Search Results (46)

Background: Implantation of modularly built-up stems with a tapered and fluted design is currently state of the art in revision total hip arthroplasty (RTHA). Nevertheless, implant-specific major complications like breakage of taper junctions as well as periprosthetic fractures (PPFs) may lead to failure of reconstruction during follow-up. Methods: A cohort of 117 cases receiving femoral RTHA by a modular stem was investigated retrospectively with a mean follow-up of 5.7 (0.5–13.7) years. Cumulative risk and potential factors affecting the occurrence of PPFs were calculated with the Kaplan–Meier method. In addition, cases were presented to discuss operative treatment options. Results: A cumulative risk of PPF of 12.1% (95% CI: 0–24.6%) was calculated at 13.7 years. Female patients had significantly higher risk compared to male patients (0% after 13.5 years for male patients vs. 20.8% (95% CI: 0.5–41.2%) after 13.7 years for female patients; log-rank p = 0.0438) as all five patients sustaining a PPF during follow-up were women. Four fractures were treated by open reduction and internal fixation. Non-union and collapse of the fracture occurred in one patient after closed reduction and internal fixation. Conclusions: Postoperative PPF after femoral revision with a modular stem has shown to be a frequent complication within this mid-term follow-up. Female patients were at a significantly higher risk in this aged cohort, indicating osteoporosis as a risk factor. The surgical treatment of PPF with an integrated long-stemmed prosthesis is challenging and thorough considerations of adequate operative treatment of PPFs are strongly advised in order to limit complication rates. Full article

Background and Clinical Significance: Non-prosthetic peri-implant fractures (NPPIFs) are rare injuries occurring around internal fixation devices, and are distinct from periprosthetic fractures. While most studies focus on the femur, humeral NPPIFs remain poorly documented. This case illustrates a complex humeral NPPIF and highlights key surgical considerations. Case Presentation: A 62-year-old woman presented with a spiral humeral shaft fracture (AO 12B2) after a fall. Following closed reduction and antegrade intramedullary nailing, an intraoperative peri-implant fracture occurred at the distal interlocking screw. CT imaging revealed a complex fracture extending from the lateral condyle to the proximal humerus. Treatment included implant removal and open reduction with dual plate fixation—lateral distal and helically contoured proximal plates—plus cerclage bands and antibiotic-loaded beads. Recovery was uneventful, with a full range of motion achieved at six months. At one year, the DASH score and MEPS were 86 and 75, respectively. Conclusions: Humeral NPPIFs are challenging and require individualized, biomechanically sound strategies. This case reinforces the importance of intraoperative assessment and careful implant selection in humeral fracture management. Full article

Background: Tibial plateau fractures (TPFs) are complex injuries often leading to long-term complications such as knee instability, limited range of motion, and osteoarthritis. Accurate diagnostic evaluations combining subjective and objective assessments are essential for identifying functional limitations, guiding rehabilitation, and improving recovery outcomes. This study examines the role of diagnostic predictors in differentiating recovery trajectories in two groups of patients treated for closed TPFs by open reduction and internal fixation (ORIF), comparing patients with less severe fractures and patients with more severe fractures (BCFs). Methods: A consecutive series of patients with a diagnosis of TPFs treated by ORIF at our institution between 2009 and 2016 were analyzed in this retrospective study. All injured patients were divided according to the Schatzker classification into two groups: mono-condylar (MCF) and bi-condylar (BCF) fracture patient groups. Diagnostic evaluations included patient-reported outcome measures (PROMs) such as KOOS, IKDC, and AKSS, alongside objective assessments of functional recovery using dynamometers, force platform tests (single-leg stance and squat jump variations), and measurements of active range of motion (AROM). Results: A total of 28 patients were included: 17 in the MCF patient group (Schatzker: 12 II; 5 III; 0 IV) and 11 in the BCF patient group (Schatzker: 6 V; 5 VI). Patients with less severe MCFs exhibited significantly better recovery outcomes, including higher KOOS (86.0 vs. 64.6, p = 0.04), IKDC (80.3 vs. 64.6, p = 0.04), and AKSS (95.3 vs. 70.5, p = 0.02) scores. They also demonstrated greater knee flexion (122.8° vs. 105.5°, p = 0.04) and faster neuromuscular recovery, as evidenced by higher rates of force development (RFD) during dynamic performance tests. Conversely, patients with more severe BCFs showed lower RFD values, indicating slower recovery and greater rehabilitation challenges. Conclusions: Integrating diagnostic tools like PROMs, AROM, and neuromuscular performance tests provides valuable insights into recovery after ORIF for TPFs. Fracture severity significantly impacts functional recovery patients with MCFs showing better outcomes and faster neuromuscular recovery, while subjects with BCFs require a longer rehabilitation treatment focusing on neuromuscular re-education and soft tissue recovery. Full article

