Biomechanical Results of Percutaneous Calcaneal Osteotomy using Two Different Osteotomy Designs

Category: Hindfoot Introduction/Purpose: Percutaneous osteotomy of calcaneus has been proposed to reduce the complication rate and became more and more popular. The bone cut can be performed as a straight or chevron-like (V) osteotomy using a Shannon burr. Comparative studies of straight or V- osteotomy as like as one or two screws in percutaneous calcaneal osteotomies are missing in the literature Methods: The straight osteotomy (9 fresh-frozen specimens) and V- osteotomy (9fresh frozen specimens) was performed and the calcaneal tuberosity was moved 10 mm medially and slightly rotated. One 6,5 mm cancellous compression screw was used for osteosynthesis. Specimens were preconditioned with 100N over 100 cycles. The force was increased after every 100N by 100N from 200 to 500N. This was followed by cyclic loading with 600N for 500 cycles. Results: Despite the higher mean values of the group with V osteotomy, no significant difference was registered between the two groups regarding the stiffness at all force levels. A significant higher failure rate was observed in the group with straight osteotomy. Conclusion: The moderate correlation of bone density and stiffness in the V-group, and significantly lower failure rate with no secondary dislocation in fluoroscopy indicates the superiority of the V-osteotomy in the present study. Whether the demonstrated advantages can be reflected in clinical practice should be investigated in further studies.

Alpine structure of the folding system of North-West Caucasus and conditions of its forming

В результате многолетнего детального изучения выявлены закономерности внутреннего строения альпийской складчатой структуры СевероЗападного Кавказа. Установлено, что одной из характерных особенностей этого региона является латеральная зональность его складчатой структуры в поперечном сечении, выразившаяся в последовательной смене с югозапада на северовосток интенсивной складчатости умеренной, а затем слабой. Это свидетельствует о спаде деформационных усилий в указанном направлении в процессе образования складчатости СевероЗападного Кавказа. Выявлено широкое развитие в пределах южного склона СевероЗападного Кавказа интерференционных складчатых структур, возникающих в результате наложения деформаций разного плана и возраста. Выяснено, что интерференционная складчатость в регионе образована в процессе повторной деформации ранее возникшей линейной складчатости северозападного простирания, тангенциальным долготным сжатием. Установлено, что интерференционная складчатость отражает изменение плана деформации СевероЗападного Кавказа от северовосточного на субмеридиональное во время образования складчатой системы. Рассмотрены кинематические особенности образования складчатости различной морфологии, развитой в пределах изученного региона. Выявлены причины разнообразия складчатых форм, наблюдаемых в современной структуре СевероЗападного Кавказа. Установлено широкое развитие в регионе многочисленных разнообразных по ориентировке, возрасту и кинематике разрывных нарушений. На основании проведенного детального анализа складчатой структуры СевероЗападного Кавказа реконструированы условия ее образования. Выяснено, что в деформировании складчатой структуры СевероЗападного Кавказа выделяются два этапа тектогенеза. На первом этапе деформации (юрасредний миоцен) ведущая роль в складкообразовании принадлежит югозападным тангенциальным силам, возникающих в результате придвигания и прижатия ЧерноморскоЗакавказкого микроконтинента к СевероЗападному Кавказу. Поэтому такую деформацию можно рассматривать как проявление микроплитовой тектоники. На втором этапе тектогенеза (поздний миоценантропоген) в обстановке субмеридионального горизонтального сжатия отдельные блокишоли микроконтинента продвигаясь на север, вторгались в складчатую систему СевероЗападного Кавказа, обусловливая ее повторную дислокацию. Показано, что действие шолевой тектоники привело к преобразованию первичной складчатости в южном активном крае СевероЗападного Кавказа. Новейший процесс деформации с образованием наложенных на первичную складчатость структур продолжается в регионе и в настоящее время. As a result of many years of detailed study, regularities of the internal structure of the Alpine folded structure of the NorthWest Caucasus are revealed. It has been established that one of the characteristic features of this region is the lateral zonality of its folded structure in cross section, which manifests a successive change of intense folding to moderate and then to weak from the southwest to the northeast. This indicates a decrease in deformation strain in the indicated direction during the formation of folding in the NorthWest Caucasus. Widespread development of interference folded structures arising as a result of superimposed deformations of different orientation and age was revealed within the southern slope of the NorthWest Caucasus. It was found that the interference folding in the region is formed in the process of repeated deformation of the linear folding of the northwestern strike formed earlier by the tangential longitudinal compression. It was determined that interference folding reflects a change of the plan of deformation of the NorthWest Caucasus from the northeast to submeridional during the formation of the folded system. The kinematic features of folding formation of various morphology developed within the studied region are considered. The reason of the variety of folded forms observed in the modern structure of the NorthWest Caucasus is revealed. Wide distribution of faults with different orientation, age and kinematics in the region is outlined. The conditions of formation of the folded structure of the NorthWest Caucasus are reconstructed on the basis of a detailed analyses. Its clarified that two stages of tectogenesis were distinguished in the forming of folded structure of NW Caucasus. At the first stage of deformation (JurassicMiddle Miocene) the leading role had the tangential forces SW direction arised as a result of movement and pressing of the Black SeaTranscaucasian Microcontinent to the NW Caucasus. Therefore, such a deformation can be considered as a manifestation of microplate tectonics. During the second stage (Late MioceneAnthropogen) of tectogenesis at the conditions of submeridional horizontal compression, traveling to the north individual blocks of the microcontinent intruded into the folded system of the region, causing its secondary dislocation. It is shown that the activities of schole tectonics led to the transformation of primary folding in the southern active region of the NorthWest Caucasus. The recent processes of deformation with the formation of new superimposed structures is continues in the region at present.

