X-rays are regularly performed after primary total knee arthroplasty (TKA). While soft tissue management and ligament tension cannot be evaluated, important information, such as inadequate component positioning and loose cement location, as well as subsequent loosening, can be detected. The aim of this study was to correlate radiological findings, referring to the radiological grading system (previously published by the same study group, henceforth abbreviated as “RGS”), with long-term outcomes and implant survival. A total of 266 patients who underwent titanium-coated TKA were included. In addition to implant survival, visual analogue scale score, Tegner activity score, knee society score (KSS), Western Ontario and McMaster Universities Osteoarthritis Index, and short form-12 score as well as range of motion were evaluated. Clinical examination as well as anterior-posterior, lateral, full-length weight bearing, and patellar view radiographs were performed pre- and postoperatively, at the 3-, 6-, and 12-month postoperative follow-ups and at the final follow-up. The radiological grading system was evaluated and correlated with long-term outcome and survivorship. The revision-free survival rate was 88.4

Background: Talar neck fractures are complex injuries that become particularly challenging when accompanied by bone loss or comminution. This case report introduces the use of an allograft bone screw as a novel method for bridging lateral comminution at the talar neck, providing structural support and promoting bone regeneration. Methods: A 20-year-old male sustained a comminuted talar neck fracture with subtalar and tibiotalar dislocation after a bouldering fall. Urgent surgical intervention involved open reduction and internal fixation using a two-incision technique. The medial key fragment was stabilized with two conventional compression screws, revealing a significant lateral bony defect. This was bridged and stabilized with an allogeneic cortical bone screw (Shark Screw®, Surgebright GmbH, Lichtenberg, Austria), supplemented by bone replacement material. Results: At three months, CT confirmed fracture healing, and weight-bearing was initiated. At six months, the AOFAS score was 85/100 and FAAM 69/84, with no significant pain or swelling. By one year, the patient demonstrated full weight-bearing with occasional pain (AOFAS 88/100, FAAM 79/84). At two years, the patient achieved a pain-free range of motion and full activity participation (AOFAS 100/100, FAAM 83/84). Conclusions: The successful application of this technique illustrates the potential of allograft bone screws for stabilizing and bridging defects in talar neck fractures.

Purpose: Adequate pain management is eminently relevant for elderly and more vulnerable patients with hip fractures in the setting of pre and postoperative pain. This study compares postoperative hip fracture patients treated with standard pain management with a variety of medications or an approach with only one option in each medication category (nonopioid: acetaminophen; opioid: fentanyl TTS 12,5 mcg/hour; rescue medication: piritramide) to simplify the treatment algorithm for nurses and improve patient well-being. Design: Double-blind randomized controlled trial. Methods: The sample was cognitively intact patients (N = 141) with hip fractures in a tertiary university hospital. Administration of fentanyl 12 mcg/hour transdermal therapeutic system was administered by the nurses in the postanesthesia care unit (PACU) to address basal wound pain to improve patient wellbeing and patient treatment in the PACU for 24 hours to better control for early complications. Findings: Well-being was equally increased in both groups in comparison to our preintervention data from 35.7% to over 60% and did not differ significantly between the intervention and control group. No statistically significant differences in numeric rating scale scores, rescue opioid dosage (piritramide i.v.) or in complications were present. Conclusions: This one -size -fits -all simplified pain management approach did not improve patient wellbeing or any other outcome but highlighted the importance of adequate pain management and a sufficient nurse -to -patient ratio. (c) 2024 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

Introduction: Bioresorbable implants ought to provide stability for fracture healing and resorb thereafter, rendering implant removal obsolete. We follow up on our long-term results of the first in human study in 5 patients with medial malleolus fractures treated with bioresorbable magnesium screws. The study is a comparison of the implantation site with the corresponding contralateral part as well as implant resorption and assessment of the implantation site of 9 implants in 5 patients with HRpQCT (high resolution peripheral quantitative computed tomography).