A major controversy in maxillofacial surgery practice is the management of mandibular condylar fractures (CFs). The debate revolves around open versus closed treatment, rather than identifying clear indications whereby open reduction and internal fixation (ORIF) is the most viable treatment modality. Opinions regarding precise indications for ORIF remain unclear and non-uniform. We aimed to refocus the debate regarding the optimal treatment for CFs by identifying the recent indications for ORIF in the literature and assessing the quality of the existing evidence for each indication. This systematic review searched Medline, Embase and the Cochrane Central Register of Controlled Trials for eligible studies. The included studies consisted of articles from the past 15 years involving patients with any type of CF who underwent ORIF based on specified indications. From 4711 papers, 100 studies were included. In these, 121 indications were identified. The most cited indications for ORIF were those proposed by Zide and Kent, namely displacement/angulation ≥10° and ramus height shortening of ≥2 mm. Evidence supporting these indications is weak, relying mainly on expert opinion rather than robust data, with a focus on treatment comparisons. Clear, evidence-based cutoffs regarding when ORIF is the only viable treatment option are needed for a consensus. Full article

Background: Orthopedic trauma during pregnancy is a rare yet complex medical challenge, impacting both maternal and fetal health. Among these, femoral fractures are particularly uncommon but require careful management to minimize maternal and fetal risks. Methods: We report the case of a 28-year-old woman, gravida 4, para 3, at 40 weeks of gestation, who sustained a left mid-femoral diaphyseal fracture following a low-energy fall. A multidisciplinary team approach, including obstetric, orthopedic, anesthetic, and neonatal specialists, was employed. Preoperative imaging by X-ray was performed under lead-apron protection. The patient underwent an emergency C-section, followed by closed reduction and internal fixation with an intramedullary nail. Results: The surgical intervention was successful, with minimal radiation exposure. Postoperative management included thromboprophylaxis, calcium, vitamin D supplementation, and physiotherapy. The patient recovered well, achieving fracture healing within three months. Postpartum bone density assessment was recommended, suspecting pregnancy- and lactation-associated osteoporosis. Conclusions: Managing femoral fractures during pregnancy necessitates a balance between maternal and fetal well-being. A collaborative, multidisciplinary approach ensures optimal outcomes. Early surgical intervention, proper radiation precautions, and postpartum bone health assessment are crucial in these cases. Further research is needed to understand risk factors and preventive strategies for pregnancy-associated osteoporosis. Full article

Bilateral asymmetrical hip dislocations are rare, occurring in only 0.01–0.02% of all joint dislocations, typically following high-energy trauma. We present a 22-year-old male involved in a high-speed motor vehicle collision, sustaining a right posterior hip dislocation with an associated posterior wall acetabular fracture and a left obturator-type anterior dislocation. He underwent successful closed reduction within two hours post-injury, but due to persistent instability of the posterior acetabular wall fracture, open reduction and internal fixation (ORIF) via a Kocher–Langenbeck approach was performed. A structured rehabilitation protocol facilitated full functional recovery at six months, with no evidence of avascular necrosis (AVN) or post-traumatic osteoarthritis. A literature review of relevant studies highlights the importance of early reduction (<6 h) to reduce AVN risk, timely surgical stabilization for acetabular fractures, and individualized rehabilitation strategies. While our case supports established treatment guidelines, long-term outcomes and optimal rehabilitation protocols remain areas for further research. Expedited diagnosis, early intervention, and evidence-based management are essential in achieving favorable outcomes for these complex injuries. Full article