Frequency of Secondary Dislocations of Initially non Displaced and Minimally Displaced Fractures of the Lateral Humeral Condyle in Children – Surveillance of a Treatment Algorithm

Aim of the Study The treatment of undisplaced fractures of the lateral humeral condyle is conservative. However, it is problematic that it is not possible to differentiate between a stable and an unstable, non-displaced fracture. A pragmatic approach is to X-ray the elbow without a cast 5 days after trauma and to compare those images with the initial ones. If there is a central increase of dislocation, then there is an indication of an unstable fracture. The dislocation can also be indicated by a translational movement, which is best observed in the border area. The aim of the study was to retrospectively determine the incidence of secondary dislocations of initially undisplaced and minimally dislocated fractures of the lateral humeral condyle in infants between 2010 and 2015. Methods We performed a retrospective, non-randomized analysis of 75 children with initially undisplaced and minimally displaced fractures of the lateral humeral condyle between 2010 and 2015. The strategy for the evaluation of a stable and an unstable fracture of the lateral humeral condyle was carried out by means of an X-ray without a cast 5 days after trauma. Further radiological controls were performed after 14 days, 4 weeks and after 10 to 12 weeks in operated children. Results Seven initially undisplaced and minimally dislocated fractures (9,3%) showed a secondary dislocation 5 days after trauma when a radiological control without a cast was performed. At the control 14 days after trauma there was no further secondary dislocation. The immobilization took place in an upper arm cast for a period of 4 weeks. Conclusion 90% of all non-dislocated fractures of the lateral humeral condyle can be treated conservatively. It is important to find out which about 10% of children will experience a secondary dislocation safely and effectively. It has been shown that the strategy for the evaluation of a stable and an unstable fracture of the lateral humeral condyle by means of a radiological control after 5 days without a cast can be effective and cost-saving. With a high degree of certainty, the unstable fracture can be detected at the radiological control 5 days after trauma. If, after 5 days, the radiological control reveals unsure finding regarding the dislocation, it is advisable to recheck the fracture in the second radiological control after 14 days.

Nonoperative Treatment of Ulnar Carpometacarpal Fracture–Dislocations

Background Ulnar carpometacarpal (CMC) joint dislocations and fracture–dislocations are uncommon injuries that are often overlooked. Most authors advocate surgical stabilization in order to prevent a secondary dislocation assuming that these injuries are inherently unstable. Case Description This is a series of eight ulnar CMC joint dislocations and fracture–dislocations treated by closed reduction and splint immobilization after assessing the joint stability. Mean follow-up was 30.2 months, and minimum follow-up was 12 months. Satisfactory results were obtained in range of motion, grip strength, pain, DASH (Disabilities of the Arm, Shoulder and Hand) questionnaire, and time to return to working activities. In the same period, the closed reduction and cast failed two (20%) cases that were referred for surgery. Literature Review There is little published literature on the nonoperative treatment of these injuries. Most of them are isolated case reports, whereas the largest series reports four cases. All of them have reported satisfactory results. Clinical Relevance Based on our results, we believe that if the diagnosis of an ulnar CMC joint dislocation or fracture–dislocation is early accomplished and a concentric and stable reduction is initially achieved, the nonoperative treatment may be a successful option to take into account but requiring a close follow-up for the first week.

