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Does intra-articular fracture change the lubricant content of synovial fluid?

Does intra-articular fracture change the lubricant content of synovial fluid?

being between the ranges of 129 and 450 μg/mL [12]. There is a large variability in the measured PRG4 levels of SF from patients with joint disease [11, 12]. Changes in PRG4 concentration after acute injury have been pre- viously noted [6, 11, 12, 18];, however, conflicting result regarding this have also been produced [6, 18]. In an animal study, the PRG4 concentration of SF decreased from 280 to a 20 to 100 μg/mL range at 3 weeks after injury [19]. These decreased PRG4 levels returned to normal values within 1 year of ACL injury [6]. Yet other studies have reported increased PRG4 concentrations after intra-articular fracture and OA patients [11, 18]. Additionally, in another study, increased PRG4 concen- trations were found to be correlated with the severity of OA [18]. These differences may be related to the study design, biochemical assay, and objective selection criteria [11]. In our study, all of the samples were taken from the same patient population (i.e., both injured and healthy joints were exemplified with same biochemical assay). The mean PRG4 concentrations were 59.51 μg/mL in injured knees and 58.82 μg/mL (p = 0.893) in healthy knees, according to our analyses. This similarity in the mean levels of the injured and healthy knees espoused the hypothesis that PRG4 levels return to normal in the long- term analyses [6].
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Finite element simulation of three surgical treatments of distal radius intra-articular fracture

Finite element simulation of three surgical treatments of distal radius intra-articular fracture

4.16 (A) Average total displacement of the fracture site under the 100 N axial compression, 2 N-m bending and 2.5 N-m torsional loads. The total displacement was averaged from the displacement of the nodes on the fracture site. (B) Maximum von Mises stress value

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Comparative study of Closed Reduction and Cast, versus Percutaneous K Wire Fixation of Extra Articular Distal End Radius Fracture in a Tertiary Care Centre

Comparative study of Closed Reduction and Cast, versus Percutaneous K Wire Fixation of Extra Articular Distal End Radius Fracture in a Tertiary Care Centre

The comminuted fracture in the younger patient is generally a high energy injury secondary to either a fall from a height or high speed motor vehicle accident. With dorsiflexion, the radius fracture in tension on its palmar surface followed by compression on the dorsal surface, results in dorsal comminution. The lunate can exert a compression force on distal radius producing a depressed fracture of the lunate fossa the so called die punch fracture , similarly a scaphoid fossa depression fracture can result from compressive forces exerted by the scaphoid. The ulnar styloidfracture so often seen with distal radius fractures probably represents an avulsion fracture from a tensile force transmitted through on intact triangular fibrocartilage complex. Treatment of such injuries is difficult. These fractures often are unstable, are difficult to reduce anatomically, and are associated with a high prevalence of complications of post-traumatic osteoarthritis after intra- articular fracture of the distal aspect of the radius. It is also known that extra-articular misalignment can lead to decreased grip strength and endurance as well as limited motion and carpal instability. Closed reduction and cast immobilization has been the mainstay of treatment of these fractures, but invariably it results in mal-union, poor functional and cosmetic outcome. [2]
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Intra-articular corrective osteotomy for malunited Hoffa fracture: A case report

Intra-articular corrective osteotomy for malunited Hoffa fracture: A case report

Hoffa described isolated coronal plane fracture of the posterior aspect of the femoral condyle in 1904 [1]. The so-called Hoffa fracture is, by definition, an intra- articular fracture and has been reported to more com- monly involve the lateral condyle [2]. Because this fracture is known as an unstable, intra-articular fracture, malunion is one of the late complications after nono- perative or even operative treatment. Malunions have been generally classified into extra-articular and intra- articular malunions. While corrective osteotomy for extra-articular malunions has been frequently reported, few reports describe the results of operative treatment for symptomatic intra-articular malunions. To the best of our knowledge, no reports have described salvage treatment for a malunited Hoffa fracture. Herein, we present our experience of intra-articular corrective oste- otomy for a case of malunited coronal plane fracture.
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Targeting pro inflammatory cytokines following joint injury: acute intra articular inhibition of interleukin 1 following knee injury prevents post traumatic arthritis

