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Background: The axial headless compression screw (AHCS) technique is a widely used method for distal interphalangeal joint (DIPJ) and thumb IPJ arthrodesis. However, it might not be suitable for cases over 10° flexion of fusion angle and extremely small-sized phalanx. Here, the authors describe the nonaxial multiple small screws (NMSS) technique, compare the mechanical strength of the NMSS technique with the AHCS technique, and suggest clinical outcomes of the NMSS technique.Methods: DIPJ and thumb IPJ arthrodesis models were simulated in the 4th generation composite bone hand. Fixation with three 1.5 mm cortical screws (NMSS) or one HCS (AHCS) was performed in each pair of the phalanx. The bending stiffness and load to failure were tested in 10 pairs of each specimen, and the torsional stiffness and torque to failure were tested in seven pairs of each specimen. Moreover, 15 consecutive clinical DIPJ and thumb IPJ arthrodesis cases were reviewed retrospectively.Results: The NMSS specimens showed significantly higher bending load to failure, torsional stiffness, and torque to failure than the AHCS specimens. All 15 arthrodesis cases were united without severe complications. The mean fusion angle was 16.3° for the nine cases of the flexed target position.Conclusions: The NMSS technique showed biomechanical stability comparable to that of the AHCS technique in DIPJ and thumb IPJ arthrodesis. Thus, the NMSS technique could be used as a feasible option in DIPJ and thumb IPJ arthrodesis, especially when a small finger is indicated and a significant flexion angle is required. [ABSTRACT FROM AUTHOR]

Background: This study aims to analyze the outcomes of subtalar distraction arthrodesis (SDA) for calcaneal malunion using structural freeze-dried iliac allograft (FDIA) compared to using autologous iliac bone (AIB).Methods: We retrospectively evaluated 57 consecutive cases (51 patients) of calcaneal malunion between March 2006 and December 2017. All patients were followed for an average of 22.8 months. All cases were treated by SDA using structural FDIA (17 cases, group 1), or AIB (40 cases, group 2). The outcome measures included the American Orthopaedic Foot and Ankle Society ankle-hindfoot (AOFAS) scores, visual analog scale (VAS) pain scores, and radiographic measurements.Results: The mean postoperative 3, 6, and 12 months of AOFAS scores and VAS pain score were significantly better in group 2 than those in group 1 (p < 0.05, for all). There were 3 cases (17.6%) of nonunion in the group 1, whereas the group 2 had 2 cases (5.0%), which did not shown significant difference between two groups (p = 0.492). Although the mean pre-, postoperative, and final follow-up radiologic parameters in both groups were similar, (p > 0.05, for all) the difference of talocalcaneal height, talocalcaneal angle, and talar declination angle from postoperative to final follow-up were significantly bigger in the group 1. (p < 0.05, for all).Conclusion: Although union rate was not significantly different between the two groups, we obtained more favorable clinical and radiologic outcomes in the autologous iliac bone group. Using FDIA without any orthobiological agent for SDA, there were significant more loss of radiological parameters due to inferior incorporation and biomechanical properties. When considering the SDA for calcaneal malunion, routine use of FDIA without any orthobiological agents as an interpositional graft for SDA is not recommended. [ABSTRACT FROM AUTHOR]

Distal interphalangeal joint arthrodesis with nonaxial multiple small screws: a biomechanical analysis with axial headless compression screw and clinical result of 15 consecutive cases. The online version of the original article can be found at https://doi.org/10.1186/s12891-022-05473-9. [Extracted from the article]

