All Articles

Ryan S. Marder, Neil V. Shah, Aditya V. Maheshwari^*

Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York, USA

Jenna M. Wahbeh^1,2, Claire J. Bogosian^1,3, Natalie M. Kistler^1,4, Sang-Hyun Park^1,5, Edward Ebramzadeh^1,4,5, Sophia N. Sangiorgio^1,2,5*

¹The J. Vernon Luck, Sr., M.D. Orthopaedic Research Center, Orthopaedic Institute for Children in Alliance with UCLA, Los Angeles, CA, USA

²Department of Bioengineering, University of California, Los Angeles, CA, USA

³Department of Bioengineering, University of California, Berkeley, CA, USA

⁴Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, USA

⁵Department of Orthopaedic Surgery, University of California, Los Angeles, CA, USA

Background: Reviews of total disc arthroplasty (TDA) performance have focused on prospective randomized controlled trials (RCTs), excluding potentially important clinical information reported by others. The goal of the present study was to perform a comprehensive review, including both RCTs and non-randomized cohorts with more than five years of clinical outcome. We further explored the differences in outcome between prospective RCT and non-randomized, including retrospective studies.

Methods: A systematic literature review was performed following PRISMA guidelines. Inclusion criteria were: clinical follow-up ≥ 5 years with quantitative clinical and radiographic outcome. All studies that met these criteria, including retrospective and non-randomized studies, were included, for a total of 62 studies. As anterior cervical discectomies and fusion (ACDF) was included as a control group in the majority of the studies, comparisons between TDA and ACDF were conducted.

Results: Overall, there was a statistically significant difference between the rates of secondary surgeries reported for prospective RCTs and all other studies, with reoperation rates of 5.4% for prospective RCT studies v. 7.5% in all others (P<0.01). Including all studies, the reoperation rate for TDA patients was 5.6% and for fusion patients (included as control groups), 7.8%, (P=0.06). Overall, the reported incidence of adjacent segment degeneration was 26.2% in TDA patients and 43.9% in fusion patients (P<0.001).

Conclusions: These findings demonstrated the need for including all available data to assess the current outcomes of cervical disc arthroplasty and account for potential biases.

Ann Spence^1*, Carrie Gilligan, Janine Bartholomew²

¹Department of Nursing, Carlow University, Pittsburgh, PA, USA

²Department of Biology, Portage Learning, Beaver Falls, PA, USA

Ashim Gupta

General Therapeutics, Cleveland Heights, OH, USA

Future Biologics, Lawrenceville, GA, USA

South Texas Orthopaedic Research Institute(STORI Inc.), Laredo, TX, USA

Adeel Hamid^*, Usman Gill, Mian Hanif

Department of Orthopaedic Surgery, Lahore General Hospital and Post Graduate Medical Institute, Lahore, Pakistan

In order to achieve good results following Total hip replacement , proper and reproducible acetabular cup placement is of paramount importance. The safe zone described by Lewwinick is still considered to be the target cup position. Various techniques have been used to improve the precision and accuracy of cup placement including the use of computer navigation which is often prohibitively expensive for developing countries. We present a ‘No touch smartphone technique’ to check positioning of acetabular cup intra operatively, without compromising the sterility of the operative field which we have found to be simple, quick, inexpensive and reproducible.

Jingqiao Chen^1,3#, Kaiwei Shen^1#, Zhiming Lu^1,2, Eryou Feng^1*

¹Department of Arthrosis Surgery, Fuzhou Second Hospital Affiliated to Xiamen University, Fuzhou, China

²The Third School of Clinical Medicine, Fujian Medical University, Fuzhou Fujian, China

³The Second School of Clinical Medicine, Fujian University of Traditional Chinese Medicine, Fujian, China

^#These authors contributed equally to this work

Background: Patients with severe lumbar spine diseases run a high risk of dislocation after total hip arthroplasty. Therefore, it is essential to determine the pathological effect of common lumbar diseases on pelvic motions before the surgery.

