Research Articles (Orthopaedic Surgery)

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Browsing Research Articles (Orthopaedic Surgery) by Subject "Bones -- Fractures"

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    Circular frames of the humerus : salvage surgery case series
    (South African Orthopaedic Association, 2019-11) Pretorius, H. S.; Strauss, K.; Ferreira, N.; Lamberts, R. P.
    INTRODUCTION: High energy fractures like gunshot-related injuries or high velocity road traffic accidents are often complex to treat and have been associated with a higher non-union rate, especially when there is extensive bone loss. Fractures with severe comminution may not heal due to bone loss and an inability to achieve adequate fracture stability. Treatment of fractures that are not amenable to plating or nailing may lead to non-unions, septic or aseptic, that need repeat surgeries. Stabilisation with external fixation is a reliable option to maintain stability and provide a suitable environment for union. MATERIALS AND METHODS: This retrospective study used medical records of all patients with complex mid-shaft humerus fractures, as well as their complications, that were treated with hexapod circular external fixation between January 2009 and September 2015. All the patients in this case series presented with severe humerus fractures or complications thereof which were not amenable to conventional therapy. RESULTS: Union was achieved in ten out of the 12 cases (83.3%). Union was achieved without bone graft or any other interventions at the fracture site except implant removal where indicated. The median time in external fixation was 196 days (interquartile range: 112-228). The most common complication encountered in this series was pin-site infection. Fixation points were noted to be infected in 33% of cases at some time during the treatment period. CONCLUSION: This study suggests that humeral non-unions and complex humerus fractures that are not amenable to conventional fixation methods, such as intramedullary nails and plates, can successfully achieve union when treated with a hexapod circular external fixator. Level of evidence: Level 4
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    A computer tomography-based anthropomorphic study of forearm osteology : implications for prosthetic design
    (Medpharm Publications, 2021-08-31) Pretorius, Henry S.; Ferreira, Nando; Burger, Marilize C.
    Background: The aim of this study was to accurately establish the variability in the anatomy of the radius and ulna in the context of the design of an intramedullary nail for both bones. Methods: Forearm computed tomography scans were used to measure the specific internal and external anatomy of the radius and ulna in adult patients. Patients with fractures or dislocations involving either the radius and/or ulna were excluded. Results: A total of 97 scans, comprising 84% male and 16% female patients, were included. The mean radius length was 238.43±18.38 mm (95% CI 234.60–241.74 mm). The mean curvature was an arc with a radius of 561.43±93.49 mm (95% CI 543.09–580.78 mm). The smallest measurement of the canal width was 5.17 mm (95% CI 4.87–5.47 mm). The ulna showed a mean length of 259.90±19.88 mm (95% CI 255.89–263.91 mm). The smallest measurement of the canal width was 4.80±1.30 mm (95% CI 4.53–5.87 mm). The mean proximal shaft angle was 11.39±3.30° (95% CI 10.76–12.82°). Conclusion: This computed tomography scan-based anthropomorphic study has identified novel anatomical features and associations of human forearm bones. This information will be used in the design and manufacture of anatomic intramedullary devices to better manage radius and ulna fractures or pathology.
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    Defining the anatomic axis joint center distance and anatomic axis joint center ratio of the distal femur in the coronal plane
    (Wolters Kluwer - Medknow, 2020-12) Ferreira, Nando; Cornelissen, Andries Johannes; Burger, Marilize; Saini, Aaron Kumar
    Background: The aim of this radiographic study was to define the anatomic axis joint center distance (aJCD) and anatomic axis joint center ratio (aJCR) of the distal femur in the coronal plane for skeletally mature individuals. Methods: A cross‑sectional radiographic study was conducted to calculate the horizontal distances between the anatomical axis and the center of the knee at the level of the intercondylar notch and the joint line. Ratios relating these points to the width of the femur were then calculated. Results: A total of 164 radiographs were included: 91 male (55.5%) and 73 female patients (44.5%) with a mean age of 44.9 ± 18.1 years, with 79 right (48.2%) and 85 left (51.8%). The mean intercondylar width was 75.6 ± 6.6 mm, the mean aJCD at the notch was 3.6 ± 1.8 mm, the mean aJCD at the joint line was 4.9 ± 1.8 mm, the mean aJCR at the notch was 45.2 ± 2.4, and the mean aJCR at the joint line was 43.5 ± 2.4. The intercondylar width was significantly different (P < 0.001) between males (79.5 ± 4.8 mm) and females (70.6 ± 5.0 mm). A significant difference between the aJCR at the notch (P = 0.004) and the aJCR at the joint line (P = 0.003) was observed in males and females. No differences between the aJCD at the notch and/or aJCD at the joint line were observed between males versus females, left versus right, and those younger versus those older than 65 years. Conclusion: This is the first objective description of the aJCR of the distal femur in the coronal plane. This ratio can be used to aid the planning and execution of distal femoral deformity correction, retrograde femoral nailing, and total knee arthroplasty. Level of Evidence: IV