This study investigated the incidence of and risk factors for nonunion in patients with posttraumatic subtalar arthrodesis (SA). We retrospectively reviewed 165 posttraumatic SA cases. Nonunion was diagnosed at 6 months after surgery based on the findings of clinical evaluations, plain radiographs, and CT scans. Patient-specific factors and surgeon-specific factors were evaluated as potential risk factors. The overall nonunion rate was 13.3 % (22 of 165 cases). In the final multivariate logistic regression analysis, smoking (odds ratio [OR] = 3.64; 95 % confidence interval [CI] = 1.23–10.75), parallel screw configuration (OR = 5.70; 95 % CI = 1.62–20.06), and freeze dried iliac crest (OR = 9.16; 95 % CI = 2.28–36.79) were demonstrated as risk factors for nonunion of posttraumatic SA. Patients with a history of smoking, parallel screw configuration fixation, and those who received freeze dried iliac crest as an interpositional graft, had a significantly higher rate of nonunion. [ABSTRACT FROM AUTHOR]

An increasing number of chronic renal failure patients are experiencing hip joint disorders. This study aimed to analyze the outcomes of hip arthroplasty in chronic renal failure patients undergoing dialysis. Of 2364 hips that underwent hip arthroplasty during 2003–2017, 37 were retrospectively examined. Radiological and clinical outcomes of hip arthroplasty, and development of local and general complications during follow-up and their associations with dialysis duration were analyzed. The mean patient age, follow-up duration, and bone mineral density T-score were 60.6 years, 36.6 months, and − 2.62, respectively. Osteoporosis was noted in 20 cases. Most patients who underwent total hip arthroplasty with a cementless acetabular cup implant exhibited excellent radiological outcomes. There were no changes in femoral stem alignment, subsidence, osteolysis, and loosening. Thirty-three patients had an excellent or good Harris hip score. Complications developed in 18 patients within 1 year postoperatively. General complications developed in 12 patients at > 1 year postoperatively; no patient experienced local complications. In conclusion, hip arthroplasty for chronic renal failure patients on dialysis yielded excellent radiological and satisfactory clinical outcomes but may be associated with postoperative complications. Careful preoperative treatment planning and overall postoperative management are required to reduce the complication risk. [ABSTRACT FROM AUTHOR]

Background: This retrospective cohort study investigated perioperative C-reactive protein (CRP) value for early detection of postoperative systemic infective complications in elderly patients with intertrochanteric femoral fracture.Methods: A total of 250 patients aged ≥65 years, with intertrochanteric femoral fractures that were surgically treated between January 2011 and December 2015 were included. CRP value was measured preoperatively and on postoperative day (POD) 3, 5, and 10, and analyzed with regard to postoperative systemic infections, delirium, and death within 1 year. The patients were divided into two groups according to postoperative systemic infection, and perioperative CRP responses between the two groups were comparedusing t-test (or Man-Whitney test where appropriate). The receiver operator characteristic (ROC) curves of CRP value were used to determine the best-supported cut-off values for identifying postoperative systemic infections. Systemic infections were reclassified as pulmonary and extra-pulmonary infections.Results: The mean CRP values preoperatively and on POD 3, 5, and 10 were 2.82, 10.10, 3.74, and 1.89 mg/dL, respectively. Postoperative systemic infections, delirium, and death within 1 year were noted in 35 (14.0%), 30 (12.0%), and 45 (18.0%) patients, respectively. The CRP value in patients with postoperative systemic infections significantly elevated on POD 5 and 10 (p < 0.001, p < 0.001), and cut-off values were 4.71 and 1.59 mg/dL on POD 5 and 10, respectively. Postoperative delirium and death within 1 year were observed more often in the group with postoperative systemic infections (p = 0.003, p = 0.014). Although preoperatively elevated CRP values did not influence the postoperative CRP responses, they were significantly associated with delirium (p = 0.015).Conclusions: The CRP value on POD 5 is the earliest predictor of postoperative systemic infections in elderly patients with intertrochanteric femoral fractures that are managed surgically. Moreover, when the CRP value on POD 5 is >4.71 mg/dL, the possibility of postoperative systemic infections should be considered.Level Of Evidence: III, Retrospective cohort study. [ABSTRACT FROM AUTHOR]

