A Systematic Review of Sacral Insufficiency Fractures: Treatment Modalities and Outcomes.

Sacral insufficiency fractures can be managed conservatively, by surgical fixation or by sacroplasty. This systematic review compared the outcomes of different treatment modalities to ascertain the best. Studies included in this systematic review were those with sacral insufficiency fracture in elderly patients with some measure of outcomes reported.

Staged Revision Hip Arthroplasty With Femoral Impaction Bone Grafting for Prosthetic Joint Infections: Radiostereometric Analyses and Clinical Outcomes at Minimum 5-Year Follow-Up.

Background: There are ongoing concerns regarding the use of bone graft following prosthetic joint infection and subsequent implant subsidence. The aim of this study was to determine whether the use of a cemented stem combined with femoral impaction bone grafting (FIBG) at second stage revision for infection results in stable femoral stem fixation, determined by accurate methods, and good clinical results.

Methods: A prospective cohort of 29 patients underwent staged revision total hip arthroplasty for infection using an interval prosthesis followed by FIBG at the final reconstruction.

The Harrington plus reconstruction for pelvic and acetabular metastases.

Background: Surgical management of periacetabular bone metastases is challenging. The Harrington Plus reconstruction is a modification of the original Harrington rod technique. An intrapelvic suprapectineal plate is used, with the aim of reconstructing a disrupted anterior column and reducing the risk of failure in cases where there is extensive medial bone loss.

The variation in hip stability measurements between supine and standing radiographs of dysplastic hips.

Aims: The aims of this study were to compare clinically relevant measurements of hip dysplasia on radiographs taken in the supine and standing position, and to compare Hip2Norm software and Picture Archiving and Communication System (PACS)-derived digital radiological measurements.

Methods: Preoperative supine and standing radiographs of 36 consecutive patients (43 hips) who underwent periacetabular osteotomy surgery were retrospectively analyzed from a single-centre, two-surgeon cohort. Anterior coverage (AC), posterior coverage (PC), lateral centre-edge angle (LCEA), acetabular inclination (AI), sharp angle (SA), pelvic tilt (PT), retroversion index (RI), femoroepiphyseal acetabular roof (FEAR) index, femoroepiphyseal horizontal angle (FEHA), leg length discrepancy (LLD), and pelvic obliquity (PO) were analyzed using both Hip2Norm software and PACS-derived measurements where applicable.

Cemented Revision Hip Arthroplasty With Femoral Impaction Bone Grafting.

Long-stemmed uncemented implants are commonly used during revision hip arthroplasty but may be difficult to re-revise. Impaction bone grafting allows for the use of a shorter cemented stem during revision hip arthroplasty and may restore bone stock in patients with substantial femoral defects. Femoral impaction bone grafting is particularly beneficial in younger patients, who are more likely to require additional revision procedures in the future.

Factors associated with mortality in older patients sustaining pelvic or acetabular fractures.

Introduction: This study aimed to investigate potential factors, including delay to surgical stabilisation, affecting mortality in older patients sustaining pelvic or acetabular (PA) fractures.

Materials And Methods: A retrospective review of the Trauma Audit and Research Network (TARN) database was performed to identify older patients (aged 65 and over) sustaining PA fractures treated surgically in a UK Major Trauma Centre (MTC) between 2015 and 2019. Chi-squared and Fisher tests were used to compare 1-year mortality rates following operative intervention between patients treated within 72 h and after 72 h.

An overview of the key principles and guidelines in the management of pelvic fractures.

Pelvic fractures are complex injuries with a range of different presentations depending on the mechanism of trauma. Due to the morbidity and mortality of pelvic fractures, patients require thorough investigation and timely management with multidisciplinary input. Various surgical and non-surgical techniques can be used to treat pelvic fractures, as well as any associated visceral injuries.

Stem cell transplantation for the treatment of osteochondral defects of the knee: Operative technique for a single-stage transplantation procedure using bone marrow-derived mesenchymal stem cells.

Background: Autologous chondrocyte implantation (ACI) is a NICE-approved technique to regenerate hyaline cartilage in chondral and osteochondral defects (OCDs). The drawbacks of ACI include that it requires a two-stage approach, involves a lengthy rehabilitation process and is expensive. Bone marrow harvest with mesenchymal stem cell transplantation using a single-stage procedure and an accelerated rehabilitation programme has been developed to overcome this.

The effect of a porous titanium alloy flange with hydroxyapatite, silver and fibronectin coatings on soft-tissue integration of intraosseous transcutaneous amputation prostheses.

Aims: The Intraosseous Transcutaneous Amputation Prosthesis (ITAP) may improve quality of life for amputees by avoiding soft-tissue complications associated with socket prostheses and by improving sensory feedback and function. It relies on the formation of a seal between the soft tissues and the implant and currently has a flange with drilled holes to promote dermal attachment. Despite this, infection remains a significant risk.

Augmenting the osseointegration of endoprostheses using laser-sintered porous collars: an in vivo study.