Targeting pro inflammatory cytokines following joint injury: acute intra articular inhibition of interleukin 1 following knee injury prevents post traumatic arthritis

We have previously reported reduced bone fraction and bone mineral density following fracture [15,19]. However, these degenerative bone changes appear to be reduced in the local saline group along with the local IL-1Ra group. The data suggest that intra-articular injections of saline may be altering the intra-articular environment in a man- ner which is beneficial to the periarticular bone. One hy- pothesis is that intra-articular injections may be diluting catabolic factors or washing out the joint. However, local saline provided no benefit in reducing cartilage degener- ation or synovial inflammation. Normal fracture healing involves the upregulation of many inflammatory cytokines and growth factors, and the temporal profiles of these fac- tors are different during the healing process [58,59]. The cytokines IL-1β and TNF-α have also been shown to stimulate the production of active bone morphogenetic protein 2 (BMP-2) [60], which may be involved in the re- pair process. Understanding the role of such systemic fac- tors found in the circulating serum following trauma may provide insight into articular fracture healing and the de- velopment of PTA. Although we saw differences in bone morphology between treatment groups, systemic measures of bone turnover were not significantly different among treatment groups following fracture. We found that markers of both osteoblast and osteoclast activity in- creased with increasing bone volume or bone fraction in the tibial plateau and metaphysis at 8 weeks post fracture. This time point would represent the remodeling phase of bone repair and has been characterized by high levels of bone resorption and formation markers [61]. Bone turn- over markers vary throughout the fracture healing process,
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Inflation osteoplasty: in vitro evaluation of a new technique for reducing depressed intra-articular fractures of the tibial plateau and distal radius

Inflation osteoplasty: in vitro evaluation of a new technique for reducing depressed intra-articular fractures of the tibial plateau and distal radius

All intra-articular fractures share the common need to restore articular alignment and congruity. It is widely accepted that joint depression fractures with concomitant fractures of the surrounding metaphyseal struts must be treated operatively. In fact, several authors have recom- mended giving priority to restoring overall joint alignment and stability first, with less emphasis on restoring a completely smooth articular surface [1, 2, 4]. Good outcomes and low rates of posttraumatic arthritis have been reported for tibial plateau fractures with residual displacement C3 mm as long as the joint mechanical alignment and stability are restored [5, 6]. Much controversy remains regarding the treatment of isolated joint depression frac- tures. Most authors prefer minimal displacement of no more than 2–3 mm in order to consider nonoperative treatment. However, it has been reported that stepoffs upward of 10 mm can be tolerated in the proximal tibia [4]. When significant comminution is encountered, anatomic reduction may be impossible and some residual deformity must be accepted. Acceptable limits for joint surface displacement have yet to be agreed upon and vary depending on the joint involved. It seems intuitive, however, that a more precise reduction of the articular surface should result in a better outcome, as joint-surface congruency is restored. Spahn et al. [7] show that severe osteoarthritis involving joint congruity loss (grade IV lesion) was associated with significantly worse outcomes. Histological studies show that chondrocytes reproducibly undergo programmed cell death following intra-articular fracture [8, 9]. It should be inferred, then, that a more congruent articular surface will minimize later articular dysfunction. Perhaps the currently ‘‘acceptable’’ parameters regarding articular surface reduction are in place based on results with conventional techniques. These methods cannot always restore completely the native anatomy either due to fracture pattern or insufficient reduction tools/methods.
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Intramedullary nailing versus proximal plating in the management of closed extra-articular proximal tibial fracture: a randomized controlled trial

Intramedullary nailing versus proximal plating in the management of closed extra-articular proximal tibial fracture: a randomized controlled trial

This randomized prospective clinical study was conducted on 58 patients with extra-articular fracture of the proximal tibia (OTA 41-A2/A3) treated with minimally invasive proximal tibial plating (PTP) or intramedullary nailing (IMN) by trained surgeons at a tertiary trauma care center in the Department of Orthopedics, SMS Medical College and Hospital, Jaipur, between January 2009 and December 2012. After excluding 14 patients who were lost to follow- up, a total of 44 patients were included in the final outcome analysis. Ethical committee approval was obtained, and patients were recruited once written informed consent had been provided.
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Intra-Articular Osteotomy for Distal Humerus Malunion