Aim: This study reviewed the literature on the hip-spine relationship during total hip arthroplasty and explored the degenerative presentations and management of four common lumbar disorders. The review showed that patients with the spinal deformity in ankylosing spondylitis (AS) were characterized by thoracolumbar kyphosis with corresponding hip extension and pelvic retroversion, prone to anterior hip dislocation; patients with lumbar spinal fusion (LSF) were more susceptible to prosthetic impingement and ultimate dislocation, especially in the limited posterior tilt of the pelvis while sitting; those with degenerative disc disease (DDD) had a greater compensatory pelvic posterior angle while standing and greater hip joint flexion while sitting to compensate for the reduced lumbar flexion; those with degenerative lumbar spondylolisthesis (DSPL) demonstrated a pelvic flexibility with a much wider range and relative acetabular anteversion, especially when standing.

Recommendation: According to the literature, spinal osteotomy and total hip arthroplasty are the most common surgical interventions in AS cases. DSPL is classified into the Flexible & Unbalanced type and should be placed more posteriorly, but the literature suggests that patients with lumbar instability should first be placed in a more predictable position. In contrast, LSF and DDD are categorized as the Rigid & Balanced type. For these two types of disorders, the literature suggests that acetabular prostheses require more anterior tilt at the time of implantation.

Conclusion: These findings indicate that for degenerative lumbar disorders, a balance between stable component implantation and minimal wear should be based on the different changes in spinopelvic mobility.

Ryan P. Hubble^1,2, Henry Wang^1,3, Paul Nagelkirk³, Jason M. Avedesian^1,4, Robert Wilkinson^1,3, D. Clark Dickin^1,3*

¹Biomechanics Laboratory, Ball State University, Muncie, IN, USA

²Wesley College of Health and Behavioral Sciences, Public and Allied Health, Delaware State University, Dover, DE, USA

³School of Kinesiology, Ball State University, Muncie, IN, USA

⁴Clemson University, Clemson, SC, USA

Plyometric training is one commonly used method of improving jump performance through improving explosive power generation. Research has also demonstrated that whole body vibration (WBV) can improve jumping and enhance explosive strength especially when supplementing resistance and plyometric training programs. With the drop jump being a common training skill, proper lower extremity landing mechanics are important to consider. Limited evidence suggests that WBV may reduce ground reaction forces and improve knee stability however, its influence on knee loading have not been reported. This study sought to examine the effects of WBV on ground reaction forces and knee valgus during a drop jump. 19 participants (10 female) completed drop jumps pre, immediately post, 10 & 20 minutes post WBV. Results were analyzed by repeated measures ANOVA. Main findings indicated that valgus knee angle increased significantly (p=0.011) post vibration and remained elevated across the 10 & 20 minute post vibration time intervals. Significant differences between sexes revealed that females demonstrated greater internal knee abduction moments (p=0.038). Findings that WBV increases knee valgus angle, a position linked to anterior cruciate ligament injury, suggest further investigation understand the effects of WBV on neuromuscular control and eccentric loading. Strength and conditioning professionals should exercise caution when incorporating WBV into plyometric protocols.

Adel A Elbeialy^1*, Abdlnby M Bauomi², Basma M Elnaggar¹, Hala M Elzomor¹

¹Department of Rheumatology, Al-Azhar faculty of Medicine, Cairo, Egypt

²Department of Radiology, Al-Azhar faculty of Medicine, Cairo, Egypt

Freddy Mertens Bombah¹*, Alphonse Ngalame², René Essomba³, Yannick Ekani Boukar², Enrique Zoa Nkoa⁴, Daniel Handy Eone⁴

¹Department of Surgery and Specialty, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Cameroon

²Department of Gynecology and Obstetrics, Faculty of Health Sciences, University of Buea, Cameroon

³Department of Surgery and Specialty, Higher Institute of Medical Technology, University of Douala, Cameroon

⁴Department of Surgery and Specialty, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Cameroon

Introduction: Obstetric fractures or Birth fractures are rare events following childbirth. Although fracture of the femur is a relatively uncommon injury, it is the most common fracture of the lower extremity in the newborn. Since evolution of cesarean section rates in Africa, it is one of the most commonly practiced modes of delivery for breech. We described one case of fracture of the femur at cesarean section treated at Adlucem hospital in bonabéri-Douala (Cameroon).