Background: Intra-articular calcaneal fracture (CF) treatment is associated with a high risk of complications, but closed reduction and internal fixation (CRIF) is a minimally invasive alternative for treatment. Methods: Forty-eight patients treated with CRIF and CALCAnail^® due to intra-articular CF between 2016 and 2021 were analyzed to check union time, complication rate, and functionality after the intervention. Functional and pain outcomes were assessed, including the Maryland Foot Score (MFS), American Orthopedic Foot & Ankle Society (AOFAS) scale questionnaires, and the numerical pain scale (NRS) at mid-term follow-ups 2–5 years after the intervention. Results: Intervention increased median Böhler’s angle from 21.5° to 32° (p < 0.01). The median bone union time was 12 weeks. The risk of malunion was higher in patients with Sanders type 4 (RR = 2.28; 95% CI 1.11–4.72) and those operated on later than the 2nd day after injury (RR = 2.1; 95% CI 1.08–4.09). Patients with at least one of the comorbidities (nicotinism, diabetes, obesity) had a higher risk of intensive pain (NRS > 3) 2–5 years after surgery (RR = 1.69; 95% CI 1.06–2.68), and 84% were satisfied with their treatment. Other complications included complex regional pain syndrome in two patients (4%), malunion in three (6%), and surgical site infection in two (4%). The MFS had a median score of 85 points, while that of the AOFAS was 82 points. Conclusions: CRIF, with the use of the CALCAnail^® implant, allows doctors to restore anatomical relationships around the subtalar joint, resulting in good clinical and functional results. Full article

Background: Diaphyseal femoral fractures in children older than 5 years and before adolescence are usually treated surgically. The literature describes several surgical techniques; however, we present an additional minimally invasive technique that combines the use of elastic intramedullary nails and a uniplanar external fixator as an optional solution for managing more complex cases. Method: This was a retrospective review of four children aged 9–12 years who suffered from unstable diaphyseal femoral fractures and were admitted to our institution. Results: We treated four children between the years 2021 and 2023. All patients underwent closed reduction of their fractures and fixation with an elastic intramedullary nail and an external fixator. Full radiographic fracture healing with acceptable alignment was achieved in all patients. The minimum clinical follow-up was 1.5 years. No major complications were observed, and all patients achieved full clinical recovery as well as proper limb alignment and length. Conclusions: Fixation of complex diaphyseal femoral fractures using a combination of internal and external fixation is a simple technique that avoids the need for extensive soft tissue exposure while also promoting fracture stability and maintenance of bone length and rotation. This method can be incorporated into the armamentarium of orthopedic surgeons as an additional solution for addressing more challenging cases. Full article

Pediatric elbow fractures are quite common, accounting for up to 34% of bone fractures in children. Among these, acute lateral humeral condyle (LHC) fractures represent up to 22%. The accurate diagnosis and early treatment of LHC fractures are crucial due to the potential for abnormal growth and significant long-term impacts on joint motion. With the aim of enhancing the understanding of pediatric LHC fracture management among pediatric healthcare practitioners, we present a literature review combined with our technical recommendations based on our experience. Imaging through AP, lateral, and internal oblique X-rays remains the gold standard for diagnosis, although there is increasing focus on non-irradiating techniques, considering the skeletally immature nature of the patients. Several classification systems aid in fracture assessment, each varying in their simplicity, reproducibility, and inter- and intra-observer correlations. The treatment approaches for LHC fractures include conservative management with immobilization for minimally displaced fractures and surgical intervention for displaced fractures. The surgical options encompass closed and open reductions, using Kirschner wires or cannulated screws for fixation. While both methods show favorable outcomes, recent years have seen a growing interest in expanding the traditional indications for closed approaches. After a period of post-surgical immobilization of the limb, rehabilitation care is recommended to assist in the recovery of the range of motion. During the postoperative period, the most frequent complications are bony overgrowth, malunion, and infection, although with highly variable rates, which typically do not result in functional impairment if managed properly. Regular follow-up and monitoring are essential for optimal recovery and minimizing long-term complications. Full article

Study Design: Retrospective with follow-up. Objective: To evaluate the long-term satisfaction of surgically treated patients with zygomaticomaxillary complex (ZMC) fractures in relation to the use of internal fixation, number of fixation points, and orbital floor (OF) reconstruction. Secondary objectives were to describe the use of antibiotics and post-operative infections. Methods: Patients with unilateral ZMC fractures between 2007–2018 and treatment with either open reduction and internal fixation (ORIF) or closed reduction (CR) were identified from medical records and invited to follow-ups between 2018–2020. Patients were examined, photographed, and completed a questionnaire. A review panel of 3 experienced surgeons evaluated photographs and computed tomography (CT) scans pre- and post-surgery. Results: The study sample consisted of 136 patients (108 ORIF, 28 CR) with a median follow-up time of 76 months. Patient satisfaction of surgical outcome was high (97.8%), with no significant differences in relation to the use of internal fixation, number of fixation points, or OF reconstruction. Dissatisfaction was primarily related to hypoesthesia. On post-operative CT scans, malar asymmetry was more often predicted in patients with 1-point fixations. On questionnaires and photographs, malar asymmetry was more common in patients with 3-point fixations. Prophylactic antibiotics had no effect on the rate of post-operative infections. Conclusions: Patient satisfaction was not influenced by internal fixation, number of fixation points, or OF reconstruction. Selected ZMC fractures can be treated with less invasive approaches. Caution should be observed when predicting long-term malar asymmetry on post-operative CT scans. The findings of this study highlight the importance of a rational and ethical use of surgery. Full article

