Search Results (20)

Management of septic arthritis of the pubic symphysis (SAS) presents with substantial clinical challenges. Firstly, the SAS is an extremely rare entity. Surgical resection of the symphysis plus targeted antibiotic therapy is a widely adopted treatment course. Some patients suffering from SAS develop posterior pelvic insufficiency fractures because of the weakened anterior pelvic ring or as a result of radiation therapy received during treatment for a malignant disease in the lesser pelvis. The literature demonstrates a lack of standardized strategies for restoring pelvic ring integrity based on pelvic instability and posterior pelvic insufficiency fractures caused by SAS. Background and Objectives: This study aimed to determine whether early, primary stand-alone dorsal fusion can be a viable treatment option in SAS and whether there is a clinical benefit compared with temporary anterior fixation or secondary posterior stabilization after failed anterior fixation. Materials and Methods: We performed a descriptive, retrospective analysis covering an eight-year period (2018–2025) including 21 patients who underwent symphyseal resection for destructive SAS. We evaluated peri- and postsurgical data to describe the different surgical methods and their respective outcomes. Results: Ten patients (10/21, 48%) received posterior stabilization (sacroiliac-joint fusion or spinopelvic stabilization). Seven patients (7/21, 33%) were anteriorly fixated either temporarily with an external fixator or permanently with ventral plate osteosynthesis. Four patients (4/21, 19%) did not receive any pelvic stabilization following symphyseal resection as pelvic integrity was present. Three of them (3/21, 14%) showed spontaneous sacroiliac-joint fusion, while 6/7 (86%) of anteriorly fixed patients presented with debilitating sacral insufficiency fractures, had longer hospital stays and a higher count of readmissions and re-operations. Primary posterior stabilization led to shorter hospital stays, less readmissions, and good clinical outcome. Conclusions: Primary posterior stabilization can be a viable course of treatment of SAS and should be considered especially when spontaneous sacroiliac-joint fusion is not present. We suggest that early stabilization of the posterior pelvic ring could be a sensible course of treatment and may prevent debilitating insufficient fractures. While there are many different surgical options for posterior stabilization available (spinopelvic/lumbosacral stabilization, sacroiliac-joint fusion and others), our preliminary data suggest that primary sacroiliac-joint fusion is a quick, minimally invasive and effective way to establish posterior pelvic stability. Full article

Background/Objectives: The primary objective of this study was to evaluate the accuracy of maxillary repositioning using a two-plate patient-specific osteosynthesis system. The secondary objective was to determine whether accuracy is influenced by the number of maxillary segments. Methods: A retrospective single-centre cohort study was conducted on patients undergoing bimaxillary orthognathic surgery with a maxilla-first two-plate PSO system. Virtual Surgical Planning was performed based on the Cone-Beam Computed Tomography (CBCT) data of the patient, with patient-specific plates being designed and manufactured accordingly. Postoperative CBCT scans (7–10 days post-op) were registered to the preoperative plan, and deviations in translation and rotation between the plan and results were determined. Sub-group analyses were performed on one-, two- and three-segment maxillary osteotomy patient groups. Results: The inclusion criteria were met by 61 patients, of whom 47 were included for analysis (mean age 27.9 ± 9.4 years). Sub-millimetre median translational accuracies were found: anteroposterior 0.7 mm, transverse 0.4 mm, vertical 0.6 mm. The median rotational deviations were ≤1° for yaw and roll, and 1.6° for pitch. Accuracy was consistent across the one-, two-, and three-segment osteotomy groups. Conclusions: The two-plate PSO system is clinically accurate in bimaxillary surgery. There is no significant difference in accuracy between one-piece and segmental osteotomies of the maxilla when using the two-plate system. Full article