Case report: A 2.1 kg male infant was delivered by lower segment cesarean section for breech presentation. Clinical and radiological examination showed shaft fracture of femur with good evolution.

Discussion: Fractures of the long bones are associated with cesarean section, breech delivery with assistance and low birth weight. Femoral fractures are the most associated long bones fracture with cesarean section.

Conclusion: The clinical and paraclinical diagnosis is simple and the management is mostly non-operative. It is important to explain to the parents and especially to the mother the benignity of the lesion.

Nicholas M Bertha, Adeshina Adeyemo, Kevin J Perry, Gary F Updegrove^*

Department of Bone and Joint, Penn State Milton Hershey Medical Center, Hershey, Pennsylvania, USA

Gregory W. Kunis¹*, Joshua A. Berko¹, Jeffrey C. Shogan¹, Joshua B. Sharan¹, Derek Jones²

¹Nova Southeastern University, Kiran C. Patel College of Osteopathic Medicine, Florida, USA

²Department of Orthopedic Surgery, Broward Health, Florida, USA

Intro: Tibial tuberosity avulsion fractures are rare fracture patterns accounting for less than 1% of all pediatric fractures. These fractures occur when there is a sudden unbalancing of forces through the patellar tendon that separates the tibial tubercle from the anterior portion of the proximal tibia. These forces are commonly introduced in sporting activities and show a predominance for adolescent males. Treatment with open reduction internal fixation commonly results in favorable outcomes with minimal complications. In this presentation, we explore a case of a tibial tuberosity avulsion fracture and give an in-depth review of all aspects concerning this fracture pattern.

Case Description: A 14-year-old male with no significant past medical history presented via emergency medical services after a ground level fall while playing basketball. Radiographs of the left knee and tibia revealed an Ogden Type III, distracted avulsion fracture of the tibial tuberosity with suprapatellar effusion. Surgical intervention was achieved through open reduction internal fixation of the left tibial tubercle.

Discussion: Although a relatively rare fracture pattern, this case demonstrates a classic presentation and treatment of a tibial tuberosity avulsion fracture. This case serves as a reminder that despite the rarity of the injury, a clinician with an appropriate index of suspicion can accurately diagnose and treat this fracture and achieve positive outcomes in returning the patient to pre-injury activities. For those reasons, we provide a comprehensive overview of all aspects regarding this fracture pattern including the anatomy, embryology, mechanism of action, predisposing conditions, treatment considerations, complications and associated injuries.

Spencer W. Sullivan*, Ioonna Félix

Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA

This clinical case presents an elite level 23-year-old female tennis athlete with a high-grade partial thickness tear of the supraspinatus with associated pain, dysfunction, and deficits in strength and range of motion (ROM) of her trunk and lower extremities. The purpose was to determine the efficacy of using a regional interdependence approach in the treatment of a partial supraspinatus tear with associated kinetic chain deficits in an elite level athlete. Following 24 physical therapy sessions, pain, mobility (ROM), strength, and function improved in the dominant shoulder in addition to further symmetry of the trunk and lower extremity due to a regional interdependence rehabilitation approach and returned to elite level of play. As a result of this case, it is important for clinicians to consider a comprehensive, global approach to patient rehabilitation following injury.

Jamie Heimroth^1*, Max L. Willinger¹, Nipun Sodhi¹, Luke J. Garbarino¹, Peter A. Gold¹, Jonathan R. Danoff², Sreevathsa Boraiah²

¹Department of Orthopedic Surgery, Long Island Jewish Medical Center, Queens, NY, USA

²Department of Orthopedic Surgery, North Shore University Hospital, Manhasset, NY, USA

Chronic refractory pain after total joint replacement is debilitating and a source of dissatisfaction for patients. The management of pain following total joint replacement varies during the acute postoperative period compared to the 3 months postoperative at which point the pain is considered chronic pain. Acute postoperative pain relief programs have seen promising results with multimodal pain control through the use of combinations of opioids, acetaminophen, nonsteroidal anti-inflammatory drugs, gabapentinoids and ketamine. The addition of regional blocks to the multimodal regimen has improved acute postoperative pain control following total joint replacements. On the other hand, chronic pain can be successfully managed with options including genicular nerve radioablation therapy (GN-RFA), neuromuscular electrical stimulation (NMES), transcutaneous electrical nerve stimulation (TENS), and peripheral subcutaneous field stimulation (PSFS). While there is still minimal data on chronic pain relief regimens, meta-analyses and case reports have demonstrated the effectiveness and promising outcomes. This paper aims to evaluate the current medications and treatment options for managing refractory pain following TJA.