Background: We aimed to compare outcomes of treatment of isolated talonavicular arthrodesis (ITNA) with screw only or screw plus plate, respectively.Methods: We retrospectively evaluated 40 consecutive cases of ITNA [two-screw fixation patients: Group 1 (23 cases); screw-plus-plate fixation patients: Group 2 (17 cases)]. Outcome measures included radiographic findings, Foot and Ankle Outcome Scores (FAOS), and visual analogue scale (VAS) scores.Results: Nonunion occurred more frequently in group 1 (21.7%) than in group 2 (5.9%), but there was no statistical significance (p = 0.216). Although the preoperative FAOS and VAS score showed similar results between both groups, there were significantly better clinical outcomes in two of five FAOS domains and VAS scores at 3 months postoperative and final follow-up (p < 0.05).Conclusion: Although union rates were not significantly different, nonunion occurred more frequently in screw only group and we obtained more favorable clinical outcomes in screw plus plate group. [ABSTRACT FROM AUTHOR]

Background: This study aimed to determine whether bone density correlates with radiologic and clinical outcomes after screw fixation of displaced intra-articular calcaneal fractures (DIACF) with the sinus tarsi approach.Materials and Methods: We retrospectively evaluated 43 consecutive cases of unilateral DIACF between March 2015 and December 2017. Radiologic evaluations were performed using preoperative, postoperative, and last follow-up calcaneal lateral and axial radiographs. In all patients, preoperative CT scanning of both injured and uninjured calcaneus were performed at one scanning and dual x-ray absorptiometry (DXA) scans were obtained. Hounsfield unit (HU) measurement values were determined by placing an elliptical region of interest confined to the cancellous region of the uninjured calcaneus. Clinical outcomes were assessed at a minimum of 12 months postoperatively using Foot and Ankle Outcome Scores (FAOS).Results: Mean HU values of the uninjured calcaneus significantly correlated with bone mineral density scores obtained from DXA scans of the lumbar and femur (Spearman ρ = 0.656 - 0.748; p < 0.001 for both). Decreased HU values of the uninjured calcaneus significantly correlated with decreased Böhler's angle and widening of calcaneal width from postoperative to last follow-up. (Pearson r = 0.348, p = 0.022; Pearson r = -0.582, p < 0.001, respectively). Increased HU values of the uninjured calcaneus significantly correlated with improved clinical outcomes in three of five FAOS domains, including activities of daily living, sports, and quality of life (beta = 0.283 - 0.322; p < 0.05 for all).Conclusion: Decreased preoperative bone density significantly correlated with decreased Böhler's angle, widening of calcaneal width, and inferior short-term clinical outcomes after screw fixation of DIACF. By quantifying bone density using HU value in area where DXA cannot be performed, such foot bones, determining whether different fixation methods or systemic treatments can be tailored to bone density could help in optimizing clinical outcomes.Level Of Evidence: Level III, Retrospective case series. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to investigate the postoperative outcomes of cementless Total hip arthroplasty (THA) following failed internal fixation for femoral neck and intertrochanteric fractures.Method: Ninety-six cementless THAs for failed internal fixation after femoral neck fracture (59, group I) and intertrochanteric fracture (37, group II) with a minimum follow-up of 3 years were analyzed. Clinical and radiologic evaluations were performed on all patients.Results: The intraoperative blood loss and operating time were significantly increased in group II (p = 0.001, p = 0.001, respectively). Harris hip score at last follow-up was significantly improved in group I (p = 0.007) but, there were no differences in hospital stay, Koval score at last follow-up, and perioperative complications between both groups. Long femoral stems for diaphyseal fitting were frequently used in group II (32/37, 86%) (p = 0.001). Radiographically, none of the acetabular cups showed evidence of migration, loosening. All cases showed stable fixation of the femoral stem at last follow-up.Conclusions: Outcomes of cementless THA following failed internal fixation for femoral neck and intertrochanteric fractures were satisfactory; increased intraoperative blood loss, operating time, and requirement of long femoral stem should be considered in the latter type of fracture. [ABSTRACT FROM AUTHOR]

