Search Results (63)

Extra-articular distal humerus fractures present surgical challenges, often requiring technically demanding posterior approaches with high radial nerve injury risks or off-label use of anatomically mismatched proximal plates. This study aimed to computationally design and optimize a novel anterior osteosynthesis plate for these fractures. A three-dimensional fracture model was developed, utilizing a parametric design exploration and finite element analysis to evaluate fourteen plate geometries. Evaluated variables included length, thickness, screw configuration, and locking mechanisms under physiological axial compression, bending, and varus loads. The analysis revealed that plate thickness primarily determines construct stability, with a four-millimeter profile optimally balancing rigidity and a low anatomical footprint. Lengths exceeding 40 mm yielded diminishing stability returns, while a dense distal locking screw configuration proved essential for maintaining fracture reduction. Compared to conventional clinical systems, the optimized plate substantially reduced the severe axial instability observed in extra-articular distal humerus plates and mitigated the critical bending stress concentrations inherent to proximal humeral internal locking systems. By achieving balanced, multi-planar stability with a minimized footprint, this novel design provides a favorable mechanical environment for secondary bone healing while facilitating a less invasive surgical approach. Full article

Objective: This study aims to report a clinical case involving posterior fixation combined with anterior transoral plate osteosynthesis in the management of chronic Gehweiler IIIb atlas fracture–dislocation, thereby providing a reference for similar cases. Methods: A patient with atlas fracture–dislocation following a fall injury underwent surgical intervention. Preoperative diagnosis confirmed Gehweiler IIIb fracture with right atlantoaxial lateral mass dislocation. The treatment protocol involved posterior reduction, instrumentation, and anterior transoral screw–plate fixation. Results: The postoperative recovery was uneventful, with significant alleviation of cervical pain. The most recent follow-up assessment revealed favorable osseous union and appropriate stabilization of the internal implants. The VAS score decreased from 4 preoperatively to 0 postoperatively, and the NDI decreased from 64% to 16%, concurrent with a notable enhancement in the patient’s quality of life. Conclusions: Combined posterior fixation and anterior transoral plate osteosynthesis demonstrates efficacy in ameliorating clinical manifestations and facilitating osseous consolidation in cases of chronic Gehweiler IIIb atlas fracture–dislocation. This surgical strategy demonstrates favorable therapeutic outcomes for refractory atlas fractures and warrants clinical application in analogous scenarios, but still requires extensive clinical verification. Full article

Background: Sonication of retrieved implants has emerged as a valuable diagnostic adjunct for Prosthetic Joint Infection (PJI), particularly in chronic infections or cases with prior antibiotic exposure. Quantitative culture of sonication fluid has been proposed to differentiate contamination from true infection; however, the diagnostic thresholds remain inconsistent across studies and may be influenced by methodological variability. Objectives: We aimed to evaluate bacterial counts obtained from the routine sonication of osteoarticular implants and assess their diagnostic performance across different infection types. Methods: A retrospective study was conducted (2011–2023) at a tertiary hospital. Implants from patients with PJI or Fracture-Related Infection (FRI), classified according to international criteria, were processed using a standardized sonication protocol, including centrifugation and inoculation onto multiple culture media. Quantitative results were expressed as CFU/mL. Bacterial counts were compared across infection types (acute PJI, chronic PJI, FRI), microbial characteristics, infection pattern, and affected joint using non-parametric tests. Results: A total of 457 sonicated implants were analyzed, including 316 PJI samples (26.3% acute; 73.7% chronic) and 141 FRI samples. The median bacterial count was 40,000 CFU/mL (IQR 1000–100,000). No significant differences were found between prosthetic and osteosynthesis implants. Polymicrobial infections showed significantly higher counts than monomicrobial infections (p < 0.005). No significant differences were observed according to Gram stain or joint site. Acute PJI tended to show higher bacterial burdens than chronic PJI, although not significantly (p = 0.052). Conclusions: Quantitative sonication yields substantial variability in bacterial loads, with higher counts in polymicrobial infections and a trend toward increased counts in acute PJI. A threshold of ≥1000 CFU/mL appeared to be clinically meaningful within our protocol. These findings support the diagnostic utility of quantitative sonication and underscore the need for protocol-specific thresholds. Full article

