Search Results (47)

Background: The management of infections involving the distal tibia and ankle is a significant challenge in orthopedic surgery due to complex anatomy and the high risk of complications. The study aims to present our clinical experience in managing these infections and focusing on surgical strategies, infection control, and functional outcomes over a minimum 24-month follow-up period. Methods: This is an observational, retrospective case series of 17 patients treated for osteoarticular infections of the distal tibia and/or ankle between January 2020 and May 2023, in a second-level referral trauma center. A staged surgical approach was employed, including radical debridement, temporary stabilization with external fixation, and, in most cases, implantation of a cement spacer loaded with antibiotics. Functional outcomes were assessed using scores such as EQ-5D-5L. Results: The cohort was predominantly male (76.5%), with a high prevalence of elevated BMI and comorbidities. Infection onset was most frequently associated with open fractures (64.7%). Staphylococcus aureus was the most common isolated pathogen (41.2%), and infections caused by Gram-negative or multidrug-resistant bacteria were associated with more reoperations. Overall, complications occurred in 10 patients (58.8%), requiring reintervention in 9 patients (52.9%). Limb salvage was achieved in 16 of 17 patients (94.1%). Conclusions: Our study highlights the critical role of a tailored, multidisciplinary approach in managing these complex infections. Meticulous surgical planning and proactive management of complications are essential for optimizing patient outcomes. Full article

Background: Pilon fractures are severe distal tibia injuries from high-energy trauma, often involving joint and soft tissue damage. Despite surgical advances, long-term outcomes remain poor. This study compared quality of life and functional limitations after surgical treatment of pilon versus tibial shaft fractures using validated PROMs. Methods: This case–control study was conducted at a Level I Trauma Center. Between 2016 and 2019, 84 patients with lower leg fractures were included: 38 pilon and 46 tibial shaft fractures. Inclusion criteria were AO type 42 or 43 fractures and follow-up of ≥24 months; exclusion criteria were polytrauma (ISS > 15), ASA ≥ 3, and incomplete consent. Outcomes were assessed with SF-12, EQ-5D-5L, and VAS-FA. Data were collected 36–48 months postoperatively. Analyses included t-tests, chi-square tests, linear regression. Results: Patients with pilon fractures had significantly poorer physical quality of life than tibial shaft fractures (SF-12 physical: 39 vs. 42, p < 0.05). Mental quality of life showed no significant difference. EQ-5D-5L scores were lower in the pilon group (70% vs. 79%). VAS-FA indicated higher pain and reduced function (total: 64 vs. 76, p = 0.009). Rehabilitation duration correlated with improved VAS outcomes in pilon fractures (p = 0.008), while physiotherapy reduced pain in tibial shaft fractures (p = 0.030). Conclusions: Pilon fractures substantially impair physical quality of life and long-term function, while mental well-being remains unaffected. PROMs provide insights beyond radiological findings and should be integrated into follow-up. Further multicenter studies are required to validate these results and optimize rehabilitation strategies. Full article

