Naoya Takada

Pediatric displaced fractures of the lateral condyle of the humerus treated using high strength, bioactive, bioresorbable F-u-HA/PLLA pins: a case report of 8 patients with at least 3 years of follow-up.

Objectives: The purpose of this report is to present our surgical technique using forged composites of unsintered hydroxyapatite particles/poly-L-lactide (F-u-HA/PLLA) pins for pediatric displaced fractures of the lateral condyle of the humerus, to retrospectively evaluate clinical outcomes, and to verify the advantages of this device by using postoperative radiographs. Design: Retrospective (level IV) case series. Setting: Academic medical center. Patients: From October 2004 to September 2006, 8 pediatric displaced closed fractures of the lateral condyle of the humerus (AO/OTA 13-B1) were treated. Intervention: Lateral condyle fractures were fixed using 2 threaded pins. All the patients were placed in a long arm cast for 4 weeks after surgery. Main Outcome Measurements: Radiographic and clinical outcomes and postoperative complications were evaluated. Results: The average follow-up period was 52.5 months. All fractures were successfully united. All shadows of pins were observed, and there were no radiolucent zones around the pins at the final radiographic follow-up. No patients experienced pain or cosmetic deformity at the most recent follow-up. Loss of reduction, malunion, deep infection, implant failure, osteolysis, skin ulcer, and foreign body reaction were not observed postoperatively. No patient required secondary operation. Conclusions: Radioopacity of F-u-HA/PLLA devices is a major advantage of this device. No radiolucent zones were present around the pins, no osteolysis was observed on postoperative radiographs, and there were no postoperative complications. Reoperation for removal was unnecessary. Open reduction, internal fixation using F-u-HA/PLLA pins offers several advantages in treating pediatric displaced fractures of the lateral condyle of the humerus. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Treatment of Lateral Tibial Condylar Fractures Using Bioactive, Bioresorbable Forged Composites of Raw Particulate Unsintered Hydroxyapatite/Poly-L-Lactide Screws

Forged composites of raw particulate unsintered hydroxyapatite/poly-L-lactide (F-u-HA/PLLA) devices possess high mechanical strength, bioactivity, and radio-opacity. The aim of this study was to assess the efficacy of F-u-HA/PLLA screws in the treatment of lateral tibial condylar fractures. From January 2005 to December 2010, a total of 7 patients with displaced closed lateral tibial condylar fractures (Schatzker type II) were treated using F-u-HA/PLLA screws. Open reduction and internal fixation was performed using 2 or 3 F-u-HA/PLLA screws. After surgery, weight bearing was not allowed for 6 weeks. Range of motion exercise was initiated after removal of the plaster splint. Radiographs were evaluated for fracture healing, joint depression, and the radioopacity of F-u-HA/PLLA screws. Clinical outcomes and postoperative complications were also assessed. Average follow-up was 44 months. All fractures were successfully healed. Average values for joint depression were 4.7 mm (range, 2-9 mm) preoperatively, 0.4 mm (range, 0-1 mm) postoperatively, and 0.4 mm (range, 0-1 mm) at final follow-up. Whole shadows of F-u-HA/PLLA screws were observed during the follow-up period. Breakage of screws, osteolysis, and a radiolucent zone around the screws were not observed at final follow-up. Average knee flexion and extension were 134° (range, 110° to 150°) and -1° (range, -10° to 0°), respectively. No patient had wound infection, late aseptic tissue response, or foreign body reaction postoperatively. None of the patients reported pain at final follow-up. These results suggest that F-u-HA/PLLA screws could be an alternative option for the treatment of lateral tibial condylar fractures. [Orthopedics. 2018; 41(3):e365-e368.].

Minimally invasive tension band wiring technique for olecranon fractures.

Some types of implants, such as plates, screws, wires, and nails, have been used for open reduction and internal fixation of olecranon fractures. A ≥ 10 cm longitudinal incision is used for open reduction and internal fixation of olecranon fractures. According to previous studies, tension band wiring is a popular method that gives good results. However, back out of the wires after the surgery is one of the main postoperative complications. Moreover, if the Kirschner wires are inserted through the anterior ulnar cortex, they may impinge on the radial neck, supinator muscle, or biceps tendon. Herein, we describe the minimally invasive tension band wiring technique using Ring-Pin. This technique can be performed through a 2 cm incision. Small skin incisions are advantageous from an esthetic viewpoint. Ring-Pin was fixed by using a dedicated cable wire that does not back out unless the cable wire breaks or slips out of the dedicated metallic clamp. As the pins are placed in intramedullary canal, this technique does not lead to postoperative complications that may occur after transcortical fixation by conventional tension band wiring. Minimally invasive tension band wiring is one of the useful options for the treatment of olecranon fractures with some advantages.

Repair of partial patellar ligament avulsion during total knee arthroplasty using the Statak device.

Abstract The Statak is a suture anchor device used for attaching soft tissue to bone. This is a report on six knees in which this device was used to repair partial avulsion of the patellar ligament during total knee arthroplasty (TKA). The six patients were all women. The average age of the patients was 69 years. The diagnosis was osteoarthritis in three patients, rheumatoid arthritis in two, and steroid arthropathy in one. Three of the operations were revision arthroplasties. In all six cases, approximately half of the patellar ligaments were accidentally detached from the tibial tubercles during surgery, and were repaired using the Statak devices. The average length of follow-up was 3 years. The Knee Society knee score improved from an average of 15 points preoperatively to 87 points at the latest follow-up. The average total range of motion measured 104° before surgery and 108° at the latest follow-up. Three of the six knees operated on had no extensor lag. The suture anchor simplifies the secure fixation of the ligament to bone. The procedure can be performed easily and quickly. In our opinion, the Statak device has proven itself to be effective for the repair of partial patellar ligament avulsion during TKA.