Jay Moran¹, Mark D. Miller², Michael J. Medvecky^1*

¹Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, USA

²Department of Orthopaedics, University of Virginia, Charlottesville, VA, USA

Jayme Bristol

APRN-C, Orthopedic Department at Nebraska Medical Center in Omaha, NE; Clarkson College, Omaha, NE, USA

Background: Total hip replacement surgeries are one of the most common orthopedic surgeries performed today1. This number continues to rise. One way to accommodate the growing need for inpatient orthopedic beds is through high hospital turnover. High turnover can possibly be accomplished through early ambulation. The goal of the study is to see if standing or walking before eight hours post-operative decreased overall length of hospital stay. Methods: This research study is a retrospective chart review that looked at 92 randomly selected general anesthesia total hip replacement patients from Nebraska Medicine in Omaha, NE from August 2017 to August 2018. This research study makes a clear definition of early ambulation after total hip replacement surgery: standing or walking within eight hours of surgery. Results: From the analyzed research the average length of stay for all 92 total hip replacement patients was 4.23 days. For those total hip replacement patients who were ambulated within eight hours of surgery completion the average length of stay was 2.83 days. For the total hip replacement patients who were ambulated after eight hours of surgery completion the average length of stay was 5.14 days. Conclusion: There is a statistically significant difference in length of hospital stay for total hip replacement patients at Nebraska Medicine who were ambulated within eight hours of surgery completion compared to those who were not.

Peter R. Reuter^*, Arie J. van Duijn, Kaylee R. Fichthorn, Lacy Mroz

Department of Rehabilitation Sciences, Marieb College of Health & Human Services, Florida Gulf Coast University, Fort Myers, Florida, USA

Joint hypermobility is largely understood as a dysfunction of collagen fibers within connective tissues, allowing for a range of motion markedly increased over validated normal values. The ulnar collateral ligament (UCL) of the elbow provides stability to the elbow during valgus stress and, thus, has great significance in overhead throwing sports due to its susceptibility to injury. Our cross-sectional study explored the relationship between the length and width of the anterior bundle of the ulnar collateral ligament of the elbow and joint hypermobility. Two hundred and eighty-four undergraduate students completed a Beighton score assessment. Ultrasound images of the participants’ UCL were obtained in both arms at rest and under gravity induced valgus force. Sixty-one participants reported hypermobility in at least one elbow joint, and hypermobility in one elbow joint was correlated with hypermobility in the other. There were moderate correlations between UCL thickness and joint gapping between left and right elbow joints. However, there was no significant difference in UCL anterior bundle thickness or medial elbow joint gapping at rest or under valgus stress between those with and without hypermobile elbow joints. The thickness of the anterior bundle of the UCL and humeroulnar joint gap at rest moderately correlates to corresponding thickness and width under valgus stress. There is no significant difference in UCL anterior bundle thickness or joint width in people with elbow hypermobility and those without.

R. Spagnolo^1*, D. Porreca², M. Vimercati³, F. Pace⁴

¹Department of Orthopaedic Surgery, Hospital Niguarda Cà Granda, Milan, Italy

²Physiotherapist, ASST BergamomOvest-Hospital, Treviglio Caravaggio, Italy

³Physiotherapist, Hospital Niguarda Cà Granda, Milan, Italy

⁴First Orthopaedic Clinic-Hospital Gaetano Pini, University of Milan, Italy

Posterior fractures of the acetabulum are the most frequent pattern of acetabular fractures. Based on the works of Judet and Letournel, accurate reduction and stable osteosynthesis with early mobilization have become the gold standard for the treatment of posterior acetabular fractures. Recently, a less invasive approach has been described to decrease Kocher-Langenbeck (K-L) approach complications. The clinical case describes a patient affected by two-column fractures of the acetabulum with skin abrasions of the gluteus. The clinical evaluation was based on Merle d’Aubigne and Postel scoring, which Matta has modified. The approach used is a modified, less invasive K-L: a straight skin incision from the midpoint between the posterior superior iliac spine and the posterior tip of the greater trochanter. We observed the essential advantages using this approach were a lesser split of the gluteus maximus and no risk of damage for the superior gluteal nerve. In the early postoperative rehabilitation, we examined the strength of the gluteus maximus, which was better than in patients treated with the typical Kocher–Langenbeck approach. The patient resumed after fifteen years after surgery; hip mobility is complete and painless.