Objectives: Against common belief, mandibular condyle fractures are not that rare, with morbidity rates ranging from 19 to 52%, depending on actual literature sources. Practitioners try to improve the surgical techniques applied to obtain the most satisfactory anatomical and functional effect. The purpose of this study is to identify the relationships that affect bone loss around screws and plates in mandibular condylar process fractures treated surgically using the Open Reduction and Internal Fixation (ORIF) technique. Materials and Methods: Our research covered 276 fractures of the base, low and high neck of the condylar process. No formal sample size calculation was performed; the study enrolled patients treated at the Department during the last 4 years, based on informed consent granted both prospectively and retrospectively compares to the actual treatment time. The study group was selected based on injury type and the ability to implement surgical treatment. The imaging modality selected for the study was computed tomography (CT), which was assessed in each case by the same operator. Therefore, there was no need to account for inter-rater variability in the results. Based on CT scans, we studied various parameters, including bone healing in the fracture area, bone loss in the screws and plates area, change in the length of the mandibular ramus following osteosynthesis and on the opposite side after 12 months, as well as deformities of the mandibular head. Results: Using screws and plates is the gold standard for treating mandibular condylar process fractures. The number of screws used affects the bone loss ratio around head of the screw. Another factor that impacts the results achieved is the distance from the plate edge to the lateral pole of the mandibular head. Statistical evaluation indicated that proximity to the lateral pole is a risk factor for bone resorption at the plate edge. Conclusions: Based on the collected data, it is possible to predict bone loss, determine the location and selection of plates and screws, as well as to plan the procedure, achieving the lowest possible loss rates. Full article

Background/Objectives: Chronic locked posterior shoulder dislocations (PSDs) are rare and often misdiagnosed, leading to delayed treatment and complex management. This study retrospectively evaluates surgical outcomes in patients treated for chronic PSDs and reports our clinical experience. Methods: Ten male patients with chronic PSDs treated between 2016 and 2022 at “Vito Fazzi Hospital” (Lecce) were analyzed. Lesions were classified according to the Randelli system (Type 1: 20–50% bone loss; Type 2: >50%; Type 3: fracture dislocation without bone loss; Type 4: multifragmentary fracture dislocation). Surgical options—subscapularis transposition, bone grafting, osteosynthesis, and reverse shoulder arthroplasty—were selected based on lesion type, age, and functional demand. Follow-ups at 1, 3, 6, and 12 months assessed ROM, SF-36, and SDQ scores. Results: Six patients had Type 1 lesions, two Type 2, and two Type 4. The mean diagnostic delay was 6 weeks (up to 5 months). Early follow-ups showed superior ROM and SDQ in patients with reverse prostheses, while at 12 months, cancellous grafts achieved better functional recovery. Subscapularis transpositions resulted in minor internal rotation loss and increased pain. One Type 4 case developed avascular necrosis. Mean healing time was 2.9 ± 0.5 months. Although SDQ differences at 12 months were not significant, internal rotation was reduced by 10% in patients treated with the McLaughlin technique (p < 0.05). Conclusions: Prompt diagnosis and tailored surgical management are key to favorable outcomes in chronic PSDs. While various techniques provide good results, subscapularis transposition should be limited to unstable cases, and osteosynthesis should be used only when strictly indicated due to necrosis risk. Full article

Fracture-related infections (FRIs) represent a significant complication in orthopedic trauma care, often leading to delayed bone healing, prolonged hospital stays, and increased patient morbidity. Pathogenesis involves microbial contamination during injury or surgery, compounded by patient-related risk factors such as diabetes, smoking, or immunosuppression. Diagnosis of FRI relies on a combination of clinical, radiological, and microbiological criteria. Common signs include persistent pain, swelling, erythema, purulent discharge, and non-union of the fracture. FRIs are classified based on the timing of infection onset into acute, delayed, and chronic forms, each requiring tailored management strategies. Treatment generally involves aggressive surgical debridement, possible hardware removal or retention, and targeted antibiotic therapy. In cases of severe tissue loss, reconstructive procedures may be necessary to restore bone and soft tissue integrity. Treatment strategies include early administration of prophylactic antibiotics, meticulous surgical technique, and timely soft tissue coverage in open fractures. A multidisciplinary approach involving orthopedic surgeons, infectious disease specialists, and microbiologists is essential for successful management. Early recognition and appropriate intervention are crucial to improving outcomes and minimizing long-term disability in patients with fracture-related infections. Full article

