Modern osteosynthesis of periarticular fractures: The role of provisional fixation revisited.

Periarticular fractures are complex injuries affecting the joint articular surface, the subchondral area, the metaphyseal region, the surrounding soft tissue envelope and not infrequently the ligamentous structures. The management of these injuries has evolved over the years, from one stage to two stage procedures thus facilitating soft tissue resuscitation, adequate pre-operative planning and the use of biologics optimizing the conditions for definitive fixation for a successful long-term outcome. Provisional fixation constitutes an essential step in the surgical treatment of these fractures.

History and Evolution of Hip Design to Decrease Failure.

The evolution of fracture fixation designs over the past 100 years is coupled with incredible advances in materials and manufacturing technology. Failures are unavoidable and should be evaluated from the perspective of refining our technology and technique to improve patient outcomes. Failure after intramedullary fixation of hip fractures is multifactorial with contributions from an unsuccessful surgery, some preventable, some unavoidable, and rarely, design and manufacturing errors.

Bone Substitute Materials and Minimally Invasive Surgery: A Convergence of Fracture Treatment for Compromised Bone.

This article focuses on the understanding of the biochemistry and surgical application of bone substitute materials (BSMs) and particularly the newer calcium phosphate materials that can form a structural orthobiologic matrix within the metaphyseal components of the periarticular bone. Six characteristics of BSMs are detailed that can be used as a guide for the proper selection and application of the optimal BSM type for periarticular fracture repair. These 6 characteristics of BSMs are divided into 2 pillars.

Hot Topics in Biomechanics: Hip Fracture Fixation.

Geriatric hip fractures continue to increase in frequency as the population ages, and intertrochanteric femur fractures are a significant part of these injuries. Plate fixation for intertrochanteric fractures of the proximal femur has been in use for many years, and application of the sliding hip screw has also been a mainstay of treatment. Recent data suggest there may be a benefit to using implants that add rotational stability to the proximal intertrochanteric fragment.

Assessment of the injection behavior of commercially available bone BSMs for Subchondroplasty® procedures.

Background: Bone substitute materials (BSMs) have been commercially available for over 30 years and have been used extensively in orthopedic procedures. Some BSMs are described as "injectable." With rising focus on minimally invasive surgical procedures, the range of applications in which these materials are injectable is of clinical interest.

Locked and minimally invasive plating: a paradigm shift? Metadiaphyseal site-specific concerns and controversies.

Metadiaphyseal fractures of long bones are associated with considerable deforming forces, tenuous soft-tissue envelopes, and, often, severely compromised osseous integrity. Contemporary methods to fix complex metadiaphyseal fractures must achieve a balance between the biomechanical and biologic environments. The advent of precontoured locking plates inserted with evolving minimally invasive techniques may achieve both goals.

Biomechanical effects of the nail entry zone and anterior cortical bone loss on the proximal tibia.

Objectives: The aims of this study were as follows: to determine if the presence of the nail entry zone alters the biomechanics of the proximal tibia after intramedullary (IM) nailing using a computational model; to determine if nail removal restores normal biomechanics to the proximal tibia; and to determine if these effects are magnified with anterior cortical bone loss.

Methods: Three-dimensional finite element (FE) tibial models were developed and used for this study: an intact tibia, a nailed tibia, and a tibia with the nail removed. One matched pair of fresh-frozen cadaver tibias was obtained to construct and validate the FE model.

Intramedullary nailing: evolutions of femoral intramedullary nailing: first to fourth generations.

Intramedullary femoral nailing is the gold standard for femoral shaft fixation but only in the past 27 years. This rapid replacement of closed traction and cast techniques in North America was a controversial and contentious evolution in surgery. As we enter the fourth generation of implant design, capabilities, and surgical technique, it is important to understand the driving forces for this technology.

Surgical treatment and management of hip fracture patients.

Introduction: Osteoporosis-related hip fractures are associated with high mortality and costs. The optimum type of treatment for such fractures is controversial. To shed some light on this issue, the surgical treatment and management of osteoporotic hip fractures were discussed during a hip fracture surgical working group at the 2009 International Society For Fracture Repair Annual Meeting comprising leading experts in the field.

Variability in the approach to total hip arthroplasty in patients with displaced femoral neck fractures.

The aim of this study was to determine the degree of variability in implants, approaches, and associated complication rates in randomized controlled trials (RCTs) evaluating primary total hip arthroplasty (THA) as an intervention for displaced femoral neck fractures. We searched 2 medical databases for RCTs involving THA for femoral neck fractures published between June 2000 and June 2010. All analyses were descriptive.

A comparison of screw insertion torque and pullout strength.

Purpose: Pullout strength of screws is a parameter used to evaluate plate screw fixation strength. However, screw fixation strength may be more closely related to its ability to generate sufficient insertion because stable nonlocked plate-screw fracture fixation requires sufficient compression between plate and bone such that no motion occurs between the plate and bone under physiological loads. Compression is generated by tightening of screws.

Intramedullary versus extramedullary fixation for subtrochanteric femur fractures.

Objectives: Both intramedullary and extramedullary internal fixation has been advocated for the treatment of subtrochanteric femur fractures. Is there clinical evidence to recommend one method of internal fixation over the other?

Data Sources: A search of MEDLINE (1950 to June 2007), CINAHL (1982 to June 2007), and EMBASE (1980 to June 2007) was performed. Results were limited to English language studies.

Comparison of autogenous bone graft and endothermic calcium phosphate cement for defect augmentation in tibial plateau fractures. A multicenter, prospective, randomized study.

Background: Bone graft augmentation is often selected to treat defects associated with unstable tibial plateau fractures. This prospective, randomized, multicenter study was undertaken to determine the efficacy of bioresorbable calcium phosphate cement compared with standard autogenous iliac bone graft in the treatment of these osseous defects.

Methods: One hundred and twenty acute, closed, unstable tibial plateau fractures (Schatzker types I through VI) in 119 adult patients were prospectively enrolled in twelve study sites in North America between 1999 and 2002.

Avoidance of malreduction of proximal femoral shaft fractures with the use of a minimally invasive nail insertion technique (MINIT).

Objectives: To determine our rate of malalignment in proximal femoral shaft fractures treated with intramedullary (IM) nails, with and without the use of a minimally invasive nail insertion technique (MINIT).

Design: Retrospective study.

Setting: Level 1 trauma center.

The use of calcium phosphate bone cement in fracture treatment. A meta-analysis of randomized trials.

Background: Available options to fill fracture voids include autogenous bone, allograft bone, and synthetic bone materials. The objective of this meta-analysis was to determine whether the use of calcium phosphate bone cement improves clinical and radiographic outcomes and reduces fracture complications as compared with conventional treatment (with or without autogenous bone graft) for the treatment of fractures of the appendicular skeleton in adult patients.

Methods: Multiple databases, online registers of randomized controlled trials, and the proceedings of the meetings of major national orthopaedic associations were searched.

A comparison of optical and electromagnetic computer-assisted navigation systems for fluoroscopic targeting.

Objectives: Freehand targeting using fluoroscopic guidance is routine for placement of interlocking screws associated with intramedullary nailing and for insertion of screws for reconstruction of pelvic and acetabular injuries. New technologies that use fluoroscopy with the assistance of computer guidance have the potential to improve accuracy and reduce radiation exposure to patient and surgeon. We sought to compare 2 fluoroscopic navigation tracking technologies, optical and electromagnetic versus standard freehand fluoroscopic targeting in a standardized model.