Background/Objectives: Resection arthroplasty is well established in treating bone defects following tumor resection, with the distal femur and proximal tibia being its most common localizations. The aim of this study was to analyze the functional outcomes and quality of life following endoprosthetic reconstruction for malignant bone tumors of the knee joint. Methods: We retrospectively included all patients treated with an endoprosthetic reconstruction following resection of a malignant bone tumor of the knee at our institution. Functional outcomes (KOOS, OKS, MSTS, and KSS) and health-related quality of life scores [QoL] (SF-36, Karnofsky Index) were evaluated. Chi-square and Fisher’s exact test was used for categorical variables, T-test and Whitney U-Mann tests for continuous variables. Survival was calculated using the Kaplan–Meier curves. Results: 32 patients were included. A total of 12 patients had died at the time of follow-up. Among the remaining 20 patients (m:w 17:3), mean follow-up was 8.1 years (range, 8.12 ± 6.8). Mean age at the time of tumor diagnosis was 50 ± 23.3 (10–83) years. According to age, patients were divided into two groups (group C1: <29 years, group C2: >29 years). Group C1 showed significantly better results regarding functional outcome (p < 0.05). The anatomic location of the replacement and a revision surgery did not influence the functional outcome (p > 0.05). QoL showed no significant differences in subgroup analysis (p > 0.05). Primary bone tumors had a significantly better survival (primary tumor: 216.90 months [168.42–265.83]; secondary tumor: 37.03 months [11.71–62.35] p = 0.01). Furthermore, pathologic fractures were associated with significantly worse survival (pathologic fracture: 50.24 months [0.00–102.43]; pathologic fracture 190.63 moths [139.28–241.45]; p = 0.007). Conclusions: Knee resection arthroplasty can offer meaningful long-term functional outcomes and acceptable quality of life in selected patients with musculoskeletal tumors. While the rarity and heterogeneity of such cases remain a challenge, our findings contribute to the growing evidence supporting this complex but limb-sparing surgical option. Full article

Osteoporosis is a common disease characterized by a reduction in bone mineral density (BMD), leading to an increased risk of pathological fractures and even mortality. Although menopause is a major risk factor, osteoporosis can also occur in premenopausal women. The aim of this study was to identify genetic variants associated with the development of osteoporosis in Korean premenopausal women. Subjects were recruited from the Anseong and Ansan cohorts of the Korean Genome and Epidemiology Study (KoGES). Clinical and epidemiological characteristics were assessed, and participants were classified based on BMD values measured at the distal radius and mid-shaft tibia. Individuals with confounding risk factors such as low body weight, smoking, high alcohol consumption, steroid/hormone therapy, or relevant medical history were excluded. A total of 247 healthy controls and 57 osteoporosis patients were included. Genotyping was performed using the Illumina Infinium HumanExome BeadChip and the Affymetrix Axiom Exome Array. Data were analyzed using the SNP and Variation Suite and PLINK, with quality control thresholds set at MAF ≥ 0.05 and HWE p ≥ 0.01. Functional annotation and protein structure predictions were performed using PolyPhen-2, SIFT, and PROVEAN. Genome-wide association analyses identified 113 single-nucleotide polymorphisms (SNPs) in 69 genes significantly associated with osteoporosis (p < 0.05) in both platforms, with 18 SNPs showing high cross-platform consistency (p < 0.01). Several of these genes were implicated in bone metabolism (e.g., ESRRG, PECAM1, COL6A5), vitamin D metabolism (e.g., NADSYN1, EFTUD1), skeletal muscle function (e.g., PACSIN2, ESRRG), and reproductive processes (e.g., CPEB1, EFCAB6, ASXL3). Notably, the CPEB1 rs783540 SNP exhibited the strongest association (p < 0.001) in both analyses. Our findings suggest that genetic polymorphisms in pathways related to bone metabolism, vitamin D signaling, muscle–bone interaction, and reproductive hormone regulation may contribute to the development of osteoporosis in Korean premenopausal women. These results provide a genetic basis for early identification of at-risk individuals and warrant further functional studies to elucidate the underlying mechanisms. Full article