Background/Objectives: Proximal humerus fractures account for approximately 5% of all skeletal injuries, and their optimal surgical management remains debated. The optimal fixation method for three-part proximal humerus fractures remains a matter of debate. This study aimed to compare the clinical and radiological outcomes of two minimally invasive osteosynthesis techniques—plate fixation and intramedullary nailing—for the treatment of three-part proximal humerus fractures. Methods: Sixty-six patients aged 60–80 years were retrospectively analyzed across two centers adopting different institutional preferences. Thirty-three patients were treated with minimally invasive plate fixation and thirty-three with intramedullary nailing. The mean age was 67.8 ± 4.2 years, and the mean follow-up duration was 27.2 months. Functional and clinical outcomes were evaluated using the Barthel Index, DASH, Simple Shoulder Test (SST), and Visual Analog Scale (VAS). Operative time, hospitalization length, healing time, and postoperative complications were recorded and statistically analyzed. Results: Intramedullary nailing was associated with shorter operative and hospitalization times and fewer complications. Early SST and VAS improvements favored the nailing group, while long-term outcomes were comparable. Conclusions: Intramedullary nailing represents a reliable and less invasive alternative to plate fixation in the treatment of three-part proximal humerus fractures. It offers shorter operative and hospitalization times, fewer postoperative complications, and faster functional recovery while achieving comparable long-term outcomes. Surgeon experience and familiarity with the chosen technique remain key determinants of success. Full article

We present a case of unexpected proximal displacement of an intramedullary pin (IMP) during plate–rod repair of a femoral fracture caused by minimally invasive plate osteosynthesis (MIPO), requiring immediate revision. Implant retrieval analysis and ex vivo modelling were performed to characterise the technique failure mode. The case details are reported. Implant retrieval analysis consisted of stereo zoom microscopic examination of the retrieved IMP. Wear patterns formed by conflict with a 2.8 mm, two-fluted surgical drill bit and a 3.5 mm AO locking screw were replicated using a simple paper impression model. The mechanism of pin movement was replicated in a benchtop laminated polyurethane foam block model, and wear patterns produced during drilling and screw insertion were characterised using stereo zoom. The wear pattern visible on the retrieved IMP suggested axial displacement caused by a rack-and-pinion-like mechanism, enacted by contact with either the drill bit or locking screws during placement of the repair construct. Significant axial displacement of the IMP due to conflict with screws during construct placement is possible during the placement of plate–rod fixation. Surgeons should confirm implant positioning if implant conflict is recognised intra-operatively. Full article

Background/Objectives: Distal forearm fractures are the most common fractures in children. Three surgical techniques are most commonly used at the level of the radial diametaphysis on the distal forearm in children: K-wire, ascending ESIN (elastic stable intramedullary nail) or plate osteosynthesis. The aim of this study was to compare these procedures in children with distal diametaphyseal radius fractures regarding operative and functional outcome. Methods: A retrospective study was conducted in two level 1 trauma centers. Children and adolescents aged 2 to 15 years were included. The study period was from January 2010 to December 2022. The hospital information system was used to record patient age, gender, height, weight, fracture location, degree of angular deformity postoperatively, surgical procedure and postoperative complications, which were described in the medical records of the hospital information system. Complications graded by modified Clavien–Dindo–Sink served as the primary outcome. Reduction accuracy, operative and fluoroscopy times, immobilization length and postoperative motion were the secondary endpoints. Results: A total of 213 children were included in the study. K-wire osteosynthesis was performed in 25%, nailing in 19% and volar plate osteosynthesis in 55%. All ESIN were inserted in ascending technique. Complications occurred in 22% of patients and did not differ overall between techniques (p = 0.20). Severe complications were significantly more frequent after ESIN (20%) than after K-wires (7%) or plates (4%) (p = 0.04). Plate fixation achieved the most accurate alignment (≤5° angular deformity in 93% vs. 57% K-wires and 61% ESIN; p < 0.0001) and the fewest late motion restrictions (p = 0.02). K-wire surgery was fastest technique and required the least fluoroscopy, but necessitated the longest postoperative cast. Conclusions: Volar plating combines reliable anatomical reduction with a low rate of major complications and early mobilization, supporting its use in older children whose remodeling potential is limited. K-wires are a swift, minimally invasive option for younger patients, albeit with less precise reduction and prolonged immobilization. Conventional ESIN showed the highest burden of severe complications. 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

