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1. Non-Union Treatment in the Foot, Ankle, and Lower Leg: A Multicenter Retrospective Study Comparing Conventional Treatment with the Human Allogeneic Cortical Bone Screw (Shark Screw®)

Author

Viktor Labmayr, Elisabeth Huber, Florian Wenzel-Schwarz, Patrick Holweg, Martin Ornig, Gerd Jakob, Wolfgang Palle, Gudrun H. Borchert, and Klaus Pastl

Subjects
bone healing, non-union, human allogeneic cortical bone screw, Shark Screw®, pseudarthrosis, foot and ankle, Medicine
Abstract

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.

Published
2024
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2. Donor site morbidity after the harvest of microvascular flaps from the medial and lateral femoral condyle region: Objective, radiologic, and patient-reported outcome of a multi-center trial

Author

Andrea Borenich, Stefan Benedikt, Maximilian Neuwirth, Elmar Janek, Karina Hoenck, Raimund Winter, Madeleine Mischitz, Thomas Ziegler, Lars P. Kamolz, Matthias Rab, Wolfgang Palle, M. V. Schintler, Heinz Buerger, Helmut Schoellnast, and Michael Mueller-Eggenberger

Subjects
Cartilage, Articular, musculoskeletal diseases, Knee function, medicine.medical_specialty, Bone flap, Intra-Articular Fractures, Knee Joint, Osteoarthritis, Free Tissue Flaps, Cohort Studies, Chart review, medicine, Humans, Femur, Patient Reported Outcome Measures, Retrospective Studies, business.industry, Cartilage, medicine.disease, Surgery, medicine.anatomical_structure, Lateral femoral condyle, Patient-reported outcome, Morbidity, business, Cohort study
Abstract

Summary Background With the experience-based hypothesis of low donor site morbidity (DSM) for free flaps from the distal femur, this cohort study aimed to evaluate the DSM according to objective and reproducible criteria. Methods One hundred and fifty-six patients who had a flap harvest from either the medial or lateral femoral condyle region between 2005 and 2017 were included. A retrospective chart review was performed for all patients. In total, 97 patients were available for a follow-up examination. Outcomes were assessed according to objective (Knee Society Score; Larson Knee Score; OAK Score; 0–100 points), patient-reported (IKDC Score; KOOS Score; 0–100 points), and radiologic criteria (Kellgren and Lawrence Score; MRI Osteoarthritis Knee Score). Results The median follow-up time was 1,529 days (range: 248–4,810). The mean Knee Society Score (94.8 ± 10.1), Larson Knee Score (94.5 ± 10.1), and OAK Score (95.5 ± 6.6) showed nearly unimpaired knee function. The overall patient-reported DSM was low (IKDC Score: 86.7 ± 17.4; KOOS Score: 89.3 ± 17.1). Osteochondral (OC) flaps had a significantly higher DSM, regardless of the donor site. Bone flaps did not show any relevant radiologic morbidity in the Kellgren and Lawrence Score. Besides the procedure-associated cartilage lesions at the OC donor sites, MRI Osteoarthritis Knee Score did not show any significant presence of further knee pathologies in the bilateral MRI Scans. The obvious cartilage lesions did not have a relevant impact on the knee function of most patients. Conclusion The DSM for bone and soft-tissue flaps from the femoral condyle region is negligible. OC flaps are associated with a significantly higher DSM, although a clinically relevant impact on knee function was not evident in the majority of patients.

Published
2022

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