Permanent reduction plate and intramedullary nailing of open tibia fractures: Do we need to take them out?

Introduction: Provisional reduction plating has been advocated as a reduction aid for tibial shaft fractures. Concerns regarding soft tissue stripping, infection, wound complications and nonunion have been postulated. Recent studies investigating reduction plating present patient cohorts where plates are removed or left to the discretion of the surgeon.

Splint Padding Thickness: Temperature Effects and X-ray Visualization.

Objectives: The purpose of this study was to determine if the thickness of splint padding could be determined on X-rays, and whether increasing layers of splint padding have an effect on temperature at the skin after placement.

Methods: Both in vitro and in vivo testing was performed. Ten cadaveric lower extremities were used.

Masquelet's induced membrane technique: Review of current concepts and future directions.

Masquelet's induced membrane technique (MIMT) is a relatively new, two-stage surgical procedure to reconstruct segmental bone defects. First performed by Dr. Masquelet in the mid-1980s, MIMT has shown great promise to revolutionize critical-sized bone defect repair and has several advantages over its alternative, distraction osteogenesis (DO).

Bone density of first and second segments of normal and dysmorphic sacra.

Background: Iliosacral screw fixation is safe and effective but can be complicated by loss of fixation, particularly in patients with osteopenic bone. Sacral morphology dictates where iliosacral screws may be placed when stabilizing pelvic ring injuries. In dysmorphic sacra, the safe osseous corridor of the upper sacral segment (S1) is smaller and lacks a transsacral corridor, increasing the need for fixation in the second sacral segment (S2).

Bilateral Isolated Fractures of the Sustentaculum Tali: A Case Report.

Case: This article presents a case of bilateral isolated fractures of the sustentaculum tali. Subtle radiographic findings of sustentaculum fractures on routine foot and ankle series are often difficult to detect, which can result in a delayed diagnosis. Early diagnosis and timely operative management allowed for a good short-term outcome.

Masquelet Technique: Effects of Spacer Material and Micro-topography on Factor Expression and Bone Regeneration.

We and others have shown that changing surface characteristics of the spacer implanted during the first Masquelet stage alters some aspects of membrane development. Previously we demonstrated that titanium (TI) spacers create membranes that are better barriers to movement of solutes > 70 kDa in size than polymethyl methacrylate (PMMA) induced-membranes, and roughening creates more mechanically compliant membranes. However, it is unclear if these alterations affect the membrane's biochemical environment or bone regeneration during the second stage.

Masquelet technique: The effect of altering implant material and topography on membrane matrix composition, mechanical and barrier properties in a rat defect model.

The Masquelet technique is a surgical procedure to regenerate segmental bone defects. The two-phase treatment relies on the production of a vascularized foreign-body membrane to support bone grafts over three times larger than the traditional maximum. Historically, the procedure has always utilized a bone cement spacer to evoke membrane production.

Altering spacer material affects bone regeneration in the Masquelet technique in a rat femoral defect.

The Masquelet technique depends on pre-development of a foreign-body membrane to support bone regeneration with grafts over three times larger than the traditional maximum. To date, the procedure has always used spacers made of bone cement, which is the polymer polymethyl methacrylate (PMMA), to induce the foreign-body membrane. This study sought to compare (i) morphology, factor expression, and cellularity in membranes formed by PMMA, titanium, and polyvinyl alcohol sponge (PVA) spacers in the Masquelet milieu and (ii) subsequent bone regeneration in the same groups.

Nailing proximal femur fractures: how to choose starting point and proximal screw configuration.

Fractures of the proximal femur can be a challenging treatment dilemma for the orthopaedic surgeon. Complex mechanical forces and anatomic variables in this region combine to make treatment of these injuries difficult and can often result in serious complications. The decision to treat this fracture with an intramedullary device requires the surgeon evaluate many variables in the context of the specific fracture pattern.

Orthobiologics in the augmentation of osteoporotic fractures.

Many orthobiologic adjuvants are available and widely utilized for general skeletal restoration. Their use for the specific task of osteoporotic fracture augmentation is less well recognized. Common conductive materials are reviewed for their value in this patient population including the large group of allograft adjuvants categorically known as the demineralized bone matrices (DBMs).

Novel venting technique for intramedullary rod fixation of pathologic fractures.

This article introduces a novel technique to vent the femur and potentially decrease the embolic load created by reaming during intramedullary rod fixation of impending pathologic femur fractures. We used readily available operating room equipment to create a distal femoral vent hole without interfering with standard intramedullary instrumentation and with minimal increase in surgical time. This technique can be used for the prophylactic intramedullary stabilization of impending pathologic femur fractures from metabolic bone disease, metastatic cancer, and bisphosphonate use.