Background: Minimally invasive plate osteosynthesis (MIPO) for clavicular shaft fracture yields favorable functional outcomes and results in less surgery-related soft tissue injury than other techniques. Anterior chest and shoulder skin numbness, a common complication after open reduction and plate fixation, is related to injury to the supraclavicular nerves. We propose MIPO combined with a mini-open approach without fluoroscopy for nerve preservation to minimize the risk of postoperative numbness compared with traditional open plating without nerve preservation. Methods: A total of 59 patients were retrospectively identified, with a follow-up period of 6 months. Thirty-two patients underwent MIPO with mini-open and nerve preservation technique (MIPO group), and 27 patients underwent traditional open plating without nerve preservation (open group). Constant–Murley shoulder outcome score, operation time, wound length, skin numbness, and number of implant removals were compared between the groups. Results: The MIPO group had significantly lower rates of anterior chest and shoulder skin numbness than the open group (MIPO: 12.5% vs. open: 55.6%; p < 0.001). Operation time was significantly longer in the MIPO group than in the open group (MIPO: 109.38 ± 18.83 vs. open: 81.48 ± 18.85; p < 0.001). Wound length was significantly shorter in the MIPO group than in the open group (MIPO: 4.73 ± 0.79 vs. open: 9.76 ± 1.64; p < 0.001). Both groups had similarly excellent Constant–Murley shoulder scores. There were significantly fewer implant removals in the MIPO group than in the open group (MIPO: 6.3% vs. open: 25.9%; p = 0.036). Neither group experienced any infection, implant failure, or nonunion. Conclusions: Our technique combining MIPO with the mini-open approach and supraclavicular nerve preservation yields a lower incidence of skin numbness than traditional open plating without nerve preservation. Full article

(1) Background: Due to the unique structural and functional characteristics of the forelimb in cats, fractures of the radius and ulna are best repaired using internal fixation and stabilization in accordance with AO principles. This study presents the results of reduction of 42 cadaveric comminuted feline radial fractures reduced by minimally invasive plate osteosynthesis (MIPO). (2) Methods: Radius fractures were created on 21 pairs of forelimbs with intact bones. MIPO was then performed using two locking bone plates pre-contoured on 3D-printed bone models of the antebrachium of a male and a female cat. Pre- and postoperative radiographs were taken, and radius length and anatomical lateral distal radial angle (aLDRA) were measured. (3) Results: All fractures were classified as complex diaphyseal fractures of the radius. The radial bone length did not change significantly after surgery (F_1,18 = 0.01, p = 0.933). However, the aLDRA was modified after surgery (F_1,18 = 7.51, p = 0.013), but this change was only observed in females, in whom the aLDRA was significantly reduced (p = 0.035) compared to the value determined by the shape of the plate. In males, the pre- and postoperative aLDRA values were similar (p = 0.824). In 40 cases, alignment, adjacency of bone fragments, and apparatus were judged to be satisfactory. In two cases, the plate was fixed to the proximal radius and distal ulna due to misidentification of the distal radius. In both cases, revision surgery and correct fixation of the radius gave proper alignment, adjacency, and apparatus. (4) Conclusion: A pre-contoured plate on a 3D-printed model of the male and female domestic cat antebrachium was suitable for the reduction and stabilization of comminuted radial fractures in a cohort of domestic cat cadavers without the need to print individual antebrachial bone models for each patient. Full article

This study aims to evaluate the clinical application of three-dimensional (3D)-printed custom reduction guides (3DRG) for minimally invasive plate osteosynthesis (MIPO) of short oblique radial diaphyseal fractures. Canine forelimb specimens (n = 24) were prepared and a diaphyseal short oblique fracture was simulated in the distal radius and ulna. Bone fragments were stabilized with the MIPO technique using a 3DRG (Group A), open reduction (Group B), or closed reduction with circular external skeletal fixation (ESF) (Group C). The diaphyseal short oblique fractures were created in each radius at one-third of the radial length from the distal radial articular surface. Surgical stabilization of the fractures was performed in each group. Pre and postoperative radiographic images were obtained to measure frontal angulation (FA), sagittal angulation (SA), frontal joint reference line angulation (fJRLA), sagittal joint reference line angulation (sJRLA), translational malalignment and fracture gap width. Surgical time was also measured. In the homogeneity test, differences in SA, sJRLA, craniocaudal translation and fracture gap before and after surgery had no significant difference among the three groups. On the other hand, differences in FA, fJRLA, mediolateral translation and surgical time before and after surgery had significant differences among the three groups. In the post hoc test, only surgical time showed a significant difference between the three groups, and group A showed the shortest surgical time. The use of 3DRG for MIPO of short oblique radial diaphyseal fractures in dogs is reliable for the alignment and apposition of fractures and reduces surgical time. Full article

