Notes

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Level IV case series analysis of retrieved surgical implants.
To evaluate biomechanical behavior of different internal fixation methods for the treatment of Pauwels Type III femoral neck fractures.

Three internal fixators were developed to treat Pauwels Type III femoral neck fracture using finite elements dynamic hip screw (DHS); DHS combined with anti-rotation screw; three cannulated screws in an inverted triangular configuration (ASNIS). selleck kinase inhibitor Under the same conditions, vertical fracture displacement, and maximum and minimum principal, and Von Mises stresses were evaluated.

The vertical displacements evaluated were 5.43mm, 5.33mm and 6.22mm, rotational displacements values were 1.1mm, 0.4mm and 1.3mm; maximum principle stress values obtained for the upper region of the femoral neck were 3.26hPa, 2.77hPa, and 4.5hPa, minimum principal stress values obtained for the inferior region of the femoral neck were-1.97hPa,-1.8hPa and t-3.15hPa; Von Mises peak stress values were 340.0MPa, 315.5MPa and 326.1 Mpa, for DHS, DHS with anti-rotation device, and ASNIS, respectively.
wels Type III fracture.We present the case of a 56-year-old man who sustained a tibial tuberosity fracture with an associated patellar fracture. In the adult population there are only a few documented cases of tibial tuberosity fractures. This is only the second recorded case of bifocal patella tendon avulsion. The patient was managed successfully by fixation of the tibial tuberosity alone as the patella fracture was undisplaced and the patella retinaculum intact. A key point was screening the patella fracture at time of fixation to aid this decision. We achieved a good outcome at one year with internal fixation and early mobilisation.Tibial plateau fracture-dislocations are relatively uncommon injuries. They represent instability patterns due to injured collateral ligaments or extensive condylar depression. Medial and lateral subluxations of the fractured fragments represent the majority of these injuries. Posterior dislocations with the tibial plateau fractures are extremely rare injuries. Moreover, isolated posterior dislocations of the tibial condyles with a normally maintained position of the remaining tibia have not been reported in literature. We describe a difficult case scenario in which whole of the articular segment of the lateral condyle of the tibia was separated from its anterolateral rim and completely dislocated posteriorly, with no contact with the lateral condyle of the femur. Besides this, there was a complete disruption of the proximal tibiofibular joint as well. To further add to the problem, the distal pulses in the affected limb had a reduced volume. Stepwise management of all aspects of this injury has been described in this technical note along with a six-month follow-up.
Correct management of Hoffa fractures is a challenge in the clinical context. Open reduction along with internal fixation should be the therapy of choice. Mechanical trials with the main internal fixation systems conducted by individualized finite element (FEM) models, to date, have been neglected. The aim of this study was to biomechanically analyze four fixation methods for the treatment of Type II Hoffa fracture (OTA Classification 33B3.2∗ lateral) using FEM.

Four internal fixators were developed to treat Type II Hoffa fracture using finite elements 4.5mm cortical screws and 7mm cannulated screw in anterior-to-posterior and posterior-to-anterior directions (4.5AP, 4.5PA, 7AP and 7 PA). Under the same conditions, fractural deviation in the vertical, maximum and minimum principal and Von Mises directions in the syntheses used were evaluated.

The vertical displacements evaluated were 0.7mm, 0.5mm, 0.8mm and 0.3mm; the values of maximum were 6.14 Mpa, 6.15hPa, 6.0 Mpa and 6.2 Mpa, the values obtained from minimum data were 6.26 Mpa,-6.45 Mpa,-7.3MPa and-6.8 Mpa and the maximum values of Von Mises peak stress were 185.0 Mpa, 194.1 Mpa, 143.6 Mpa and 741.4 Mpa, for the fixation models 4.5AP, 4.5PA, 7AP and 7PA, respectively.

The 7mm-cannulated screw fixation system yielded the best mechanical results evaluated by FEM in the treatment of Type II Hoffa fracture, causing a decrease in vertical displacement when used in retrograde and in Von Mises peak stress in anterograde.
The 7 mm-cannulated screw fixation system yielded the best mechanical results evaluated by FEM in the treatment of Type II Hoffa fracture, causing a decrease in vertical displacement when used in retrograde and in Von Mises peak stress in anterograde.
Fracture union is a fundamental goal in orthopaedics. There is variability in assessment and lack of consensus on reliability of various methods to evaluate progress of union. The purpose of this study was to study the temporal association of non-conventional methods i.e. Serum Alkaline Phosphatase (ALP) and Ultrasound (USG) in assessment of fracture healing with reference to plain radiographs (X-ray).

This was a prospective observational cohort study of 161 adult patients with surgically treated long bone diaphyseal fractures. Plain radiographs, ALP and USG evaluation was done every 6 weekly for 6 months. USG evaluation included assessment of echogenicity and Doppler measurement of Vascular Resistance Index (RI) of callus. Fractures were considered united when X-ray showed bridging callus. ALP and USG changes over the follow-up period were analysed based on the final outcome of fractures.

151 patients showed signs of fracture union at final follow-up. ALP which peaked at 6 weeks in all cases always rem appear as promising investigations in assessment of the progress in fracture union.
High tibial osteotomy (HTO) is an established procedure to treat medial compartmental osteoarthritis (OA) knee associated with varus deformity. It is well documented that precise correction of deformity and maintenance of correction achieved is important to ensure long term good results. This study was undertaken to record changes in radiological parameters and its effect on the functional outcomes in first two years following HTO done for varus degenerative OA kneeby hemicallotasis technique using HTO fixator.

31 patients meeting our inclusion-exclusion criteria who underwent HTO by hemicallotasis method using self-adjusting unilateral HTO fixator were included in the study. Their femoro tibial angle (FTA), mechanical axis %, Insall- Salvati ratio, proximal tibial antero-posterior slope and knee injury and osteoarthritis outcome Score (KOOS) were recorded preoperatively, postoperatively at the time of removal of fixator, at 1 year and at 2 years.

The FTA and mechanical axis significantly improved from a mean of 183.
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