Background: This retrospective cohort study investigated the prevalence of and risk factors for preoperative venous thromboembolism (VTE) in patients with a hip fracture and a delay of >24 hours from injury to surgery.Methods: This observational study included 208 patients with a hip fracture surgically treated at 1 university hospital between December 2010 and August 2014. Patients underwent indirect multidetector computed tomographic (MDCT) venography for preoperative VTE detection after admission. Overall VTE risk and median time from injury to CT scan were calculated. Age, sex, fracture type, time from injury to CT scan, body mass index, preinjury mobility score, previous anticoagulation treatment, previous hospitalization for VTE, varicose veins, and medical comorbidities were considered potential risk factors.Results: The prevalence of preoperative VTE was 11.1% (23 of 208 patients), including 12 patients with deep vein thrombosis alone, 7 patients with pulmonary embolism alone, and 4 patients with both. The mean time from injury to CT scan was 4.9 days. The delay from the time of injury to CT scan averaged 7.6 days for patients who developed preoperative VTE, compared with 4.2 days for patients who had not developed VTE. In the adjusted models, female sex, subtrochanteric fracture, pulmonary disease, cancer, previous hospitalization for VTE, and varicose veins were risk factors for VTE. The final multivariate logistic regression analysis demonstrated that female sex (odds ratio [OR] = 5.86; 95% confidence interval [CI] = 1.21 to 28.21), subtrochanteric fracture (OR = 22.17; 95% CI = 4.02 to 122.06), pulmonary disease (OR = 21.10; 95% CI = 5.35 to 83.21), and previous hospitalization for VTE (OR = 16.36; 95% CI = 3.41 to 78.43) increased the risk of VTE.Conclusions: Our findings show a high prevalence of preoperative VTE in patients with a hip fracture. Therefore, preoperative investigation for VTE should be routinely considered for patients in whom surgery is delayed for >24 hours. At this time, indirect MDCT venography seems to be effective and useful.Level Of Evidence: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Background: Isolated greater trochanter (GT) fractures are relatively rare and few studies have assessed the appropriate diagnostic and therapeutic strategies for these fractures. When initial plain radiographs show an isolated GT fracture, underestimation of occult intertrochanteric extension may result in displacement of a previously non-displaced fracture. This study examined the clinical results and value of different diagnostic strategies in elderly patients with isolated GT fractures on plain radiographs.Methods: Between January 2010 and January 2015, 30 patients with initial plain radiographs showing isolated GT fractures were examined using MRI, bone scanning and/or CT for suspected occult intertrochanteric extension. We assessed the sensitivity, specificity, and positive and negative predictive value of each test. In addition, we noted the location of the fracture or soft-tissue injury on MRI in addition to treatment results.Results: All 30 patients had osteoporosis and fractures caused by minor trauma. MRI revealed isolated GT fractures in nine patients and occult intertrochanteric fractures in 21 patients. Using the MRI-based diagnosis as a reference, the results showed that plain radiographs, bone scans, and CT scans can be used for supplementary examination but they are not appropriate as confirmatory tests for these fractures. However, in patients with both isolated GT fractures seen on plain radiographs and increased uptake in only the GT area on bone scans, MRI revealed isolated GT fractures. The fractures were treated surgically in 20 patients and conservatively in 10 patients with satisfactory clinical results.Conclusions: We confirmed that MRI-based examination is useful in all symptomatic elderly patients whose plain radiographic findings reveal isolated GT fractures. However, we suggest that there is a need to establish a diagnostic strategy through increased understanding of the available diagnostic methods. We believe that surgical treatment should be considered in patients with occult intertrochanteric fractures that are detected on MRI. [ABSTRACT FROM AUTHOR]