Carbon fiber-reinforced polyetheretherketone (CFR-PEEK) as an alternative to metallics in orthopedic implants offers biomechanical and radiological advantages. However, the extent of wear particle generation and its clinical impact are unclear. This systematic review evaluates clinical evidence of wear in fracture fixation devices. A systematic search was conducted to identify clinical studies reporting wear of metallic and CFR-PEEK implants used in extremities. Nineteen studies were included: three prospective cohorts, eight retrospective cohorts, one case series, and six case reports. Among 208 fixation plates, 43 were CFR-PEEK and all 93 intramedullary nails were metallic. Risk of bias ranged from low to serious, mainly due to selection bias. Wear-related complications were reported for both materials. Metallic implants showed elevated serum ion levels, metallic debris in tissues, and, in some cases, metallosis. CFR-PEEK implants showed limited evidence of carbon fiber fragments near implants. One comparative study reported higher inflammatory responses in CFR-PEEK explants, though no direct link between debris and implant removal was found. Both metallic and CFR-PEEK fracture fixation devices generate wear particles, which may induce biological responses. However, wear-related complications appear rare, especially with validated implant designs, and clinical significance of wear debris remains limited. Full article

Background: The Induced Membrane Technique (IMT), commonly known as the Masquelet Technique (MT), has shown promising results in the reconstruction of bone defects caused by osteomyelitis. However, it is not a standardized surgical protocol but a treatment concept that has undergone various modifications, often yielding heterogeneous outcomes. Methods: This retrospective, single-center clinical cohort study included 49 patients treated with the Bone Block Technique (BBT) between 2013 and 2019 for bone defects resulting from osteomyelitis. The primary outcomes were time to bone healing, reinfection rate, and time to full weight-bearing. Additionally, infectious disease parameters, surgical site complications (SSCs), and epidemiological data were evaluated. Results: Data from 49 patients (mean age: 51 years, range: 17.6–76.9; 28.6% female) were analyzed, with a mean follow-up of 6.1 years (range: 4–10.5). The average bone defect length was 4.2 cm (range: 2.1–8.4 cm), predominantly involving the lower extremity. Primary bone consolidation was achieved in 93%, and secondary consolidation (requiring additional surgery) in 7%. Revision surgery due to recurrent infection was necessary in 16.6% of cases. The average time to full weight-bearing was 101.3 days. Conclusions: The BBT, as a modified approach based on the original IMT, represents a viable and reproducible option for bone defect reconstruction. When applied in accordance with the principles of the Diamond Concept, this technique facilitates reliable primary consolidation with a low complication rate. Full article

Background: Facial nerve palsy is a relatively common complication following open rigid internal fixation (ORIF) of a mandibular condylar fracture. The aim of this study was to investigate the risk factors that influence post-operative facial nerve function and the recovery process. Methods: A retrospective study was conducted based on the medical records of 329 patients who underwent ORIF treatment for condyle fractures, with the follow-up period being 24 months long. Results: During the initial post-operative examination, 50.45% of patients exhibited some signs of facial nerve dysfunction, ranging from slight to severe, and 48.63% of patients presented transient palsy, while only 1.82% presented permanent facial nerve palsy. Female patients were found to be more susceptible to post-operative facial nerve palsy. Patients with multiple mandibular fractures and bilateral condyle fractures had a worse prognosis. The preauricular approach and its modifications were identified as posing the greatest risk to the facial nerve. The safest approach was the retromandibular approach. Patients treated for injuries resulting from traffic accidents or falls had a worse prognosis than those treated for assault injuries. Conclusions: Post-operative facial nerve palsy following ORIF of the mandibular condyle is, in most cases, transient and can be effectively treated. However, it is important to choose the safest possible surgical approach. The safer approach, the retromandibular approach, should be considered when possible. Full article

Distal radius fractures (DRFs) constitute one of the most prevalent injuries in adults. This study compares the clinical and radiological outcomes of intra- and extra-articular DRFs treated with percutaneous Kirschner wires (PKW) or volar locking plates (VLP). Materials and Methods: A retrospective analysis was conducted on 42 patients (aged 18 to 85) treated between 2017 and 2019 with a minimum follow-up of five years. Outcomes were assessed using radiographic parameters and validated clinical scoring systems such as Disabilities of the Arm, Shoulder, and Hand (DASH), Patient-Rated Wrist Evaluation (PRWE), and Mayo Wrist Score (MAYO). Results: Clinical outcomes were better in the VLP group but not statistically significant (p > 0.05). For extra-articular fractures, DASH were 1.5 (VLP) vs. 6.4 (PKW) (p = 0.5007), PRWE were 1.3 (VLP) vs. 2.9 (PKW) (p = 0.4049), and MAYO were 95 (VLP) vs. 86.1 (PKW) (p = 0.2406). For intra-articular fractures, DASH were 6.6 (VLP) vs. 19.7 (PKW) (p = 0.0981), PRWE 12.9 (VLP) vs. 21.1 (PKW) (p = 0.3661), and MAYO 78.9 (VLP) vs. 72.2 (PKW) (p = 0.4503). Conclusions: PKW and VLP showed satisfactory long-term outcomes. VLP fixation allowed better short-term recovery and anatomical restoration, but long-term functional outcomes were comparable. Full article

