All Articles

Canser Yilmaz Demir^1*, Celaleddin Soyalp², Burak Necati Isik¹, Borhan Mohammed Abdo Radman¹

¹Department of Plastic, Reconstructive and Aesthetic Surgery, Van Yuzuncu Yil University, Medical Faculty, Van, Turkey

²Department of Anesthesiology and Reanimation, Van Yuzuncu Yil University, Medical Faculty, Van, Turkey

Objective: Systemic diseases negatively affect carpal tunnel syndrome (CTS). Therefore, it is logical to hypothesize that systemic diseases may also be related to poor post-operative outcomes. Herein, the authors aimed to address the relationship between systemic diseases and carpal tunnel release outcomes.

Methods: Cases with carpal tunnel release were grouped and compared regarding to presence or absence of systemic diseases such as rheumatoid arthritis, diabetes mellitus, hypothyroidism, obesity, and hypertension. In this study, 48 cases were included (24 with and 24 without systemic diseases). The Boston Carpal Tunnel Questionnaire was used to evaluate the symptoms and functions in cases. Its higher scores indicate more negative symptoms and functional capacity.

Results: The groups with and without systemic diseases exhibited similarity in age and gender scores. Given symptoms and functions, cases with systemic diseases had significantly higher pre- and post-operative scores than cases without systemic diseases. In both groups, the scores from post-operative period were significantly lower than those in the pre-operative period (p<0.001). However, the groups exhibited similarity in mean difference in symptom and function scores between pre- and post-operative periods. Also, there were significant positive correlations between pre- and post-treatment scores.

Conclusion: This study demonstrated that systemic diseases are negatively associated with poor pre- and post-operative outcomes in CTS. These findings may contribute to more realistic post-operative expectations.

Biruk Ferede Zewdu^*, Endalk Fenta Andualem

Department of Orthopedics & Trauma Surgery, School of Medicine, College of Medicine and Health Sciences, Bahir Dar University, Ethiopia

The subtalar joint is a complex joint in the foot formed by the articulation of the talus, calcaneus and navicular bone. Subtalar dislocations occur due to simultaneous dislocation of both talocalcaneal and talonavicular joints, without significant talus fracture. Neglected talar dislocations pose a significant challenge due to the high risk of complications. Tibiotalocalcaneal arthrodesis is an effective treatment for neglected talar dislocations, providing pain relief and functional improvement. Early surgical intervention is crucial to prevent long-term complications and achieve optimal outcomes. We report the functional results of case of a neglected subtalar dislocation in a 23-year-old man treated with open reduction and a tibiotalocalcaneal arthrodesis with a tibiotalocalcaneal nailing.

Isabell Igo^*, Anderson Lee, Cody Smith, Maged Hanna

Department of Orthopedic Surgery, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA

Aims: This review investigates the musculoskeletal complications across all mucopolysaccharidosis types, highlighting those specific to each subtype and exploring perioperative concerns.

Methods: A comprehensive literature review was conducted using PubMed, Google Scholar, and Cochrane without restrictions on publication date, language, or article type. Search terms included: mucopolysaccharidoses, MPS, Hurler, Hunter, Sanfilippo, Morquio, Maroteaux-Lamy, Sly, Natowicz, orthopedic, musculoskeletal, anesthesia and perioperative complications.

Conclusions: MPS disorders are multifaceted conditions with diverse musculoskeletal involvement. Orthopedic management is crucial, as these abnormalities impair mobility, reduce quality of life, and pose unique perioperative challenges. Common findings include joint contractures, dysostosis multiplex, and spinal malformations, all of which increase operative risk. Limited joint and spine mobility, or cervical instability may complicate intubation and anesthesia.

Radiologic screening for cervical instability and early neurological evaluation are recommended before anesthesia. Orthopedic surgeons must recognize these manifestations and perioperative complications to ensure proper multidisciplinary management and improve surgical safety.

Akhil John^*, Reuben Nappoly, Viju Daniel

Department of Orthopaedics, Christian Medical College (CMC), Vellore, India

Objective: To provide a state-of-the-art narrative review of contemporary reduction techniques for the intramedullary nailing (IMN) of subtrochanteric femur fractures (SFFs). This review critically appraises the evidence for various methods, culminating in a synthesized, evidence-based clinical algorithm to guide surgical decision-making.

Evidence Acquisition: A comprehensive literature search of the PubMed and Embase databases was conducted to identify relevant clinical studies, meta-analyses, biomechanical reports, and authoritative reviews published through 2024. The search focused on the biomechanics of SFFs, fracture classification, reduction techniques (including percutaneous joysticks, soft tissue rebalancing, and open cerclage/clamping), implant-related considerations, and the management of atypical femur fractures (AFFs). Emphasis was placed on incorporating high-quality evidence from 2018 to 2024 to ensure timeliness and comprehensiveness.

Evidence Synthesis: Anatomical reduction prior to fixation is the most critical determinant of successful outcomes in SFFs treated with IMN. The choice of reduction technique exists on a spectrum, balancing the biological benefits of minimally invasive surgery against the mechanical necessity of stable fixation. Recent evidence suggests that novel minimally invasive approaches, such as the soft tissue rebalancing technique, can achieve clinical and radiological outcomes equivalent to more invasive open methods while significantly improving operative efficiency. However, these techniques have specific limitations and learning curves. A balanced perspective on IMN reveals not only its clear biomechanical advantages but also potential risks, including iatrogenic malreduction, implant failure, and challenges in revision surgery. The management of AFFs requires distinct strategic modifications due to altered bone pathology and femoral geometry.