Intra-Articular Osteotomy for Distal Humerus Malunion

Figure 1: (a) Our patient was a 48-year-old dentist who was seen 10 months after a high energy fall that resulted in a complex intra- articular fracture of her left nondominant distal humerus. (b) Initial treatment performed at an outside institution consisted of static external fixation with the arm in 90 ◦ flexion and the forearm in neutral rotation. (c) The external fixator was removed after 8 weeks and follow-up the radiographs revealed distal humerus intra-articular malunion. (d) An oscillating saw was used to create a trapezoid wedge to correct overlength varus of the lateral column and flexion of the capitellum in order to realign capitellum and trochlea. Extreme caution was taken no to disrupt blood supply of the capitellum. (e) The patient had loss of anterior translation of the distal end of the humerus resulting in loss of flexion of 35 degrees, with 10 degrees of hyperextension of the left elbow. (f) Patient opted for removal of hardware and extra-articular excavation of the prominent ventral distal humerus creating a new fossa coronoidea in order to gain flexion.
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Biologic plating of unstable distal radial fractures

Biologic plating of unstable distal radial fractures

Following the introduction of the 2.4 mm volar locking plate system, five locking screws could be inserted into the subchondral row of the distal fragment [1]. Thus, in- dications for this procedure may be expanded to include extra-articular fractures with metaphyseal comminutions in both cortices, regardless of the size of the distal frag- ment (Fig. 4). Single volar plating of an articular fracture requires the articular fragment to be of sufficient size, large enough for at least two screws of the 2.4 mm lock- ing plate system [25]. We found that, following satisfac- tory reduction of the articular surface, the indications were similar for bridge plating and conventional options in the treatment of articular fractures. However, it is very important to verify the reduction status of the radial
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Comparison of two surgical approaches for displaced intra articular calcaneal fractures: sinus tarsi versus extensile lateral approach

Comparison of two surgical approaches for displaced intra articular calcaneal fractures: sinus tarsi versus extensile lateral approach

Approach was performed by placing the patient in either the lateral decubitus or semilateral positions with the use of a beanbag on a translucent table under general anesthesia using a thigh tourniquet. After exsanguin- ation of the lower extremity, the calcaneus is approached through an L-shape incision. The incision begins lat- erally 3–4 cm superior to the calcaneal tuberosity and 1–2 cm anterior to the heel cord. The incision was extended distally and continued retrofibularly to the junction of the dorsal and plantar skin, where a smooth curve was made, curving the incision anteriorly toward the calcaneocuboid joint and the fifth metatarsal base. This approach minimizes sequelae of peroneal tendinitis and devascularization of the anterior skin flap and pre- serves the sural nerve. The fracture line at the level of the Gissane angle was identified, and the thin lateral wall was retracted inferiorly to expose the articular fracture
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Outcome Analysis of Intra-Articular Scapula Fracture Fixation with Distal Radius Plate: A Multicenter Prospective Study

Outcome Analysis of Intra-Articular Scapula Fracture Fixation with Distal Radius Plate: A Multicenter Prospective Study

terior branches, so while splitting of the deltoid between its posterior and middle thirds we took precaution not to injure them. Then we carried this division of the deltoid to its insertion to give full access to the quadrangular space whenever desired according to the fracture pattern. To ex- pose the glenohumeral joint, we incised the shoulder cuff in its tendinous part, and divided the capsule. Fracture was visualized and reduced under direct vision of both the intra-articular and extra-articular aspects. The fragments were held temporarily in the reduced position with small- diameter Steinmann pins or K wires. After articular recon- struction of glenoid fracture with a 4.5 mm lag screw, the stabilization of the intra-articular fracture was achieved using a 3.5 mm distal radius plate and extra-articular part was stabilized with a 2.7 mm Recon plate depending on the fracture type. To render adequate strength, in few cases 2.7 mm dynamic compression plates were used for fixation along the lateral border of the scapula. The longest plate was chosen for lateral border of scapula. The incision in the capsule of the shoulder was closed. The infraspinatus muscle was then repositioned in its fossa. Rotator cuff was repaired. The deltoid muscle was then sutured to the spine of the scapula. A suction drain was placed, and the skin wound was closed.
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Obturator Dislocation of the Hip at Yopougon/Abidjan Teaching Hospital