Introduction: Cold welding is an anecdotally well-known complication of removal of metalwork, most commonly at the screw–plate interface, and can often complicate extraction of implants after fracture fixation. Even though this phenomenon is familiar amongst the orthopedic community, there is relatively little formalized discussion or literature pertaining to its identification and management clinically. In addition, as far as we can establish, there does not seem to be a paper that discusses the various techniques described in the literature that are employed to combat cold welding. Methods: A systematic review was carried out in accordance with the PRISMA guidance, with two independent reviewers and a third person to arbitrate for any discrepancies. Manuscripts were identified using a search of PubMed/MEDLINE and Google Scholar. Studies eligible for inclusion were tabulated and the results categorized qualitatively with respect to the technique described for removal of the implants. Results: A total of 272 manuscripts were identified using a search of PubMed/MEDLINE and Google Scholar, and of these 14 were ruled to be eligible for inclusion reporting on 292 patients. Common locations of the cold-welded screws included femur, tibia, distal radius and clavicle. The most common technique for metalwork removal was using either bolt cutters or burrs to cut the plates between the screws and mobilize the screw and plate as one unit. Other techniques included using specialized removal tools and cutting between the screw head and body. There was no appreciable correlation between the specific anatomic location of the welded implant and the technique used in its removal. From the studies, it was found that, of the total number of screws (n = 1654), 58 (3.5%) were cold welded. The mean time to metalwork removal was 1104 days (36.8 months). Conclusions: As far as we can tell, this is the first systematic review pertaining to the phenomenon of cold welding specifically, and with this project we have collated the techniques used to remove implants affected by cold welding from a variety of different articles. Our work aims to highlight the relative paucity of literature in this area and provide a number of accessible and safe techniques to facilitate the removal of cold-welded implants in fracture fixation. Full article

Background/Objectives: High-energy trauma to the lower limb often results in extensive soft tissue loss with exposure of critical structures, posing a serious threat to limb viability. Early and effective coverage is crucial to prevent infection, promote bone healing, and preserve function. This report presents the use of a latissimus dorsi free flap for circumferential soft tissue reconstruction following a severe crush injury. Methods: We describe the case of a young female patient who sustained a high-energy crush trauma with a comminuted, displaced fracture of the middle and distal third of the tibia and complete circumferential soft tissue loss. Due to the extent and location of the defect, a latissimus dorsi free flap was selected for reconstruction. The surgical technique, microsurgical anastomosis, postoperative care, and rehabilitation protocol are detailed. Results: The latissimus dorsi flap provided reliable coverage of the entire defect, protected the underlying bone and hardware, and promoted wound healing. No major complications were observed. Functional recovery was satisfactory, with progressive weight-bearing and joint mobility achieved during follow-up. Conclusions: In complex lower limb injuries with extensive soft tissue damage, free flap transfer remains a key strategy for limb salvage. The latissimus dorsi flap, due to its size, reliability, and versatility, represents a valuable option for circumferential coverage and restoration of limb function following high-energy trauma. Full article

Background: Curettage represents a reliable therapeutic option for large-sized benign and locally aggressive bone tumors. In cases of impending fractures, internal fixation with plates and screws can be necessary to stabilize the treated bone after curettage. Metal plates have been the only fixation devices available on the market for decades, but Carbon-fiber-reinforced polyetheretherketone (CFR-PEEK) now represents an alternative in orthopedic oncology. Methods: We reviewed our patients with benign or locally aggressive bone tumors treated with curettage and fixation with CFR-PEEK plates. Plate length and curettage technique were chosen considering the characteristics of each lesion. We recorded the size and location of the lesions, adjuvant treatments and fillers used after curettage, complications, and local recurrences. Postoperative functionality was assessed using the MSTS score. Results: Forty cases were included in our study. The tumors were located in the distal femur (19 cases), femur shaft (1), humerus (17), or proximal tibia (3). Local adjuvants were used in 20 cases. Cavities were filled with bone allografts in 30 cases and cement in 10 cases. Only four cases suffered postoperative complications, and two developed local recurrences. The mean postoperative follow-up was 29.2 months. The mean postoperative upper and lower limb MSTS was 28.0 and 26.7, respectively. Conclusions: After an accurate curettage and an adequate filling of the resulting bone gap, CFR-PEEK plates can provide good mechanical resistance, and their radio-transparency can ease the early diagnosis of local recurrences. CFR-PEEK plates should be considered in selected cases, in a personalized surgical approach. Full article

