
As the commonly used fixation strategy of medial malleolar fractures, cancellous screws (CS) have been challenged for instability, bone destruction, and metal prominence. It is still unclear whether a locking compression plate (LCP) is a better choice in such fractures. Our purpose is to compare the mechanical efficacy of LCP with traditional 4.0-mm CS for transverse, oblique, and vertical medial malleolar fractures by using finite element analysis. In this study, 3-dimensional models of the distal tibia were reconstructed from a computed tomography scan of a young healthy male adult. Conditions included 3 fracture lines at 30°, 60°, and 90°; 2 groups of fixation (LCP and CS); and 3 adduction loads of 300, 500, and 700 N applied to the medial malleolar joint surface. The proximal part of the tibia was fixed for all degrees of freedom. The fracture displacements of the LCP were smaller than those of CS (p < .05). The stiffness of the LCP constructs was much higher than that of the CS constructs, especially in the 90° fractures (490.3 versus 163.6 N/mm). The mean stress around the CS was higher than that in LCP for 60° and 90° fractures, but there was no difference for 30°. Maximal bone stress increased (19.84 to 50.86 MPa) and concentrated on cortical bone in LCP, whereas it concentrated on cancellous bone in CS. The results showed that LCP could improve stability, preventing bone destruction in oblique and vertical medial malleolar fractures. However, in transverse fractures, CS provides sufficient stability, with no need to use LCP.