Obturator Dislocation of the Hip at Yopougon/Abidjan Teaching Hospital

Obturator dislocation of the hip is caused by high-velocity accidents as evidenced by its frequent association with other traumatic injuries and, seldom found. Its main complication remains femoral head avascular necrosis. We report on four cases of obturator dislocation of the hip. The mean age of patients was 30 years, and all their injuries followed a road traffic accident. Associated lesions were a contralateral femur fracture in two cases and an osteochondral fracture in one case. Reduction of dislocations was achieved orthopedically under general anaesthesia and the average waiting time before reduction was 20 hours. One patient had an intra-articular incarcerated frag- ment visible on X-ray, and another patient showed signs of early coxarthrosis 15 months later. The average follow-up time was 24 months.
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Tissue-sparing surgery with the bi-unicompartmental knee prosthesis: retrospective study with minimum follow-up of 36 months

Tissue-sparing surgery with the bi-unicompartmental knee prosthesis: retrospective study with minimum follow-up of 36 months

Originally indicated for selected young patients (for example, with intra-articular bicompartmental deformity fol- lowing fracture of the tibial plateau), bi-UKR slowly began to be used as a treatment for atraumatic arthritis of the knee in older patients. Although not recommended for obese patients, bi-UKR can be performed in patients who are over- weight, if they have the will and capacity to lose weight. The operation often helps patients return to physical activities that had been interrupted previously by pain or limb malfunction. Because of its lesser invasiveness, even in selected patients with mild ACL insufficiency and an incomplete range of motion of the knee, a bi-UKR implant can be considered as a practical solution. However there are also absolute contraindications to bi-UKR:
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Treatment of Traumatic Acetabulum Lesions in an African Orthopaedic Trauma Department

Treatment of Traumatic Acetabulum Lesions in an African Orthopaedic Trauma Department

Two cases of death were reported (3.2%), one in a hemorrhagic shock table and the other in a septic shock table. Post-treatment complications included 13 pressure ulcers, 1 bronchopneumonia, 5 hypertensive attacks, 1 urinary tract in- fection, 1 secondary pubic dislocation after orthopedic reduction of acetabular fracture, 1 iatrogenic lesion of the ischial nerve, 1 peroperative hemorrhage, 1 surgical site infection, 1 periarticular ossification, 3 necrosis of the femoral head and 3 hip osteoarthritis. The average duration of hospitalization was 26.7 days (1 - 63). A post-therapeutic improvement was observed in 31 victims of hip dislo- cations (77.5%) and 31 fractures of the acetabulum (75.6%). Only 7 patients (11.1%) were reviewed and evaluated. Only one patient had consolidated his fracture at 7 months. The reduction was good in one patient at 6 months of fol- low-up, but he suffered from persistent pain in the hip. As for the quality of life, one patient had total autonomy, five patients had partial autonomy and one pa- tient was not autonomous. According to Merle d’Aubigné, Matta and Duquen- noy et al. [9] [10], the reduction was anatomical in 1 case, satisfactory in 5 cases, unsatisfactory in 1 case, with satisfactory head-to-head congruence; the func- tional results were very good (1 case), good (5 cases) and bad (1 case). The evo- lutionary results are specified in Table 9.
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Concomitant glenohumeral injuries in Neer type II distal clavicle fractures

