Mihai Nica

Fixation System Design in Ipsilateral Proximal Femur and Diaphyseal Fractures in Elderly Patients

Ipsilateral proximal femur combined with diaphyseal fracture is a rare and problematic combination of injuries with serious potential complications first reported in the literature by Delaney and Street in 1953. This paper offers a retrospective view of 21 cases involving ipsilateral, proximal and diaphyseal fractures in elderly patients who were treated in our department, in order to emphasize the challenges of managing these pathological entities in elderly patients and the need for improvement of implant design. A number of 21 patients treated in our department, over a five year period for ipsilateral, combined proximal (intertrochanteric or femoral neck fractures) and femoral shaft fractures was selected. The cases were the result of various types of trauma as follows: 8 patients injured in motor vehicle accidents, 11 falls from standing position and 2 falls from more than own height. No open fractures or pathological fractures were recorded for this study. The patients were grouped according to treatment approach as group A (n=13), managed using intramedullary fixation devices and group B (n=8), treated with plating. All 21 patients were followed-up for 1 to 2 years after surgery. The data was analysed using Students t-test and a comparison between the two groups was devised. None of the available fixation methods has shown clear superiority for addressing this fracture association. The multitude of variables affecting the management of this injury pattern is complemented by the poor local biomechanical environment provided by the low bone mineral density characteristic for the elderly patients. This raises the challenge of improving the design of the implants to better suit the biomechanical requirements, which sometimes are dictated by the age of the patients.

Mechanical Failure of Angle Locking Plates in Distal Comminuted Tibial Fractures

Distal comminuted tibial fracture with or without intra-articular involvement is a very common injury of the lower limb, especially in younger patients due to high energy trauma. The anatomical and biomechanical properties of this segment of tibia, makes this pathology a major surgical challenge with a preserved clinical outcome. The aim of this study is to present different outcome of tibial fracture, treated with open reduction and internal fixation (ORIF) with titanium angle locking plates (ALP) and to underline the physiological and non-physiological bone healing effects on implants. In this study we included 48 patients with tibial pilon fracture who underwent to ORIF, applying ALP in the Orthopedics and Trauma department of the University Emergency Hospital in Bucharest. Due to preserved biomechanical properties of ALP and this anatomical region, weight bearing is not allowed till 6 to 8 weeks. Comminuted fracture of this part of tibia often have de-vascularized bony fragments which leads to delayed union or non-union. These complications often lead to implant failure, improper bone healing or non-union. Internal fixation with angle stable screws, offers a good stability of reduction in the early postoperative period. Titanium angle locking plates offers good anatomical reduction and stable fixation in the early period of healing process. Due to its rigid, fixed position of the screws in the plates, bone remodelling during healing process and early weight bearing, increases the mechanical failure of implant.Keywords: tibial pilon fractures, angle locking plates, implant failure.

Post-chemotherapy bone metastasis recurrence of colorectal adenocarcinoma - case report

Abstract One of the most common neoplasms in the world, ranking third, is the colorectal cancer. 96% of all cases of colorectal cancer are adenocarcinoma. The prognostic of this diagnostic is a bad one, with low 5-years survival rate. Although the most common locations for the metastases are the liver and the lungs, the bones can also be targeted (5.5%). We present the case of a 65-year-old male who came to the hospital with pain and tumefaction at the right fibular head. After extensive clinical and paraclinical examinations, a biopsy was performed, at which stage the entire tumor was removed. The result was that of moderate differentiated adenocarcinoma. The patient was then further examined and a tumor was discovered at the sigmoid colon. The primary tumor was removed and the patient underwent oncological treatment. 2 years later, the patient returned with a recurrence of the bone metastasis. After a PET-CT that infirmed other metastases coupled with a satisfactory evolution of the primary tumor, the decision was made to amputate the knee above. Biopsy is an essential step that establishes the correct diagnostic and dictates the right choice of treatment solution. Counseling is also essential, so that the patient can choose and accept the best treatment option.

Non-Hodgkin lymphoma as primary bone tumor in a patient with B hepatic viral infection - case report

Abstract Diffuse large B cell lymphoma (DLBCL) is the most common form of non-Hodgkin lymphomas, which has shown an increasing incidence in the past decades. 7% of primary bone tumors consist of non-Hodgkin lymphomas. The etiology of this type of lymphoma is still unclear. Our aim was to study the latest research papers; to highlight the importance of cooperation between different medical specialty departments, in rare cases like NHL as PBT with associated HBV infection. Case report: We present the case of a 39-year-old male patient, who presented to the orthopedic department of the University Emergency Hospital of Bucharest, with moderate pain, swelling, and a palpable mass of the right lower limb. Management and Outcome: The patient underwent several investigations, whose result was DLBCL and an associated HBV infection. Due to the aggressive form of DLBCL, chemotherapeutical treatment has to be initiated as soon as possible to prevent further growth of the tumor. An antiviral therapy had to be initiated to prevent the hepatic failure, which could appear after chemotherapy and in the acute phase of viral infection. Discussion: Our case raised the question regarding what kind of relationship could be identified between the HBV infection and NHL, and how this condition influenced the outcome of the treatment.