Addressing non-unions involves stabilizing the affected area through osteosynthesis and improving bone biology using bone grafts. However, there is no consensus on the optimal treatment method. This study aims to compare outcomes of non-union surgery using conventional treatment methods (metal hardware ± graft) versus osteosynthesis with the human allogeneic cortical bone screw (Shark Screw®) alone or in combination with a metallic plate. Thirty-four patients underwent conventional treatment, while twenty-eight cases received one or more Shark Screws®. Patient demographics, bone healing, time to bone healing, and complications were assessed. Results revealed a healing rate of 96.4% for the Shark Screw® group, compared to 82.3% for the conventionally treated group. The Shark Screw® group exhibited a tendency for faster bone healing (9.4 ± 3.2 vs. 12.9 ± 8.5 weeks, p = 0.05061). Hardware irritations led to six metal removals in the conventional group versus two in the Shark Screw® group. The Shark Screw® emerges as a promising option for personalized non-union treatment in the foot, ankle, and select lower leg cases, facilitating effective osteosynthesis and grafting within a single construct and promoting high union rates, low complications, and a rapid healing process.

Zusammenfassung Ziel Die Punktion großer Gelenke erfolgt einerseits zur Diagnostik und andererseits zur Behandlung von Gelenkspathologien. Mittels Punktion kann eine rasche Schmerzreduktion durch Entlastung von Ergüssen oder intraartikulären Hämatomen erfolgen. Das gewonnene Punktat erlaubt schon bei der Beschau mit dem freien Auge eine erste Einschätzung und in der Folge eine mikroskopisch-zytologische sowie mikrobiologische Befundung im Labor. Indikationen Die Punktion eines großen Gelenkes ist zur Diagnose und/oder Therapie bei entzündlichen, traumatischen oder postoperativen Gelenksveränderungen angezeigt. Diagnostische Punktionen dienen der Punktatgewinnung, der differentialdiagnostischen Schmerzausschaltung oder (selten) der Kontrastmittelapplikation für die Magnetresonanzarthrographie. Therapeutische Punktionen ermöglichen die Injektion von Medikamenten oder plättchenreichem Plasma (PRP) sowie die Entlastung bzw. Drainage von Ergüssen. Kontraindikationen Bei entzündlichen und insbesondere eitrigen Hautveränderungen im Punktionsbereich sind Gelenkpunktionen kontraindiziert. Obwohl keine absolute Kontraindikation, ist bei Einnahme blutgerinnungswirksamer Substanzen Vorsicht geboten. Operationstechnik Besonderes Augenmerk ist auf ein steriles Vorgehen zu legen. Unnötige Schmerzen können durch das sterile Setzen einer Lokalanästhesiequaddel, „sichere“ Punktionspunkte sowie vorsichtiges Hantieren mit den Punktionskanülen vermieden werden. Weiterbehandlung Punktate müssen entsprechend den lokalen, intrahospitalen Richtlinien zeitgerecht aufgearbeitet bzw. entsorgt werden. Die Punktionsstellen werden mit sterilem Pflasterverband abgedeckt, bei Medikamentenapplikation die Gelenke zur Verteilung des Wirkstoffes passiv durchbewegt. Danach erfolgt eine Kompressionsbehandlung mit elastischer Bandage von distal nach proximal bis über die Punktionsstelle zur Vermeidung von Nachblutungen oder sofortiger Ergussneubildung. Fakten Werden sämtliche Maßnahmen der Sterilität bei der Punktion großer Gelenke eingehalten, ist davon auszugehen, dass Infektionen mit 0,04–0,08 % (4 bis 8/10.000 Punktionen) nur sehr selten auftreten. Das Risiko für falsch positive Erregernachweise ist äußerst gering.

Objective Puncture of large joints is performed for diagnostic purposes on the one hand and for the treatment of joint pathologies on the other. Puncture can be used for rapid pain relief by relieving effusions or intra-articular hematomas. The obtained puncture specimen allows immediate visual assessment and subsequent microscopic-cytological and microbiological evaluation in the laboratory.Indications The indication for puncture of a large joint is for diagnosis and/or therapy of inflammatory, traumatic or postoperative joint problems. Diagnostic punctures are used to obtain punctate, to differentiate the location of pain or (rarely) to apply contrast medium for magnetic resonance arthrography. Therapeutic punctures allow the injection of drugs or platelet-rich plasma (PRP) as well as the relief or drainage of effusions.Contraindications If there are inflammatory skin alterations-especially purulent inflammation-joint punctures through these lesions are absolutely contraindicated. Special attention is necessary if the patients are on anticoagulants.Surgical technique Absolute sterile handling is mandatory. Unnecessary pain can be avoided by a sterile skin wheal of local anesthesia, safe puncture points, and careful handling of the cannulas.Postoperative management Joint aspiration material has to be handled according to the local, intrahospital rules in a timely manner. Puncture sites are covered with sterile dressings, and if intra-articular medication is administered, the joints have to be passively moved through the range of motion to distribute the medication. Thereafter, compression therapy from distally to proximally while also covering the puncture site avoids recurrence of swelling or hematoma.Facts If sterile conditions are guaranteed, infections rarely occur (0.04-0.08%, 4-8/10,000 cases). The risk of false-positive detection of microorganisms is extremely low.