Concomitant glenohumeral injuries in Neer type II distal clavicle fractures

Fractures to the distal third of the clavicle represent 10– 30% of all clavicle fractures and can be treated conserva- tively with satisfying outcome in the majority of cases. However, symptomatic non-union under conservative treatment exists and therefore, distal clavicle fractures with instability should be treated operatively, with re- spect to patient’s age and functional demands. Over the last decades, surgical treatment of distal clavicle frac- tures developed from open reduction and fixation by k- wires, conventional plates or hook-plating to minimal in- vasive approaches and arthroscopically assisted fracture management. Arthroscopically assisted fracture fixation may be beneficial in terms of minimally invasive ap- proach as well as assessment and treatment of associated glenohumeral lesions. While impaired functional out- come and prolonged pain was historically contributed to fracture non-union, several authors noted that other rea- sons for a limited shoulder function may be present [13]. In this context, due to an increase of arthroscopic assisted fracture treatment, concomitant glenohumeral lesions were observed more frequently and proclaimed as potentially causing shoulder dysfunction [14].
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Analysis of results and outcome of arthroscopy assisted management of tibial plateau fractures

Analysis of results and outcome of arthroscopy assisted management of tibial plateau fractures

When a patient sustains varus or valgus force with an axial load, the respective femoral condyle exerts shearing and comp ressive forces on the articular surface of the tibia. This frequently results in a split fracture, a depressed fracture or split depression fracture. Isolated split fractures are virtually confined to adults with dense cancellous bone that is capable of withstanding the compressive forces on the knee joint surface. With advancing age, strong cancellous bone of the proximal tibia gradually becomes more sparse and is no longer able to withstand the compressive forces. With impact loading, a depressed or split depressed fracture results.
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The application of central tension plate with sharp hook in the treatment of intra articular olecranon fracture

The application of central tension plate with sharp hook in the treatment of intra articular olecranon fracture

Background: Standard plate fixation can be used to treat intraarticular olecranon fractures with satisfactory functional recovery, but its use is accompanied by implant related complications. This retrospective study reports on the functional outcome of intraarticular olecranon fractures treated with a central tension plate with sharp hook. Methods: A retrospective review of any patient with an olecranon fracture from August 2007 to December 2008 was conducted. Patients were considered for inclusion in the study if they were treated surgically with a central tension plate with sharp hook. Patients with pathological fractures or previous fractures of the proximal ulna were excluded. The quality of reduction was evaluated using postoperative imaging. The functional recoveries of the affected upper limbs were evaluated postoperatively at regular intervals using the Mayo Elbow Performance (MEP) score and Disability of the Arm, Shoulder and Hand questionnaire (DASH).
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A comparative study between locking compression plate and non locking compression plate in the treatment of intraarticular calcaneal fracture

A comparative study between locking compression plate and non locking compression plate in the treatment of intraarticular calcaneal fracture

The posterior facet reduction is done under direct vision. In cases with severe crush injuries the articular surface may be rotated to 90-180 degrees and lies within the void in the neutral triangle, we elevated the fragment using cervical spine inter-body spreader gently and held in position by means of k wires (fig35). Intra-operative radiographic assessment of Bohler’s and Gissane’s angle is done.

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Carpal alignment in distal radial fractures

Carpal alignment in distal radial fractures

Pre-reduction radiograph of most fractures with midcar- pal malalignment showed an increased SLA (Table 2). Twenty-four (20.3%) of our patients had SLA exceeding 60°. An increased SLA has also been reported to occur in association with distal radial fractures [15]. The average SLA has been described to be 46 ° with range of 30 ° -60 ° [2]. The wrist flexion is reported to show increased SLA with an average of 63 ° against 51 ° in the neutral wrist po- sition while the wrist extension produces decreased scapho-lunate angle with an average of 36° due to the var- iable rotation of the carpals of the proximal row [8]. We feel the increased SLA found to occur with displaced distal radial fracture in pre-reduction radiographs may be the re- sult of the effective flexed position of the wrist joint due to the dorsal radial tilt and should not always be interpreted as injury to the scapho-lunate complex. The increased SLA and the midcarpal instability with an extended lunate Figure 1
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Imaging Review of Adolescent Tibial Tuberosity Fractures

Imaging Review of Adolescent Tibial Tuberosity Fractures

Although standard radiographs are helpful in diagnos- ing the complex fracture pattern, precise configuration is only established by computed tomography. Advanced imaging can result in upgrading the classification of some avulsion injuries compared to initial evaluation with plain film. CT imaging and 3D volume rendering (Figures 9-12) are useful to these recognize complex fracture patterns and aid in preoperative planning [16].

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