Osteomyelitis of the tibia is a challenging condition, particularly when it occurs as a result of trauma. This abstract presents a case study detailing the successful staged treatment of posttraumatic tibial osteomyelitis utilizing a unique combination of rib graft and serratus anterior muscle. This medical abstract presents a case study of a 52-year-old male with a history of heavy smoking and obliterating arteriopathy of the lower limbs. The patient sustained a traumatic open fracture classified as Type IIIA Gustilo Anderson involving one-third of the distal right tibia diaphysis, with an associated right fibular malleolus fracture. The treatment approach comprised multiple stages, focusing on wound management, infection control, and limb salvage. The initial stage involved the application of an external fixation device in the emergency setting. Seven days later, an osteosynthesis procedure was performed using a Kuntscher nail and wire cerclage. However, complications emerged, with wound dehiscence and purulent secretion observed at 14 days postsurgery. Subsequently, secondary suturing was carried out at the 20-day mark. The second stage of the treatment involved implant removal, wide excisional debridement, pulse lavage, osteoclasia, and relaxation of the peroneal malleolus. A monoplane external fixation system was applied. As a part of postoperative care, aspiration therapy with a vacuum pump was administered, along with a 10-day course of vancomycin according to the antibiogram. Positive clinical signs of healing were noted, and sterile cultures confirmed the results. The third stage of the intervention focused on grafting the osteo-muscular defect, utilizing autografts from the rib and serratus anterior muscle. The external fixator was maintained in place during this phase. In the fourth and final stage, after an 8-week integration period of the musculocutaneous flap, the external fixator was removed, and internal fixation was accomplished with a blocked Less Invasive Stabilization System (LISS) plate inserted using the Minimally Invasive Plate Osteosynthesis (MIPO) technique. This case underscores the significance of a multistage approach in managing complex limb injuries, emphasizing the importance of timely intervention, infection control, and innovative techniques for limb salvage and restoration of function. Full article

Introduction: Distal tibial fractures make up approximately 3% to 10% of all tibial fractures or about 1% of lower extremity fractures. MIPO is an appropriate procedure and method to achieve stable metal plate fixation and osseointegration by minimizing soft tissue damage and vascular integrity at the fracture site. MIPO to the medial tibia during distal tibial fractures induces skin irritation due to the thickness of the metal plate, which causes discomfort and pain on the medial side of the distal leg, and if severe, complications such as infection and skin defect may occur. The reverse sural flap is a well-researched approach for covering defects in the lower third of the leg, ankle, and foot. Materials and Methods: Among 151 patients with distal tibia fractures who underwent minimally invasive metal plate fixation, soft tissue was injured due to postoperative complications. We treated 13 cases with necrosis and exposed metal plates by retrograde nasogastric artery flap surgery. For these patients, we collected obligatory patient records, radiological data, and wound photographs of the treatment results and complications of reconstructive surgery. Results: In all the cases, flap survival was confirmed at the final outpatient follow-up. The exposed area of the metal plate was well coated, and there was no plate failure due to complete necrosis. Three out of four women complained of aesthetic dissatisfaction because the volume of the tunnel through which the skin mirror passed and the skin plate itself were thick. In two cases, defatting was performed to reduce the thickness of the plate while removing the metal plate. Conclusions: Metal plate exposure after distal tibial fractures have been treated with minimally invasive metal plate fusion and can be successfully treated with retrograde nasogastric artery flaps, and several surgical techniques are used during flap surgery. Full article