Metallic biomaterials are prevalent in medical applications. In the treatment of mandibular fractures, the use of metallic biomaterials makes it possible to recover the ability to bite and partially recover speech through preventing ankylosis of the temporomandibular joints, the formation of pseudoarthritic joints, and the consolidation of reduced bones. This article presents the concept of a triaxial plate for osteosynthesis of basal fractures of the mandibular condyle, which are very common fractures in humans. Approximately half of patients with such fractures have wide (squat) condylar processes, which allows for the use of as many as three straight plates. However, installing three plates is quite troublesome, and the use of a single and transversely reinforced plate would facilitate treatment. This study proposes a plate with three reinforcements running along three divergent axes. The plate is fixed to the bone fragments with 11 screws. This concept for the treatment of basal fractures allows patients to quickly recover their primary system functions due to rigid fixation through the use of short (4 mm) screws, as there is no trauma to the medial pterygoid muscle and the mandible canal contents and no intermaxillary immobilization. Full article

Background: The autogenous bone core block (BCB) is a viable, biologically advantageous, and minimally invasive alternative to other augmentation procedures for small bone defects around dental implants. This study focused specifically on horizontal vestibular defects in the mandible, a frequently encountered yet underrepresented clinical situation, to evaluate the effectiveness and predictability of bone core grafting. Methods: Cylindrical autogenous bone cores, harvested from the implant-site osteotomy using trephine drills with a 2.5 internal diameter, were stabilized with osteosynthesis screws, and implants were placed simultaneously. Initial preoperative measurements of the edentulous ridge width were performed based on cone beam computer tomography (CBCT). At 4 months postoperatively, a subsequent CBCT measurement was performed for each implant site. Results: A total of 38 augmentation procedures were analyzed with a mean horizontal bone gain of 1.8 mm (p = 0.000). Improved outcomes were observed in V-shaped defects with remaining vertical bony walls, which contributed to better graft stability and volume preservation. While Khoury et al. previously validated the general applicability of this technique across various defect types, our study refines its indication by offering a clear protocol tailored to a common clinical niche. Conclusions: The proposed BCB method proved to be a safe, efficient, and with reduced morbidity procedure, providing clinicians with a practical and evidence-based tool for predictable horizontal bone augmentation. Full article

Polylactic acid (PLA) is a bioresorbable and biocompatible material and is a promising alternative to the current materials used for permanent implants as it has osteosynthesis properties. However, this material has some drawbacks due to its low mechanical and thermal resistance after 3D printing. Extensive research has been conducted to improve the properties of this material, for example, with the addition of other compounds, such as magnesium (Mg) or Hydroxyapatite (HA). These reinforced materials have been shown to reduce the internal stress of the matrix of PLA, improving the thermal, optical and structural properties of the material, even though the performance achieved is lower than needed to be implanted. In addition, although it is known that the addition of Mg or HA affects the mechanical performance of the material, mechanical properties have not been studied in the literature. Thus, the aim of this study is to research the effect of thermal post-processing based on annealing of composites made of PLA with Mg and PLA with HA, manufactured by fused filament fabrication, with the goal of finding an improvement in the mechanical properties of these materials. As a result, different designs of annealing processes have been studied with different reinforced materials and their mechanical properties have been compared, studying axial traction and compression, radial compression as well as flexibility, among others. The comparative results achieved show the relevance of the design of the annealing process for the improvement of the mechanical properties of these materials. Full article