Short Term Behaviour of Fixed-Loop Cortical Suspension System Used for Surgical Treatment of Hallux valgus

Hallux valgus represents an acquired foot deformity characterized by lateral deviation of the hallux and medial deviation of the first metatarsal. Pain during gait is the main complain and is caused by reduction of plantar pressure under the first ray leading to insufficiency of the first ray and overload of the lesser rays. Treatment can be nonoperative or surgical with more than one hundred surgical techniques described so far. The scope of this study was to assess the short term reliability and stability of fixed loop suspension systems used for surgical treatment of this pathology using radiological evaluation of hallux valgus angle and the intermetatarsal angle. Our results show good stability of the reduction and good reliability of the suspension system, with a six months follow-up. Only one specific complication (failure of the wiring material) is highlighted by our conclusions and the need for biomechanical testing in controlled laboratory studies.

Bioabsorbable Anchors for Medial Patellofemoral Ligament Reconstruction

Acute dislocation of the patella is a very common injury of the knee. In more than 90% of the cases the medial patellofemoral ligament (MPFL) is injured. Reconstruction of the MPFL has become a popular soft tissue procedure, which reduces hospitalization and the rehabilitation period. Bioabsorbable materials, in form of screws and anchors are ideal for soft fixation to bones in orthopedics. We would like to present our experience and short-term results after MPFL reconstruction with semitendinous autograft and bioabsorbable fixation devices. 10 patients were involved in this study with PF joint instability, who underwent to MPFL reconstruction. In order to evaluate the functional outcome of the procedure we applied the Tegner Lysholm scoring system before and after 3 Months of surgery. MPFL reconstruction significantly improved the functionality of the PF joint. Gender distribution of the studied group was: 7 female with an average age of 25 5,03 SD and 3 male patients with an average age of 29 1 SD. The key for the success in MPFL reconstruction is the positioning of the femoral tunnel, followed by an isometric tensioning of the graft. Bioabsorbable materials reduce inflammatory, and foreign body response facilitating biointegration of the autograft.

Influence of Antibiotics Addition in Bone Cements for Hip Arthroplasty on their Mechanical Properties: Clinical Perspective and In Vitro Tests

Bone cement has been used for over half a century, to successfully anchor artificial joints. From its emergence there have appeared a number of types of bone cement, with the 2 major classes being bone cement with or without active substances. The one with the added antibiotics is used primarily in the treatment and revision surgery of infected total hip arthroplasty (THA), as well as a prophylactic method in primary THA in patients with high risks for this complication. The purpose of this study is to determine the mechanical properties of bone cement with added antibiotics. Over a period of 2 years, a number of 41 cases were chosen for this study: 25 with revision surgery for THA, where bone cement with antibiotics was used, and 16 with primary THA, where regular bone cement was used. A number of studies have been performed on the mechanical properties of the 2 types of cement, which determined that the cement with antibiotics presents a slightly lower compressive strength, tensile strength, elastic modulus and fatigue strength compared with regular cement. These variations, however, become more pronounced as the quantity of the antibiotic goes up. The mechanical properties of the cement with antibiotics are similar with those of the regular cement, when low doses of antibiotics are used and become more evident as the doses go up. In conclusion, the antibiotic bone cement is a trustworthy tool in the surgeon’s arsenal against infection, with minimal detriments from the mechanical view.

The Analysis of Main Causes of Different Osteosynthesis Implants Failure in a Series of Clinical Cases

The study presented in this paper was conducted to assess the main causes of osteosynthesis implants failure, among which implant material defects and unstable osteosynthesis fixation occur. A total number of 42 patients with osteosynthesis implant failure were included in this study in the Orthopedics and Traumatology Clinic of Bucharest Emergency University Hospital. The osteosynthesis implants failure was determined using radiological examination, only the patients with the age between 18 and 60 were selected. From the total number of patient included in our study, 18 had osteosynthesis performed with open reduction and plates and screws fixation, 5 intramedullary implants with open reduction, 4 intramedullary implants with close reduction, 15 cases of fixation with locking screws. For evaluating the macroscopic and microstructural features of the failure, we use microscopically techniques like stereomicroscopy, optical microscopy and scanning electron microscopy (SEM) techniques in conjunction with radiological images. After our analysis, in 14 cases we found a correct fixation but the microscopic examination of the implant materials reveals cracks in their structure, 24 cases showed an imperfect reduction of the fracture with interfragmentary diastasis and malrotation, and 4 had inadequate size devices, where the examination of failed metallic implants revealed no structural defects in implant materials. The results of our study showed that both design errors and inappropriate surgical procedures were causes of osteosynthesis failure. Therefore, special attention should be paid to the surgical fixation procedure but also to the fixation implant materials used.