Management of post-traumatic femoral defects with a monorail external fixator over an intramedullary nail

European Journal of Orthopaedic Surgery & Traumatology - The management of limb-length discrepancy secondary to traumatic femoral bone loss poses a unique challenge for surgeons. The Ilizarov...     

A retrospective analysis of the definitive management of open talus fractures at a major trauma centre,comparing ORIF to FUSION: cohort study and audit of BOAST 4 guidelines

Purpose

Open talus fractures are notoriously difficult to manage, and they are commonly associated with a high level of complications including non-union, avascular necrosis and infection. Currently, the management of such injuries is based upon BOAST 4 guidelines although there is no suggested definitive management, and thus, definitive management is based upon surgeon preference. The key principles of open talus fracture management which do not vary between surgeons are early debridement, orthoplastic wound care, anatomic reduction and definitive fixation whenever possible. However, there is much debate over whether the talus should be preserved or removed after open talus fracture/dislocation and proceeded to tibiocalcaneal fusion.

Methods

A review of electronic hospital records for open talus fractures from 2014 to 2021 returned fourteen patients with fifteen open talus fractures. Seven cases were initially managed with ORIF, and five cases were definitively managed with FUSION, while the others were managed with alternative methods. We collected patient’s age, gender, surgical complications, surgical risk factors and post-treatment functional ability and pain and compliance with BOAST guidelines. The average follow-up of the cohort was 4 years and one month. EQ-5D-5L and FAAM-ADL/Sports score was used as a patient reported outcome measure. Data were analysed using the software PRISM.

Results

Comparison between FUSION and ORIF groups showed no statistically significant difference in EQ-5D-5L score (P = 0.13), FAAM-ADL (P = 0.20), FAAM-Sport (P = 0.34), infection rate (P = 0.55), surgical times (P = 0.91) and time to weight bearing (P = 0.39), despite a higher proportion of polytrauma and Hawkins III and IV fractures in the FUSION group.

Conclusion

FUSION is typically used as second line to ORIF or failed ORIF. However, there is a lack of studies that directly compared outcome in open talus fracture patients definitively managed with FUSION or ORIF. Our results demonstrate for the first time that FUSION may not be inferior to ORIF in terms of patient functional outcome, infection rate and quality of life, in the management of patients with open talus fracture patients. Of note, as open talus fractures have increased risks of complications such as osteonecrosis and non-union, FUSION should be considered as a viable option to mitigate these potential complications in these patients.

     

Charcot knee — presentation,diagnosis, management — a scoping review

Clinical Rheumatology - Charcot arthropathy is a progressive, non-infectious, destructive inflammatory process. Charcot arthropathy of the knee (CK) is rare and diagnosis is often delayed,...     

An Analysis of the Pattern of Adaptive Emotion Regulation Associated with Low Paranoid Ideation in Healthy and Clinical Samples

Cognitive Therapy and Research - Research on emotion regulation and paranoid ideation has mostly focused on isolated regulation strategies and has remained largely inconclusive. According to the...     

Eccentric Taylor spatial frame placement for the correction of femoral fracture deformity: a novel technique

European Journal of Orthopaedic Surgery & Traumatology - The treatment of post-traumatic femoral deformity with circular frames can be difficult both for the patient and for the surgeon....     

Modified pre-curved patellar basket plate, reconstruction of the proper length and position of the patellar ligament--a biomechanical analysis

Biomechanical properties of basket plate fixation for fracture dislocation in the distal part of the patella were studied on 22 fresh-frozen lower extremities (human cadaveric knees). The patella and the patellar ligament with the proximal tibia were removed. A comminuted fracture of the distal part of the patella was created with a chisel. The fractured patella, patellar ligament and tibial tuberosity of each specimen were fixed with a basket plate and mounted into the jaws of the testing machine. The measured load to failure was 421.66+/-45.90 N, which is approximately 70% higher than the results in other studies. The results of the measurements verified the results of finite element analysis. The modified precurved patellar basket plate developed in this study showed improved performance compared to the pre-existing fixation methods.     

Subperiosteal elevation of the ulnar nerve-Anatomical considerations and preliminary results

Mobilisation of the ulnar nerve often leads to perineural scarring. About 30 years ago, B.F. Korosec, M.D., developed a novel surgical approach to the distal humerus combined with osteotomy of the olecranon, which avoids visualisation or direct manipulation of the ulnar nerve. The main advantage of his technique lies in subperiosteal elevation of the ulnar nerve together with all structures of the cubital tunnel. In the present study, anatomical dissections of distal humerus structures were performed in a cadaver to define individual steps of the technique introduced by Dr. Korosec. Ten phases of the procedure were identified. Ten patients (4 males and 6 females) with type 13-C and 13-B fractures of the distal humerus (AO/ASIF) were operated on. The patients showed no clinical signs of ulnar nerve injury before surgery. During the operation, the ulnar nerve was electrically stimulated at the axilla and compound muscle action potentials were continuously recorded from hypothenar muscles. Latency and amplitude of the potentials were monitored. Analysis of these data using the unpaired t-test for median values revealed no statistically significant differences between individual stages of the operation (p<0.00625). An amplitude decrease accompanied by a latency increase by more than 10% over the baseline value was found to indicate impending nerve damage. The novel approach to the distal humerus presented in this article is a safe procedure.     

Development of the Demotivating Beliefs Inventory and Test of the Cognitive Triad of Amotivation

Recent cognitive models of negative symptoms in psychosis posit that amotivation relevant beliefs are reflected in the cognitive triad of negative beliefs concerning the self, others and the future. The aim of this study was to test the proposed three-factor structure of putative ‘demotivating beliefs’ and to ascertain the strength of their association with self-reported amotivation. We combined existing scales assessing ‘demotivating beliefs’ to the Demotivating Beliefs Inventory. This scale was used for exploratory and confirmatory factor analyses as well as latent regression analyses with amotivation in two independent community (n₁?=?98; n₂?=?347) and one clinical sample (n?=?36). We found a three-factor structure with satisfying model fit (‘selfdefeating beliefs’, ‘social indifference beliefs’ and ‘low-expectancy-of-pleasure beliefs’). Each factor showed moderate associations with amotivation (β-coefficients from 0.34 to 0.43; R²?=?.30). Our results support the validity of the cognitive triad and its benefit as a framework to analyze demotivating beliefs.     

Stabilisation of the elbow in cases of severe disruption of the lateral collateral complex

Introduction  

Rupture of the lateral collateral ligamentous complex of the elbow is a serious injury. If direct repair of the ligamentous complex is not possible, then an alternative method must be found to stabilise the elbow.     

Risk factors for septic arthritis and multiple arthroscopic washouts: minimum 2-year follow-up at a major trauma centre

Clinical Rheumatology - Septic arthritis (SA) is a dangerous condition that requires emergency treatment. Managed by culture-specific antibiotics, irrigation, and debridement (I&amp;D), some...