Background: Mandibular condyle fractures in pediatric patients can lead to crippling sequelae such as ankylosis, pain and facial deformity if not managed properly. However, there is no consensus on the best approach for treating these fractures in children. Objective: This study aimed to describe the management of mandibular condyle fractures in growing patients across 14 maxillofacial departments worldwide. Methods: A retrospective multicenter study was conducted on children and adolescents aged 0 to 16 who had at least one mandibular condyle fracture. This study included patients who underwent expectant, closed, or open management and were treated over an 11-year period. Results: 180 patients had at least one mandibular condyle fracture, and 37 had a second condylar fracture. One hundred sixteen patients (65%) were males, and 64 (35%) were females (ratio 1.8:1). An expectant strategy was chosen in 51 (28%) patients, a closed treatment—stand-alone maxillomandibular fixation (MMF)—in 47 (26%), and open reduction and internal fixation (ORIF) was performed in 82 (46%) patients. The management varied significantly between the different departments (p < 0.0001). Significant differences were also identified between the fracture type (non-displaced, displaced or comminuted) and the management of the 180 patients with a single condylar fracture. Out of 50 non-displaced fractures, only 3 (6%) had ORIF, 25 (50%) had expectant management, and 22 (44%) had MMF. Out of 129 displaced fractures, 79 (62%) had ORIF, 25 (19%) had a soft diet, and 25 (19%) had MMF. Conclusions: Expectative management, MMF, and ORIF were all effective in treating pediatric mandibular condyle fractures, with a low incidence of complications and asymmetry. Full article

Background: Proximal humerus fractures are common fractures of the elderly population which can lead to long-term compromise of a patient’s shoulder function. Closed reduction and internal fixation with intramedullary nailing is a well-established surgical technique yielding good outcomes, as perceived by patients, obtained via Patient-Reported Outcome Measures, and objectified by clinical shoulder testing. Apart from conventional range-of-motion testing and clinical shoulder tests, strength testing of the shoulder is a yet-neglected but meaningful and standardizable outcome parameter. In this study, isometric shoulder strength is evaluated in relation to fracture morphology/postoperative reduction quality as well as with patient-reported outcomes. Methods: 25 patients (mean age 73.2 ± 10.5 years) underwent isometrics strength-testing of the shoulder joint in the scapular plane (abduction) as well as in the sagittal plane (flexion) as well as hand-grip strength-testing at 4.5 ± 1.88 years follow-up. Pre- and postoperative radiographs were analysed. Patients completed ASES and CMS questionnaires. Results: Patients exhibited a decrease in abduction and flexion force (−24.47% and −25.30%, respectively, p < 0.001) using the contralateral, uninjured arm as reference. Abduction force tended to be decreased in three- and four-part fractures. Patient satisfaction correlated negatively with the relatively reduced force of the affected arm. Varus-angulated humeral heads produced significantly lower abduction force output than valgus- or physiologic angulation (p = 0.014), whereas flexion force was unaffected (p = 0.468). The anatomical reduction had no influence on shoulder strength. Conclusions: Proximal humerus fractures may cause a significant reduction in shoulder function, both reported by patients and objectified by shoulder strength testing. Varus head angulation demonstrated the greatest loss of shoulder strength and should be avoided to ensure proper functioning. Further, strength testing seems a valuable outcome parameter for a thorough shoulder examination with easy obtainability. Full article