Júlia Benini Kohler¹, Jader Joel Machado Junqueira¹, Taysa Cristiane Moreira da Silva³, Marco Antonio Gonçalves Pontes Filho^3,4, Iolanda De Fátima L C Tibério¹, Fernanda Degobbi T Q S Lopes¹, Alexandre Póvoa Barbosa^1,2*

¹Department of Medicine, Laboratory of Experimental Therapeutics (LIM-20), School of Medicine, University of Sao Paulo, Sao Paulo, Brazil

²Department of Orthopaedics, Hospital do Coração - SP Brazil

³Department of Rheumatology, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil

⁴Departments of Orthopaedics and Rheumatology, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil

Despite of clinical evidence of increased incidence of bone diseases amongst smokers as well as worsening recovery in orthopedic surgeries, it is still unclear which pathological mechanisms are induced by smoking and how these events impair bone turnover.

Animal models and in vitro studies have been used to better elucidate these questions and smoking-induced oxidative stress have been pointed as playing crucial role in the worsening of bone cells activities leading bone damage.

Oxidative stress is a physiological mechanism characterized by an imbalance between oxidants and antioxidants components. This imbalance leads cell damage and consequent release of inflammatory mediators, resulting in structural changes that impair the functionality of compromised organ.

In this review, we summarize findings from clinical, animal models and in vitro studies that have elucidated the importance of the oxidative stress induced by smoking in different bone cells activities, leading bone mineral and organic matrix structural changes.

Highlights

We present the newest findings in understanding the impact of smoking in bone matrix composition. Review the clinical and experimental evidence for smoking-induced oxidative stress potential roles in bone turnover. Descript future directions for research and clinical management.

Sagar Tontanahal¹, Gahukamble Abhay Deodas¹, Deeptiman James¹, Anand Kurian², Thomas Palocaren^1*

¹Department of Paediatric Orthopaedics, Christian Medical College, Vellore, India

²Department of Orthopaedics, Christian Medical College, Vellore, India

Background: The management of malignant bone tumors in children has come a long way in the past few decades. The transition from amputation to limb salvage has been made possible due to the rapid development in the diagnosis and the oncological management of these malignant tumors. However, there exist significant reservations regarding endoprosthetic reconstruction in children.

Material and methods: A mini-review was conducted of articles detailing the use of prosthetic reconstruction following tumor resection in children. The data regarding complications and functional outcomes following surgery were collected and presented.

Results: The studies reviewed reported a 5-year survival rate between 60 – 70 %. Uniform across the studies was the need for multiple surgeries when endoprosthesis was used for limb reconstruction, ranging between 2.8 – 3.5 surgeries. The most common complication noted across the studies was related to soft tissue problems such as joint instability followed by structural failure of the prosthesis. Infections were noted with a frequency of 10 – 15 %. Studies showed successful management of limb length discrepancy with expandible prosthesis. Musculoskeletal Tumor Society (MSTS) score used to evaluate the functional outcome showed satisfactory outcomes.

Conclusion: Limb salvage surgery, with recent advances in technique and prosthesis design, is an attractive option in children with extremity malignant bone tumors. In recent time, endoprosthetic reconstruction of extremities have yielded good functional results and are well accepted by the child and the parents. The purpose of this mini-review is to shed some light on the use of endoprosthetic reconstruction in children following tumor resection with its potential benefits and drawbacks.