Aims: Massive endoprostheses rely on extra-cortical bone bridging (ECBB) to enhance fixation. The aim of this study was to investigate the role of selective laser sintered (SLS) porous collars in augmenting the osseointegration of these prostheses.

Materials And Methods: The two novel designs of porous SLS collars, one with small pores (Ø700 μm, SP) and one with large pores (Ø1500 μm, LP), were compared in an ovine tibial diaphyseal model.

Preventing infection of osseointegrated transcutaneous implants: Incorporation of silver into preconditioned fibronectin-functionalized hydroxyapatite coatings suppresses Staphylococcus aureus colonization while promoting viable fibroblast growth in vitro.

The success of transcutaneous implants depends on the achievement of a soft tissue seal by enabling fibroblasts to win the race for the surface against bacteria. Fibronectin-functionalized hydroxyapatite coatings (HAFn) have been shown to improve dermal tissue ingrowth and attachment. However, during the early postoperative period before a soft tissue seal has formed, bacterial colonization may occur.

Oedema of the abductor digiti quinti muscle due to subacute denervation: report of two cases.

The clinical presentation of abductor digiti quinti (ADQ) denervation is often non-specific. The diagnosis is generally clinical and may be easily missed. This case report of two patients describes the magnetic resonance imaging (MRI) finding of unilateral oedema and fatty infiltration isolated to the ADQ.

Limb reconstruction after traumatic bone loss.

A variety of options exist to reconstruct limbs following traumatic bone loss. The management of these injuries is challenging and often requires prolonged and potentially painful treatment. The Ilizarov technique of bone transport using circular external fixators is widely used for limb reconstruction of large bone defects.

Stem cell therapy for knee ligament, articular cartilage and meniscal injuries.

Knee injuries involving ligament, articular cartilage and meniscus are common. The capacity for regeneration and repair of these tissues is limited due to their poor vascularity. Autologous or allogeneic stem cell transplantation has the potential to stimulate healing of these tissues.

The potential of stem cell therapy for osteoarthritis and rheumatoid arthritis.

Joint diseases are a major cause of disability and are a significant financial burden on health care systems. Regenerative medicine offers exciting possibilities for treating osteoarthritis and rheumatoid arthritis. As well as possessing the ability to differentiate into other tissue lineages, some stem cells such as mesenchymal stem cells possess immmunomodulatory properties that make them useful in the search for alternative treatments for rheumatoid arthritis specifically.

Applications of stem cell therapy for physeal injuries.

Physeal injuries may lead to the formation of a bone bridge resulting in limb length discrepancies and angular deformity in children. Current treatment of physeal injuries may be challenging. A number of strategies have been used to repair physeal defects with varying results.

The use of stem cells for the treatment of spinal surgical conditions.

Spinal pathologies are a major burden on society and individuals. Recent years have seen a large number of studies dedicated to the use of stem cells in spinal surgery. This review focuses on recent advances and controversies regarding the applications of stem cells in spinal fusion surgery, spinal cord injury and intervertebral disc degeneration.

Stem cell therapy for human cartilage defects: a systematic review.

Objectives: The use of stem cell therapy for the repair of cartilage defects has shown promising results in in vitro and animal studies. However, only a small number of studies have been performed to evaluate the benefits in human subjects. The aim of this study is to systematically review studies that focus on the clinical application of stem cell therapy to treat cartilage defects in human subjects.

Recent advances and developments in knee surgery: principles of periprosthetic knee fracture management.

The management of distal femoral, tibial and patellar fractures after total knee arthroplasty can be complex. The incidence of these fractures is increasing as the number of total knee arthroplasties being performed and patient longevity is increasing. There is a wide range of treatment options including revision arthroplasty for loose implants.

Recent advances and developments in neural repair and regeneration for hand surgery.

End-to-end suture of nerves and autologous nerve grafts are the 'gold standard' for repair and reconstruction of peripheral nerves. However, techniques such as sutureless nerve repair with tissue glues, end-to-side nerve repair and allografts exist as alternatives. Biological and synthetic nerve conduits have had some success in early clinical studies on reconstruction of nerve defects in the hand.

Advances in the use of stem cells and tissue engineering applications in bone repair.

Tissue engineering of bone has the potential to overcome the limitations of using autologous, allogeneic or synthetic bone grafts to treat extensive bone defects. It involves culturing of osteogenic cells within appropriate scaffold materials under conditions that optimize bone development. Stem cells, progenitor cells, terminally differentiated cells or genetically modified cells may be used.

Recent advances in designs, approaches and materials in total knee replacement: literature review and evidence today.

Ever since Themistocles Gluck described the use of an ivory cup as a tibial hemiarthroplasty in 1894, knee arthoplasty has continued to evolve. Both human ingenuity and intensive clinical research has led to an improved understanding of biomaterials and knee kinematics, resulting in the modern total knee replacement which has enjoyed such a clinical and commercial success. As it increases in popularity, attempts to improve knee arthroplasty have been driven by demands for improved function and implant survival, particularly in younger, more demanding patients.