Background and Objectives: Distal radius fractures (DRFs) are among the most common fractures globally, with a lifetime incidence of around 9%. They typically present in two age peaks: high-impact trauma in patients under 40 and low-energy trauma in those over 40. Intra-articular DRFs are classified according to the Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification, influencing the treatment approach. Surgical management, particularly open reduction and internal fixation (ORIF) using volar plate osteosynthesis, is considered the gold standard. This study aims to compare the treatment costs of fluoroscopy-assisted ORIF and arthroscopy-assisted ORIF for intra-articular DRF. The analysis includes surgical procedure costs, material expenses, and operating time to evaluate the cost-effectiveness of both methods, considering reimbursement within the German healthcare system. Materials and Methods: A retrospective, monocentric study was conducted at Ludwig-Maximilians-University (LMU) Hospital, a supraregional hand trauma center in southern Germany. Patients with DRFs requiring ORIF were treated either with fluoroscopy or arthroscopic assistance. Group 1 included patients treated by the Department of Hand Surgery (Plastic Surgery), subdivided into Group 1a (arthroscopy-assisted) and Group 1b (fluoroscopy-only). Group 2 comprised patients treated by Orthopaedics and Trauma Surgery (fluoroscopy-only). Costs associated with surgical procedures, including materials, operating time, and postoperative care, were analyzed. Results: A total of 43 DRFs were treated. Group 1 consisted of 17 cases, with an average age of 49.6 years (SD = 19.4) and a 64% majority of female patients. Of these, 10 cases were treated with arthroscopy-assisted ORIF (Group 1a) and 7 with fluoroscopy-only ORIF (Group 1b). In Group 1a, the average age was 53.9 years (SD = 16.3) with 60% female and 40% male patients, while in Group 1b, the average age was 43.6 years (SD = 23.1) with 71.4% female patients. Group 2 included 25 cases, with an average age of 54.2 years (SD = 21.0) and a distribution of 64% female and 36% male patients. There was no significant difference in age and gender distribution within the groups and subgroups (p > 0.05). The mean procedure time was longer for arthroscopically assisted ORIF (111.5 min) compared to fluoroscopy-only ORIF (80.1 min), and even longer compared to Group 2 (65.0 min). Material costs were slightly higher in Group 1. Total costs for Group 1 averaged EUR 4906.58, with subgroup costs of EUR 5448.24 for arthroscopy-assisted and EUR 4132.80 for fluoroscopy-only. In comparison, Group 2 costs averaged EUR 3344.08. Conclusions: Intra-articular DRFs with severely displaced fragments or concomitant injuries benefit from arthroscopically assisted fracture treatment. While material costs do not significantly differ between arthroscopically assisted and fluoroscopy-only treatments, the significantly longer procedure time for arthroscopy-assisted ORIF results in the largest cost component. Despite this, reimbursement through the DRG system remains fixed and does not account for the increased operative duration or complexity of arthroscopic procedures. Our findings demonstrate that DRF treatment, regardless of the method used, is either not or only marginally cost-covering under the current German reimbursement structure. In the context of the ongoing shift towards outpatient hand surgery, including the management of DRF, adequate reimbursement rates are necessary to ensure the economic viability of DRF management, particularly for complex intra-articular fractures requiring arthroscopic assistance. Full article

Background: Functional recovery following the surgical fixation of acetabular posterior wall fractures remains a challenge. This study compares outcomes of posterior wall fracture reconstruction using an anatomical posterior acetabular plate (APAP) versus conventional reconstruction plates. Methods: Forty patients with acetabular fractures involving the posterior wall or column underwent surgery, with 20 treated using APAPs (APAP group) and 20 with conventional pelvic reconstruction plates (control group). Baseline patient characteristics, intraoperative blood loss and time, reduction quality, postoperative function, and postoperative complications were compared using appropriate non-parametric statistical tests. A general linear model for repeated measures analysis of variance was employed to analyze trends in functional recovery. Results: No significant differences were observed in baseline characteristics. APAP significantly reduced surgical time by 40 min (186.5 ± 51.0 versus 225.0 ± 47.7, p =0.004) and blood loss (695 ± 393 versus 930 ± 609, p = 0.049) compared to conventional plates. At 3 and 6 months following surgery, the APAP group exhibited higher functional scores (modified Merle d’Aubigné scores 10 ± 1.8 versus 7.8 ± 1.4, p < 0.001; 13.4 ± 2.8 versus 10.1 ± 2.1, p = 0.001), converging with the control group by 12 months (modified Merle d’Aubigné scores 14.2 ± 2.6 versus 12.7 ± 2.6, p = 0.072; OHS 31.6 ± 12.3 versus 30.3 ± 10.1, p = 0.398). Radiologically, the APAP group demonstrated superior outcomes (p = 0.047). Complication and conversion rates to hip arthroplasty did not significantly differ between groups (10% versus 15%, p = 0.633). Conclusions: The use of an APAP in reconstructing the posterior acetabulum significantly reduces surgical time, decreases intraoperative blood loss, and leads to earlier functional recovery compared to conventional reconstruction plates. The APAP provides stable fixation of the posterior wall and ensures the durable maintenance of reduction, ultimately yielding favorable surgical outcomes. Full article