AimInternal fixation of femoral neck fractures is a widely used procedure that is comparatively less invasive and faster than hip replacement. While head preserving internal fixation of these fractures are still preferred where feasible, a faster recovery and lower reoperation rates make arthroplasty increasingly more appealing, in spite of being a more invasive option. Our aim was to determine the reoperation rate after internal fixation at our institution and to explore relevant risk factors in a geriatric population.MethodsThis monocentric follow-up study was conducted analyzing 116 patients aged 65 and older with femoral neck fractures who were surgically treated with either cancellous screws or dynamic hip screws between 2010 and 2017. We retrospectively collected longitudinal data from our patient database, supplemented by a telephone survey, with a follow-up period of at least 18 months.ResultsTwenty reoperations, due to either a failure of fixation, avascular necrosis, or posttraumatic osteoarthritis, were identified in our cohort, which constituted a reoperation rate of 17.2% (20/116). Fracture displacement was significantly associated with the reoperation risk (HR 8, CI 3-20; P < .001). The reoperation rate was 52.2% in displaced fractures vs 8.9% in undisplaced fractures. No link was found between the reoperation rate and gender, age, BMI, ASA score, type of implant, quality of internal fixation, type of living accommodation, and pre-fracture mobility.ConclusionInternal fixation has been found to be an effective option in elderly patients with undisplaced fractures regardless of their specific age, cognitive ability or physical condition. In displaced fractures the reoperation rate was found to be high, therefore a primary hip replacement should be recommended.

Magnesium alloys have recently become the focus of research, as these implants exhibit suitable biocompatibility and appropriate mechanical properties (Grün et al., 2018 [1]).Through intensive preclinical and clinical investigation, many questions regarding stability, biocompatibility and degradation behavior have been answered (Holweg et al., 2020 [2]). This case report aims to describe handling of these implants in a revision situation, especially when located in situ. To describe available options and relevant considerations, including planning and implementation, a revision surgery of a healed medial malleolus fracture is presented. A medial malleolus fracture was primarily treated by a trauma surgeon with two magnesium screws. Due to an osteochondral lesion of the talus, a revision surgery with osteotomy of the medial malleolus was necessary after 17 months. In this revision, conventional screw removal was not possible due to the degradation of the implant. Taking the degradation and the yield strength of the implant into account, we have chosen on the one hand to over-drill and on the other to leave and perforate the screw.To the best of our knowledge, this is the first case study focusing on the clinical intraoperative site of human bone stabilized with magnesium screws. Despite the hydrogen gas production that occurs during degradation, a solid bone-to-implant interface was evident. With this report, we want to encourage the surgical user to get more involved with resorbable magnesium implants.

Einleitung Bioresorbierbare Implantate sollen Stabilität für die Frakturheilung bieten und danach resorbiert werden, so dass eine Implantatentfernung überflüssig wird. Wir stellen die Langzeitergebnisse der First in Human Studie vor und berichten über die Nachbeobachtung von 6 PatientInnen mit medialen Malleolusfrakturen, die mit bioresorbierbaren Magnesiumschrauben ZX00 versorgt wurden.