Tibial shaft fractures are a commonly seen injury in orthopedic trauma patients. Fractures commonly occur following high energy mechanisms, such as motor vehicle collisions. There are multiple ways to stabilize tibial shaft fractures. Knowledge of the indications, contraindications, techniques, and complications associated with each technique allows the orthopedic surgeon to make the appropriate decision for each patient by providing both fracture and patient characteristics. This review discusses the indications, techniques, outcomes, and complications associated with intramedullary nailing, minimally invasive percutaneous plate osteosynthesis, and external fixation of tibial shaft fractures. Full article

Introduction: Fracture reduction and fixation of distal femur fractures are technically demanding. Postoperative malalignment is still commonly reported after minimally invasive plate osteosynthesis (MIPO). We evaluated the postoperative alignment after MIPO using a traction table with a dedicated femoral support. Methods: The study included 32 patients aged 65 years or older with distal femur fractures of all AO/OTA types 32 (c) and 33 (except 33 B3 and C3) and peri-implant fractures with stable implants. Internal fixation was achieved with MIPO using a bridge-plating construct. Bilateral computed tomography (CT) scans of the entire femur were performed postoperatively, and measurements of the uninjured contralateral side defined anatomical alignment. Due to incomplete CT scans or excessively distorted femoral anatomy, seven patients were excluded from analyses. Results: Fracture reduction and fixation on the traction table provided excellent postoperative alignment. Only one of the 25 patients had a rotational malalignment of more than 15° (18°). Conclusions: The surgical setup for MIPO of distal femur fractures on a traction table with a dedicated femoral support facilitated reduction and fixation, resulting in a low rate of postoperative malalignment, despite a high rate of peri-implant fractures, and could be recommended for surgical treatment of distal femur fractures. Full article

Correction of rotational malalignments caused by fractures is essential as it may cause pain and gait disturbances. This study evaluated the intraoperative use of a smartphone application (SP app) to measure the extent of corrective rotation in patients treated using minimally invasive derotational osteotomy. Intraoperatively, two parallel 5 mm Schanz pins were placed above and below the fractured/injured site, and derotation was performed manually after percutaneous osteotomy. A protractor SP app was used intraoperatively to measure the angle between the two Schanz pins (angle-SP). Intramedullary nailing or minimally invasive plate osteosynthesis was performed after derotation, and computerized tomography (CT) scans were used to assess the angle of correction postoperatively (angle-CT). The accuracy of rotational correction was assessed by comparing angle-SP and angle-CT. The mean preoperative rotational difference observed was 22.1°, while the mean angle-SP and angle-CT were 21.6° and 21.3°, respectively. A significant positive correlation between angle-SP and angle-CT was observed, and 18 out of 19 patients exhibited complete healing within 17.7 weeks (1 patient exhibited nonunion). These findings suggest that using an SP app during minimally invasive derotational osteotomy can result in accurate correction of malrotation of long bones in a reproducible manner. Therefore, SP technology with integrated gyroscope function represents a suitable alternative for determination of the magnitude of rotational correction when performing corrective osteotomy. Full article

(1) Background: As age in western populations is rising, so too are fractures, e.g., of the distal fibula. The aim of this study was to find out whether a novel, minimally invasive intramedullary osteosynthesis technique for the treatment of distal fibula fractures in elderly patients results in not only a reduction of postoperative complications, but also a shorter hospitalization time, an improved clinical outcome, and preserved autonomy in geriatric trauma patients. (2) Methods: In this prospective study, the results following surgical treatment for distal fibula fractures in geriatric patients after using DePuy Synthes^® one-third semitubular plate (Group I) or a minimally invasive intramedullary photodynamic Bone StabilizationSystem (IlluminOss^®) (Group II) were compared at 6 weeks, 12 weeks, 6 months, and 1 year after initial treatment. (3) Results: Significant improvement regarding clinical outcome was shown in Group II 6 and 12 weeks after surgery. (4) Conclusions: Our study results demonstrate that the use of this new intramedullary stabilization system in combination with an immediate postoperative weight bearing seems to be a safe and stable treatment option for ankle fractures in geriatric patients, especially in the early stages of recovery. Full article