Adrienn Markovics^1*, Daniel M. Toth², Tibor T. Glant¹, Katalin Mikecz¹

¹Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA

²Division of Rheumatology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA

Rheumatoid arthritis (RA) is a systemic autoimmune disease leading primarily to the inflammatory destruction of the synovial joints, ultimately resulting in loss of mobility and a decreased quality of life. Recent advances in RA-related research resulted in the introduction of Janus kinase (JAK) inhibitors to the therapeutic arsenal. JAK inhibitors are orally available and provide efficacy similar to that of disease-modifying anti-rheumatic drugs. However, due to the limited selectivity of these drugs, many RA patients experience adverse effects. The potential benefit of modulating protein tyrosine phosphatases, instead of inhibiting kinases, has not been explored. Using an animal model of RA, our group investigated the role of the Src homology region 2 domain-containing phosphatase 1 (SHP-1) in inflammatory arthritis. The purpose of the present article is to highlight important conclusions of our previous paper entitled “Regulation of autoimmune arthritis by the SHP-1 tyrosine phosphatase”. Herein we briefly present and discuss the observations of this study. We also outline future directions toward investigating the therapeutic potential of targeting SHP-1 in inflammatory arthritis in order to develop a new type of orally available drugs for the treatment of RA.

Sophia L. Mancini¹, Clark Dickin¹, Dorice A. Hankemeier², Lindsey Rolston³, Henry Wang¹*

¹Biomechanics Laboratory, Ball State University, Muncie, IN, USA

²Ball State University, Muncie, IN, USA

³Henry County Center for Orthopedic Surgery & Sports Medicine, New Castle, IN, USA

Soccer is becoming an increasingly popular sport amongst women. Common movements during play, such as jumping and cutting, require rapid acceleration and deceleration of multiple lower-limb joints. The anterior cruciate ligament (ACL), which contributes to stabilization of the knee, is often injured during these events. ACL injury typically requires costly surgery, extended time away from sports, and jeopardizes long-term joint health. Due to sex-specific factors such as menstruation and anatomical disadvantages, women are more susceptible to tearing their ACL. Injury often occurs in non-contact scenarios during rapid acceleration or deceleration movements. Research has examined these movements and established several kinematic and kinetic mechanisms as well as muscle activation patterns that frequently occur at the time of injury, however results tend to vary based on population. This article summarizes recent and relevant literature of ACL injury mechanisms and highlights the lack of specific research in the high-risk female soccer athlete population. Due to inconclusive risk factors, injury prevention programs within this population have been inconsistent. ACL injury risk for female soccer athletes should be closer examined so that more specific injury risks can be established, and effective protective measures can be taken. Raised awareness of this need may capture attention in the research and medical communities and potentially stimulate the development of strategies that limit future ACL injury and thus the challenges it brings to the high-risk female soccer athlete.

Kentaro Amaha

Department of Orthopedic Surgery, Foot and Ankle; St. Luke's International Hospital, Tokyo, Japan

Metatarsalgia is one of the most common causes of forefoot pain, and it is characterized by pain in the front part of the foot under the head of the metatarsal bones. Primary metatarsalgia is idiopathic, but it has been suggested to be related to forefoot plantar compression. Because of the various causes of metatarsalgia, there is the need to thoroughly consider the etiology of metatarsalgia to find novel, effective, and conservative treatments for metatarsalgia to avoid surgical treatment. Pressure reduction or redistribution can be achieved using toe exercise, flat shoe inserts, metatarsal pads, custom-molded inserts, and rockerbars. There was no need for one treatment. If toe function was poor, toe exercises were recommended. If dorsiflexion of the ankle joint was limited, the Achilles tendon was stretched. If the pain was localized to the plantar aspect of the 2nd MTP, a decompression insole was applied. If the pain was limited to the plantar aspect of the 2nd MTP, a decompression insole was worn. If swelling occurred, anti-inflammatory drugs were indicated to reduce inflammation. The combination of the two was appropriate for this condition. Toe exercises can improve balance and are worth trying. An in-depth understanding of the various etiologies of metatarsal and toe deformities is essential for successful treatment.

Shaan S. Patel*, Julian Gatta, Adrienne Lee, Blaine T. Bafus

Department of Orthopaedic Surgery, MetroHealth Medical Center, Cleveland, OH, USA

Background: Transolecranon distal humerus fractures are uncommon injuries. The purpose of this study is to review the outcomes and complications associated with transolecranon distal humerus fractures.