Ankle is the most common site of hardware removal, mainly performed within 12 months of the primary surgery. The prominence of the metallic hardware is a frequent cause of pain after fracture fixation. Over the last decade, the development of bioresorbable materials based on magnesium (Mg) has increased. Bioresorbable metals aim to avoid a second surgery for hardware removal. Methods: Twenty patients with isolated, bimalleolar, or trimalleolar ankle fractures were treated with bioresorbable screws made of Mg, 0.45wt% calcium (Ca) and 0.45wt% zinc (Zn) (ZX00). Patient-reported outcome measures (PROMs) including visual analogue scale (VAS) for pain, the presence of complications 6 and 12 months after surgery and the AOFAS scale after 12 months were reported. The functional out-comes were analysed through the range of motion (ROM) of the ankle joint with a standard goniometer. Degradation products and the bioresorbability of the screws were evaluated using plane radiographs. Results: One patient was lost to follow-up. All patients were free of pain, no complications, shoe conflict or misalignement were reported after 12 months of follow-up. No Mg screws were surgically removed. An additional fixation of the distal fibula or the dorsal tibial fragment with conventional titanium implants (Ti) was performed in 17 patients. Within 12 months after primary refixation, 12 of these patients (71%) underwent a second surgery for Ti hardware removal. The mean AOFAS score was 89.8 +/- 7.1 and the difference between the treated and the non-treated site in the ROM of the talocrural joint was 2 degrees +/- 11 degrees after 12 months. Radiolucent areas around the screws were attributed to degradation and did not affect clinical or functional outcomes. After one year, the Mg screw heads could not be detected in the plane radiographs of 17 patients which suggests that the majority of the screw head is degraded without introducing adverse reactions. Conclusions: At 6 and 12 months, the bioresorbable Mg screws show excellent PROMs without complications or need for screw removal. The resorbability of the screw heads in most of the patients after one year could also provide an advantage over conventional bio-inert implants by avoiding related skin irritation due for instance to shoe conflict. (C) 2021 The Author(s). Published by Elsevier Ltd.

Antibiotic-loaded bone cements (ALBCs) are used as spacers in two-stage revision arthroplasty for periprosthetic joint infection. We previously described a new technique applying vancomycin powder coating to custom-made cements. To our best knowledge, this method of superficial vancomycin coating (SVC) has not been assessed. We therefore performed an in-vitro study to determine: 1) whether manually applied SVC strengthened the cements’ antibiotic effect; and 2) whether the mechanical requirements for the cements were fulfilled. SVC increases the antibiotic effect of cement within the first 24 hours. Cuboid blocks were produced from two commercially available acrylic ALBCs (Palacos R+G and Copal G+V) with and without SVC. Each block was eluted in phosphate-buffered saline at 37 °C. Eluates obtained at 1, 2, 3, 4, 5, 10, 15, 30 and 60 minutes and 3, 6 and 24 hours were evaluated against Staphylococcus aureus (Palacos, Copal) and methicillin-resistant Staphylococcus aureus (MRSA) (Copal) using zone of inhibition tests. Mechanical test results (bending modulus, bending strength) were compared to ISO requirements (≥ 1800 MPa, ≥ 50 MPa). Palacos with SVC produced significantly greater zones of inhibition against Staphylococcus aureus than Palacos without SVC (p = 0.002). Copal with SVC showed greater zones of inhibition against both Staphylococcus aureus and MRSA (p = 0.002). The antibiotic effect was enhanced by SVC in both cements at every time point within 24 hours. The bending modulus and bending strength of Palacos with SVC (2089 ± 166 MPa, 60.8 ± 2.6 MPA) and Copal with SVC (2283 ± 195 MPa, 56.9 ± 2.4 MPa) were significantly above ISO requirements. SVC boosts the antibiotic effect of ALBCs in the first 24 hours, while maintaining sufficient stability. These findings endorse SVC as a promising additive in septic revision surgery. III; case control study.

Introduction. Antibiotic-loaded bone cements (ALBCs) are used as spacers in two-stage revision arthroplasty for periprosthetic joint infection. We previously described a new technique applying vancomycin powder coating to custom-made cements. To our best knowledge, this method of superficial vancomycin coating (SVC) has not been assessed before. We therefore performed an in-vitro study to determine: (1) whether manually applied SVC strengthened the cements' antibiotic effect; and (2) whether the mechanical requirements for the cements were fulfilled. Hypothesis. SVC increases the antibiotic effect of cement within the first 24 hours. Methods. Cuboid blocks were produced from two commercially available acrylic ALBCs (Palacos R+G and Copal G+V) with and without SVC. Each block was eluted in phosphate-buffered saline at 37 degrees C. Eluates obtained at 1, 2, 3, 4, 5, 10, 15, 30 and 60 minutes and 3, 6 and 24 hours were evaluated against Staphylococcus aureus (Palacos, Copal) and methicillin-resistant Staphylococcus aureus (MRSA) (Copal) using zone of inhibition tests. Mechanical test results (bending modulus, bending strength) were compared to ISO requirements (> 1800 MPa, > 50 MPa). Results. Palacos with SVC produced significantly greater zones of inhibition against Staphylococcus aureus than Palacos without SVC (p = 0.002). Copal with SVC showed greater zones of inhibition against both Staphylococcus aureus and MRSA (p = 0.002). The antibiotic effect was enhanced by SVC in both cements at every time point within 24 hours. The bending modulus and bending strength of Palacos with SVC (2089 +/- 166 MPa, 60.8 +/- 2.6 MPA) and Copal with SVC (2283 +/- 195 MPa, 56.9 +/- 2.4 MPa) were significantly above ISO requirements. Conclusion. SVC boosts the antibiotic effect of ALBCs in the first 24 hours, while maintaining sufficient stability. These findings endorse SVC as a promising additive in septic revision surgery. Level of evidence. III; case control study. (C) 2021 L'Auteur(s). Publie par Elsevier Masson SAS.