Background and Objectives: Distal tibia fractures are high-energy injuries characterized by a mismatch between standard plate designs and the patient’s specific anatomical bone structure, which can lead to severe soft tissue damage. Recent advancements have focused on the development of customized metal plates using three-dimensional (3D) printing technology. However, 3D-printed metal plates using titanium alloys have not incorporated a locking system due to the brittleness of these alloys. Therefore, this study aimed to determine whether a locking mechanism can be effectively implemented using 3D-printed pure titanium and further evaluate the clinical outcomes of such implants in patients with distal tibia fractures. Materials and Methods: Between March 2021 and June 2022, nine patients who underwent open reduction and internal fixation for distal tibia fractures using 3D-printed pure titanium plates were enrolled. Pure titanium powder (Ti Gr.2, Type A, 3D Systems, USA) was spread to a thickness of 30 μm and partially sintered using a 500 W laser to produce the 3D-printed metal plates. The locking screws were fabricated using a milling process. Open reduction and internal fixation were performed on the nine patients using 10 customized plates. The clinical efficacy was analyzed using the union rate, and complications, such as infection and skin irritation, were evaluated to ensure a comprehensive outcome assessment. Results: Surgical treatment was successfully performed on nine patients, with nine of ten plates remaining stable and undamaged. However, one patient with neurofibromatosis experienced a fractured metal plate, which necessitated revision surgery using a metal rod. No screw loosening or surgical wound complications occurred. Conclusions: This study showed that 3D-printed pure titanium plates with integrated locking screw systems provide a viable and effective solution for managing distal tibia fractures. Three-dimensional printing and pure titanium show promise for orthopedic advancements. Full article

In a prospective study, we examined the recovery trajectory of patients with lower extremity fractures to better understand the healing process in the absence of complications. Using a chest-mounted inertial measurement unit (IMU) device for gait analysis and collecting patient-reported outcome measures, we focused on 12 key gait variables, including Mean Leg Lift Acceleration, Stance Time, and Body Orientation. We employed a linear mixed model (LMM) to analyze these variables over time, incorporating both fixed and random effects to account for individual differences and the time since injury. This model also adjusted for varying intervals between assessments. Our study provided insights into gait recovery across different fracture types using data from 318 patients who experienced no complications or readmissions during their recovery. Through LMM analysis, we found that Tibia-Distal fractures demonstrated the fastest recovery, particularly in terms of mobility and strength. Tibia-Proximal fractures showed balanced improvements in both mobility and stability, suggesting that rehabilitation should target both strength and balance. Femur fractures exhibited varied recovery, with Diaphyseal fractures showing clear improvements in stability, while Distal fractures reflected gains in limb strength but with some variability in stability. To examine patients with readmissions, we conducted a Chi-squared test of independence to determine whether there was a relationship between fracture type and readmission rates, revealing a significant association (p < 0.001). Pelvis fractures had the highest readmission rates, while Tibia-Diaphyseal and Tibia-Distal fractures were more prone to infections, highlighting the need for enhanced infection control strategies. Femur fractures showed moderate readmission and infection rates, indicating a mixed risk profile. In conclusion, our findings emphasize the importance of fracture-specific rehabilitation strategies, focusing on infection prevention and individualized treatment plans to optimize recovery outcomes. Full article

Background/Objectives: Salter–Harris II (SH-II) distal tibia fractures are the most common physeal ankle fractures in children; however, indications for surgical management remain controversial, and patient-reported outcomes for different management strategies are unknown. The purpose of the current study is to compare differences in clinical and patient-reported outcomes following operative and non-operative management of this injury. Methods: We performed a retrospective cohort study of pediatric patients who were treated at a single institution for SH-II distal tibia fractures between 2013 and 2020. Variables included age, gender, operative versus non-operative treatment, and premature physeal closure (PPC). Patients were also contacted for patient-reported outcome scores (PROs), which included the visual analog scale foot and ankle (VAS-FA) and the PROMIS pediatric mobility instrument obtained at a minimum of 2 years post-injury. Results: Demographic and clinical information was obtained for 46 patients. Our cohort was 52% male with mean age of 11.9 years at injury. At 6 months, the rate of PPC in our cohort was 25%, with no differences between operative and non-operative patients (29% vs. 24%, p = 0.80). A total of 15 of the 46 patients provided PROs, with an average follow-up time of 5.1 years (range: 2.9–9.1). VAS-FA and PROMIS pediatric mobility scores were similar between operative and non-operative patients. Conclusions: This pilot study suggests no differences in PROs following operative and non-operative management for SH-II distal tibia fractures; however, future studies with larger cohort sizes and longer follow-up times are needed to further examine these outcomes. Full article