Proposal of a New Dynamic Distraction Device to Treat Complex Periarticular Fractures of the Metacarpophalangeal Joint of Long Finger

Background: Complex periarticular fractures of the metacarpophalangeal joint (MCPJ) are often challenging to treat. Conservative and operative treatments are often burdened with stiffness, loss of function, and poor clinical outcome. These phenomena could be a direct consequence of long period of immobilization. To promote a short time of immobilization and a quick return to daily activities, it is mandatory to stabilize the fracture maintaining the active range of motion (AROM) of the ray. A simple solution is to reduce the fragments by means of dynamic ligamentotaxis. The authors propose a new dynamic distraction device (DDD) for the MCPJ. Methods: The DDD for the MCPJ was made of Kirschner wires bent and connected to counteract dislocation forces and to allow mobilization of the joint. The DDD was tested on a cadaver model under a simulated load in physiological conditions, and also in metacarpal and proximal phalanx (P1) fracture patterns. The effectiveness of the device was evaluated under fluoroscopy. Results: The data showed that DDD is able to achieve fracture reduction through ligamentotaxis and primary fragments stability and to avoid secondary dislocation during AROM of complex periarticular fractures of the MCPJ. Conclusions: The frame could be an alternative option to treat periarticular fractures of the MCPJ. The DDD implant has several advantages: It is time efficient because assembly and application take only few minutes. Furthermore, it is very versatile; indeed, it can be used in all metacarpal and phalanx bones, even in the central rays.

Axial Length of the Eyeball Is Important in Secondary Dislocation of the Intraocular Lens, Capsular Bag, and Capsular Tension Ring Complex

Purpose. To analyze the patients with secondary dislocation of CTR and IOL within 5 years from cataract surgery, to determine predisposing factors.Methods. 16 eyes of 15 patients aged66.2±6.7(from 49 to 82) with CTR/IOL complex dislocation within 5 years from cataract surgery were compared with 26 patients aged67.1±7.2(from 53 to 85), implanted with CTR during cataract surgery to manage zonule dehiscence and did not dislocate for at least 5 years, in respect of cause, axial length and IOL power, refraction, coexistent pathology, and trauma.Results. Axial length of the eyeball was23.8±1.3(from 21 to 29) in the group of patients with CTR/IOL dislocation and20.7±1.2(from 19 to 24) in patients with no dislocation present (p=0.008). Crystalline lens dislocation was diagnosed before surgery in 13 of 16 patients with CTR/IOL complex dislocation as opposed to 7 of 26 eyes in the control group (p=0.01). Pseudoexfoliation was present in 50% and 58% in both groups, respectively. Traumatic dislocation was present in 8 patients, none of them with CTR/IOL dislocation (p=0.04).Conclusion. Longer axial length may contribute to the failure of the CTR to prevent in-the-bag IOL dislocation. Traumatic dislocation appears to be well fixed with the CTR.

Arthroscopic-Assisted Treatment of a Reversed Hill-Sachs Lesion: Description of a New Technique Using Cerament

Purpose. Impaction fractures of the anterior aspect of the humeral head, the reversed Hill-Sachs lesion, are common in posterior shoulder dislocation. We present a new technique to address these lesions arthroscopic-assisted with the use of a bone substitute.Methods. We report the case of a 45-year-old male with a reversed Hill-Sachs lesion after posterior shoulder dislocation. Initially a glenohumeral arthroscopy is performed to address concomitant intra-articular injuries. Guided by the k-wire a cannulated sizer was inserted for reduction of the fracture under arthroscopic visualization. For reduction of the impacted part of the humeral head the subcortical defect was filled with an injectable bone substitute (Cerament) to prevent secondary dislocation.Results. X-ray at follow-up 6 months after the index procedure documents the bony remodeling of the bone substitute. At that time the patient was pain-free (VAS 0) and satisfied with the outcome (Constant score: 78, Rand-36 score: 84, Rowe score: 81) with a good ROM.Conclusions. In conclusion, arthroscopic-assisted reconstruction of reversed Hill-Sachs lesions with an injectable bone substitute is feasible and may provide patients with all the benefits of an anatomic reconstruction with decreased risks related to open surgery.