INTRODUCTION:Popliteal artery entrapment syndrome (PAES) is caused by compression of the popliteal artery (PA) due to deranged myotendinous structures. It can be asymptomatic or may present with exercise intolerance, claudication, or even limb-threatening ischemia. The clinical picture depends on the anatomy and degree of vascular compromise.CASE DESCRIPTION:We report a case of a 17-year-old Caucasian male with PAES Type II presenting with intermittent claudication and progression towards acute limb ischemia.DIAGNOSTICS:MRI and MRA helped identifying the aberrant anatomy and thrombotic occlusion. Doppler ultrasound and conventional angiography have also been employed in a stepwise approach.INTERVENTION:The thrombus at the site of occlusion was removed by the use of catheter-directed lysis. Subsequently, popliteal artery release was achieved by myotomy of the aberrant medial head of gastrocnemius muscle (MHGM) and muscle transfer to the medial femoral condyle. A three-month regimen of 60mg edoxaban was recommended after surgery.OUTCOME:Surgical correction of the anomalous anatomy and postoperative anticoagulation led to freedom of symptoms.LESSON:Clinical presentation of PAES mimicking peripheral artery occlusive disease is very rare but potentially limb-threatening. PAES should be considered in young and otherwise healthy individuals.

This case report is about myopericytomatosis, a recently described rare tumor entity with only a dozen cases found in PubMed. Histologically, this tumor is characterized by diffuse infiltration of innumerable discrete myopericytoma-like nodules composed of myoid cells in a perivascular distribution. PDGFRB mutation has been linked to myopericytomatosis as well as other myopericytic tumors. The aim of this paper is to share the clinical presentation and expand the spectrum of genetic findings. We report a case of myopericytomatosis arising around the left ankle of a 73-year-old man. MRI, biopsy, and histopathology were the main diagnostic steps. Targeted next-generation sequencing was carried out to analyze the tumor sample. We performed local excision for tumor mass reduction, as wide resection was impossible a priori based on the delicate anatomical region with important structures in close proximity. Genetic analysis revealed a missense mutation of PDGFRB. PDGFRB alteration seems to play a pathogenic role in myopericytomatosis as highlighted in previously reported cases. Currently, myopericytomatosis is best treated surgically.

Objective Adolescents with obesity have increased risk of type 2 diabetes and metabolic syndrome (MetS). Pancreatic fat has been related to these conditions; however, little is known about associations in pediatric obesity. The present study was designed to explore these associations further. Methods We examined 116 subjects, 90 with obesity. Anthropometry, MetS, blood samples, and oral glucose tolerance tests were assessed using standard techniques. Pancreatic fat fraction (PFF) and other fat depots were quantified using magnetic resonance imaging. Results The PFF was elevated in subjects with obesity. No association between PFF and body mass index-standard deviation score (BMI-SDS) was found in the obesity subcohort. Pancreatic fat fraction correlated to Insulin Secretion Sensitivity Index-2 and Homeostatic Model Assessment of Insulin Resistance in simple regression; however, when using adjusted regression and correcting for BMI-SDS and other fat compartments, PFF correlated only to visceral adipose tissue and fasting glucose. Highest levels of PFF were found in subjects with obesity and MetS. Conclusions In adolescents with obesity, PFF is elevated and associated to MetS, fasting glucose, and visceral adipose tissue but not to beta-cell function, glucose tolerance, or BMI-SDS. This study demonstrates that conclusions regarding PFF and its associations depend on the body mass features of the cohort.