Background: Osteoporosis-related fragility fractures are increasing worldwide. An assessment of the prevalence of fragility fractures in Bahrain is needed to determine proper action and preventive strategies. The main objective of this study was to conduct a retrospective cross-sectional study to investigate the prevalence of fragility fractures in adult Bahraini patients. Another objective was to explore the relationship of fragility fracture risk with BMD, age, sex, BMI, vitamin D status, and therapy. Methods: To investigate the fragility fractures, we retrospectively reviewed the dual-energy X-ray absorptiometry (DEXA) data of patients who underwent scans for the diagnosis of osteoporosis between 2016 and 2018. The data were collected from four large centers in Bahrain. The patients’ medical records were reviewed for the fragility fracture data, BMD, sex, age, BMI, vitamin D status, and therapy. Results: Among a total of 4572 patients who visited the radiology departments during the 3-year study period, only 412 patients with fragility fractures were considered for the current study. The mean age of the patients in this cohort was 63.9 ± 12.2 years. There were 393 females (95.6%). Among the 431 fragility fractures, there were 175 (40.6%) belonging to three common fracture sites: vertebral (86, 20.9%), femur (60, 14.6%), and distal radius (Colles) fractures (29, 7%). Other fragility fractures were hand (7%), radius and ulna (3.7%), humerus (6.5%), tibia and fibula (5.6%), foot/ankle (27.9%), ribs (3.0%), and pelvis (1.6%). Our results revealed a significant association between the fragility fractures and BMD (χ² = 6.7, p = 0.035). We reported a significant association of fragility fracture with sex (p = 0.006) and with denosumab therapy (p < 0.001). Conclusions: This study reported a reduced BMD and an increased prevalence of fragility fractures among Bahraini subjects. The highest frequencies of fragility fractures among our cohort were foot/ankle, vertebral, and hip fractures, respectively. We showed a statistically significant association between fragility fractures and BMD. The current study indicated that not only patients with low BMD but also patients with fragility fractures were undertreated. Thus, the immediate initiation of treatment and the synthesis of local osteoporosis treatment guidelines are warranted. Full article

Objective: To review imaging findings of isolated tibiofibular interosseous membrane (IOM) injury and propose an injury mechanism. Case Report: A retrospective review was conducted on five patients who presented with lower leg pain following a traumatic athletic injury. MRI examinations revealed isolated tibiofibular IOM injury without associated fractures or distal syndesmotic disruption. The observed injury patterns, along with the blunt, non-rotational trauma reported in each case, suggest that the mechanism behind this unique presentation may involve sudden traction or direct impact to the lower leg. Conclusion: Isolated tibiofibular IOM injury should be considered in patients with lower leg pain after blunt trauma. MRI of the entire tibia and fibula can be instrumental in characterizing and confirming the injury and should be considered when clinical and injury mechanism indicators are present. Full article