Aims: This study aims to compare the outcomes of immediate (followed by closed-incision negative-pressure therapy use) versus delayed ORIF in patients with Schatzker type IV–VI TPFs. Patients and Methods: A prospective study of patients undergoing ORIF between January 2018 and December 2019 was performed. The inclusion criteria were patients (>18 years) with a closed fracture sent to the emergency room (ER) within 24 h of injury. All the patients underwent preoperative image evaluation. Two senior orthopedic trauma surgeons evaluated the soft tissue condition in the ER by 5P’s of the compartment syndrome, judging the timing of the operation of definitive ORIF. Group 1 (n = 16) received delayed ORIF. Group 2 (n = 16) received immediate ORIF and ciNPT use. Patient follow-up occurred after 2 and 6 weeks and 3, 6, and 12 months after surgery. The assessments included the time to definitive fixation, the length of hospital stay, the time to bone union, surgical site complications, and reoperation within 12 months. A universal goniometer was used to measure the postoperative 3 m, 6 m, and 12 m ROM. Results: The patient demographics were similar between the groups (p > 0.05). Group 2 displayed significantly a shorter time to definitive fixation (5.94 ± 2.02 vs. 0.61 ± 0.28, p < 0.0001) and hospital stay (14.90 ± 8/78 vs. 10.30 ± 6.78, p = 0.0016). No significant difference was observed in the time to bone union, surgical site complication incidence, and reoperation rates (p > 0.05). Flexion and flexion–extension knee ROM were demonstrated to be significantly improved in Group 2, 3, 6, and 12 months postoperatively (p < 0.0001). Conclusions: In this study, early ORIF and ciNPT use resulted in a shorter hospital length of stay, a reduced time to early active motion of the knee, and improved knee ROM. These results suggest that early ORIF with ciNPT for Schatzker type IV–VI TPFs is safe and effective in some patients. However, further research to confirm these findings across larger and more diverse populations is needed. Full article

The treatment for humeral shaft fractures (HSFs) is still controversial, consisting of a wide variety of orthopedic osteosynthesis materials that imply different grades of invasiveness. The aim of this study is to investigate the correlation between inflammatory blood-derived markers and the magnitude of the surgical procedure in young and middle-aged patients who sustained these fractures. Observational, retrospective research was conducted between January 2018 and December 2023. It followed patients diagnosed with recent HFSs (AO/OTA 12−A and B) and followed operative treatment. They were split in two groups, depending on the surgical protocol: group A, operated by closed reduction and internal fixation (CRIF) with intramedullary nails (IMNs), and group B, operated by open reduction and internal fixation (ORIF) with dynamic compression plates (DCPs). Statistically significant differences (p < 0.05) between the two groups could be observed in injury on the basis of surgery durations, surgical times, pre- and postoperative neutrophil-per-lymphocyte ratio (NLR), postoperative platelet-per-lymphocyte ratio (PLR), monocyte-per-lymphocyte ratio (MLR), systemic inflammatory index (SII), systemic inflammatory response index (SIRI) and aggregate inflammatory systemic index (AISI). The multivariate regression model proposed revealed that NLR > 7.99 (p = 0.007), AISI > 1668.58 (p = 0.008), and the surgical times (p < 0.0001) are strongly correlated to the magnitude of the surgical protocol followed. Using receiver operating characteristic (ROC) curve analysis, a balanced reliability was determined for both postoperative NLR > 7.99 (sensitivity 75.0% and specificity 75.6) and AISI > 1668.58 (sensitivity 70.6% and specificity 82.2%). Postoperative NLR and AISI as inflammatory markers are highly associated with the magnitude of surgical trauma sustained during humeral shaft fracture osteosynthesis in a younger population. Full article

The aim of this study was to assess surgical treatment in metacarpal shaft fractures of the second to fifth ray to determine the functional outcomes and complications in open reduction and internal fixation (ORIF) versus closed reduction and internal fixation (CRIF). This was a retrospective study that included patients with metacarpal shaft fractures of the second to fifth rays who were treated surgically between 1 January 2007 and 31 December 2019. Functional outcomes were scored using the QuickDASH and Eq5D score. A total of 231 treated patients were included. Single fractures were seen in 180 patients, and multiple fractures in 51 patients. ORIF was applied in 141 patients and CRIF in 90 patients. The functional outcomes were not significantly different between the groups. Complications were found in 41 (29%) of the ORIF patients and 15 (17%) of the CRIF patients. The functional outcomes after single or multiple metacarpal shaft fractures were similar in the ORIF and CRIF patients. ORIF showed significantly more complications, such as functional impairment and infections and a higher reoperation rate. In conclusion, CRIF is as safe as ORIF for the surgical treatment of metacarpal shaft fractures in terms of its functional outcome and slightly preferable due to its lower complication rate. Full article