Material and Methods: We performed a systematic search of PubMed for articles published between 1990 and 2021. Included studies reported outcomes and complications of transolecranon distal humerus fractures. Data was extracted from the included studies to describe patient demographics, injury characteristics, outcome measurements, and complications.

Results: A total of 4 studies met inclusion criteria for data extraction and analysis. Two studies evaluated an adult cohort of a total of 18 patients. The average Disabilities of the Arm, Shoulder, and Hand (DASH) score was 40 (range 4.2 – 76.5). Fifteen patients (83%) had a complication. Elbow stiffness (11/18, 61%) was the most common complication. Eleven patients (61%) underwent more than one procedure. Two studies evaluated a pediatric cohort of a total of 9 patients. Five patients (56%) underwent non-operative treatment with immobilization and four patients (44%) underwent open reduction and internal fixation. There were no complications reported. All the pediatric patients regained near full range of motion of the elbow at their final follow-up.

Conclusion: Transolecranon distal humerus fractures are complex elbow injuries. In the adult population, they remain a challenge for orthopaedic surgeons. Complications, including elbow stiffness and infection, are high with frequent long-term functional limitations as represented by DASH scores. In contrast, pediatric patients have good outcomes and minimal complications that are similar to isolated olecranon and distal humerus fractures in children.

Francisco Molina-Rueda¹, Alicia Cuesta-Gómez^1*, María Carratalá-Tejada¹, Pilar Fernández-González¹, Juan Carlos Miangolarra-Page^1,2, Isabel Mª Alguacil-Diego¹

¹Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine. Faculty of Health of Sciences. Rey Juan Carlos University, Madrid, Spain

²Physical Medicine and Rehabilitation Service of the University Hospital of Fuenlabrada, Madrid, Spain

Background: Subjects with a unilateral transtibial amputation (UTA) that have used prosthesis for over five years have a higher occurrence rate of osteoarthritis at the knee and hip joints of the intact limb.
Objective: To research the joint internal moments of the hip, knee, and ankle in the sagittal and frontal planes during gait in persons with UTA.
Methods: 25 individuals with UTA (50.26 years ± 13.76) and 25 subjects without amputation (46.71 years ± 13.76) participated in this study. Gait analysis was carried out using a Vicon® Motion System (Oxford Metrics, Oxford, UK) with eight 100 Hz cameras with infrared strobes, two 1000 Hz AMTI® force-plates.
Results: People with UTA walk with a greater hip extensor moment in both intact and prosthetic limbs. The hip abductor moment was lower on the prosthetic limb compared to the intact limb and the control group. At the knee joint, the subjects with UTA walked with a reduced knee extensor and valgus moment on their prosthetic limb compared to the control group. At the ankle joint, the statistical analysis showed that the individuals with UTA walked with a reduced plantarflexor moment during the stance period on the intact limb compared to the people without amputation.
Conclusions: Subjects with UTA walk with a different joint kinetic pattern in the sagittal and frontal planes compared to non-disabled individuals.

Joshua CY Ong*, Mahmoud A Awadallah, Andrew J White, Paul M Robinson

Trauma & Orthopaedic Department, Peterborough City Hospital, Bretton Gate, UK

Background: Fracture of the proximal humerus combined with dislocation of the glenohumeral joint and a soft tissue or bony Bankart lesion are rare. Management options are largely surgical and different approaches to fixation have been described. The reported outcomes are generally poor.

Methods: We present a series of three rare cases of traumatic dislocations of the shoulder associated with combined fractures of the proximal humerus and glenoid that were treated with surgical fixation. We describe the surgical technique and clinical outcomes.

Results: Our patients had multiple medical comorbidities; and coupled with the burden of injury, made a slow post-operative recovery (mean Constant-Murley score of 48 points over a mean follow-up time of 20 months).

Conclusion: A high index of suspicion and appropriate imaging is required to properly diagnose and surgically manage this uncommon pattern of injury. We recommend surgical treatment of these severe injuries, to stabilise the glenohumeral joint, and to achieve optimal clinical outcomes.