Background and Objectives: Robotic-assisted total knee arthroplasty (TKA) is gaining popularity worldwide, leading to a potential increase in the number of pin tracker–related complications. This study determined the effectiveness of periarticular pin tracker placement in the distal femur and proximal tibia through a single main incision during robotic-assisted TKA over a minimum follow-up period of 6 months. Materials and Methods: A consecutive series of 149 TKAs was performed in 108 patients using the triathlon posterior-stabilized total knee prosthesis with a robotic-assisted system at our hospital from December 2023 to February 2024. Clinical outcomes and complications associated with pin tracker sites, including pin-site infection, neurovascular injury, hematoma, soft-tissue morbidity, and pin-site fracture, were assessed. Results: The mean Knee Society knee score improved from 42.5 preoperatively to 76.3 points at the final follow-up, whereas the mean Knee Society function score improved from 43.1 preoperatively to 78.1 points at the final follow-up (both p < 0.05). No patient experienced any minor or major complications related to the use of pin trackers in the distal femur and proximal tibia. Conclusions: This periarticular technique that uses pin trackers in the distal femur and proximal tibia through a single main incision could be a useful option for orthopedic surgeons while performing robotic-assisted TKA. Full article

Background: Compound fractures of the distal tibia (with or without the middle third) represent a challenge for orthopedic and plastic surgeons because of the scarcity of available soft tissue reconstruction and the important comminution of the fractures that usually appear. Methods: The design of this study is based on the PRISMA guidelines. Databases were searched for articles published and available until the first half of 2023. Articles that presented the evolution of patients treated by combining circular external fixators with reconstructive methods were selected. Results: After searching the literature using keywords, we obtained 3355 articles, out of which 14 articles met all the inclusion criteria, with a total number of participants of 283. The bone loss varied between 0.7 and 18.2 cm, while the soft tissue defect was between 3/3 cm and 16/21 cm. The average period of fixation ranged from 4 to 22.74 months. The most used reconstruction methods were 80 free flaps and 73 pedicled flaps out of 249 interventions. Complete flap loss appeared only in 3/283 patients. Regarding the bone union, the percentage of non-union was low, and in all cases, it was achieved after reintervention. A low rate of major complications was observed. Conclusions: The orthoplastic team is the key to successfully treating the high-energy traumatism of the distal tibia (with or without a middle third). The Ilizarov external fixator can be used as a definitive limb-salvage treatment (secondary to the standard primary methods of fixation) in combination with a flap to cover the defects because it does not damage the pedicle, and it helps stabilize the soft tissues and bones around the flap to lower the complications. Full article

Background: Fractures through the physis account for 18–30% of all paediatric fractures, leading to growth arrest in up to 5.5% of cases. We have limited knowledge to predict which physeal fractures result in growth arrest and subsequent deformity or limb length discrepancy. The purpose of this study is to identify factors associated with physeal growth arrest to improve patient outcomes. Methods: This prospective cohort study was designed to develop a clinical prediction model for growth arrest after physeal injury. Patients ≤ 18 years old presenting within four weeks of injury were enrolled if they had open physes and sustained a physeal fracture of the humerus, radius, ulna, femur, tibia or fibula. Patients with prior history of same-site fracture or a condition known to alter bone growth or healing were excluded. Demographic data, potential prognostic indicators, and radiographic data were collected at baseline, during healing, and at one- and two-years post-injury. Results: A total of 332 patients had at least six months of follow-up or a diagnosis of growth arrest within six months of injury. In a comparison analysis, patients who developed growth arrest were more likely to be older (12.8 years vs. 9.4 years) and injured on the right side (53.0% vs. 45.7%). Initial displacement and angulation rates were higher in the growth arrest group (59.0% vs. 47.8% and 47.0% vs. 38.8%, respectively), but the amount of angulation was similar (27.0° vs. 28.4°). Rates of growth arrest were highest in distal femoral fractures (86%). Conclusions: The incidence of growth arrest in this patient population appears higher than the past literature reports at 30.1%. However, there may be variances in diagnostic criteria for growth arrest, and the true incidence may be lower. A number of patients were approaching skeletal maturity, and any growth arrest is likely to have less clinical significance in these cases. Further prospective long-term follow-up is required to determine risk factors, incidence, and true clinical impact of growth arrest when it does occur. Full article