Conclusions: The optimal management of SFFs requires a versatile, graduated approach to reduction. Surgeons should begin with the least invasive methods and maintain a low threshold to escalate to more direct or open techniques as dictated by fracture complexity to achieve an anatomical result. The proposed clinical algorithm provides a systematic framework for technique selection. While novel techniques show promise, there is a clear need for high-level evidence, including prospective randomized controlled trials, to definitively establish their role. Future advancements in computer navigation, robotics, and implant design may further refine the treatment of these challenging injuries.

Paul Carr

Department of Emergency Medicine, Northumberland Hills Hospital, Cobourg, Ontario, Canada

Christina Ziebart

School of Physical Therapy, Western University, London, Canada

Todd Lansford¹, Anthony Russo², Nasim Eshragh Nia³, Ian Cowgill^3*

¹South Carolina Sports Medicine, North Charleston, SC, USA

²Benefis Health System, Great Falls, MT, USA

³Orthofix US LLC, Lewisville, TX, USA

Introduction: Solid fusion is critical for successful spine and foot and ankle arthrodesis. Risk factors including smoking, obesity, diabetes, osteoporosis, and multilevel surgery elevate the risk of non-union. Cellular bone allografts (CBAs) have emerged as alternatives to autograft, but outcomes in high-risk populations remain insufficiently characterized.

Methods: This review examines a cellular bone allograft (TE-CBA) in spine and foot and ankle fusion procedures, with a particular emphasis on outcomes in patients with risk factors for non-union. Clinical endpoints included fusion success, patient-reported outcomes, complication rates, and the influence of patient risk profiles. Only studies that included high-risk populations were analyzed. The included studies were primarily Level IV evidence (prospective/retrospective with comparisons to previously published outcomes).

Results: In the lumbar spine, TE-CBA achieved a 90.5% fusion rate at 12 months and 95.3% at 24 months, with significant improvements in pain and function, even among high-risk patients. In ACDF procedures up to four levels, TE-CBA achieved a 97.4% fusion rate at 12 months, including 100% in one-, two-, and four-level procedures. In foot and ankle arthrodesis, 95.5% of patients achieved fusion within 12 months, with an average time to union of 6 months across patients with major risk factors. Studies employed strict fusion criteria, including combined motion analysis and CT-confirmed bridging bone.

Conclusion: TE-CBA demonstrated consistently high fusion success across anatomical sites in cohorts that included patients at high risk for non-union. Further controlled trials and mechanistic studies are needed to elucidate how CBAs might mitigate biologically impaired bone healing environments.

Himanshu Bhayana, Aditya Gupta, Vikas Bachhal, Shashank Chaurasia^*

Post Graduate Institute of Medical Education and Research, Chandigarh, India

Varus posteromedial rotatory instability (VPMRI) of the elbow is a complex condition that results from a combination of bony and ligamentous injuries. Traditional treatment strategies often involve open reduction and internal fixation (ORIF) combined with primary ligament repair, necessitating postoperative immobilization to facilitate healing. However, prolonged immobilization can lead to joint stiffness, complicating rehabilitation. Recent advances have introduced internal brace augmentation as a potential solution to these challenges. This review article discusses the pathophysiology of VPMRI, traditional treatment approaches, and the emerging role of internal brace augmentation, with a specific focus on the study conducted by Greiner et al. which highlights the advantages of this technique in preventing stiffness and allowing early rehabilitation. Additional studies supporting internal bracing are reviewed, emphasizing its biomechanical benefits and improved patient outcomes.

Jacob S. Borgida¹, Perry L. Lim^1,2*, Hany S. Bedair^1,2, Christopher M. Melnic^1,2

¹Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA

²Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, Massachusetts, USA

Davide Gravina^1*, Alessandro Portoghese², Filippo Pantaleoni¹, Marta Montanari¹, Andrea Manfredi¹, Andrea Leti Acciaro¹

¹Department of Hand Surgery and Microsurgery, AOU Policlinico di Modena, Italy

²Department of Plastic, Reconstructive and Aesthethic Surgery, University of Modena and Reggio Emilia, AOU Policlinico di Modena, Italy

Background: Bony mallet finger injuries result from distal phalanx fracture, often involving avulsion fractures of the distal phalanx. Optimal management remains debated, particularly between pediatric and adult populations.

Objective: This review compares surgical and conservative treatments for acute bony mallet finger fractures, focusing on healing times, functional recovery, and complications.

Methods: A systematic search of PubMed, Scopus, and Cochrane Library (2014–2024) identified studies evaluating treatment strategies in adults and children. Outcomes assessed included healing time, clinical recovery, and complication rates.

Results: Conservative treatment, was preferred in adults, leading to healing times of 6–8 weeks but with a higher incidence of deformities. Surgery, useful in pediatric cases, provided faster recovery and superior functional outcomes. The Ishiguro method in children showed improved extension recovery with shorter immobilization. Surgery in adults led to quicker functional recovery but had higher complication rates. Pediatric surgical cases had a slightly higher risk of growth disturbances, though overall better functional outcomes.

Conclusions: Pediatric patients had superior long-term outcomes regardless of treatment modality. While conservative treatment in adults resulted in prolonged recovery and more deformities, surgery carried a higher complication risk. Both groups showed a favorable prognosis, warranting further research to refine treatment strategies.

Cameron Bussey-Sutton¹, Peter K. Sculco³, Stephen Duncan², Ran Schwarzkopf¹, Matthew Hepinstall^1*

¹Department of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA

²Department of Orthopaedic Surgery, University of Kentucky, Lexington, KY, USA

³Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA

Impingement of femoral stems against metal dual mobility (DM) acetabular components after total hip arthroplasty (THA) can lead to notching of the femoral neck. The consequences may include debilitating pain, mechanical symptoms, release of metal debris, aseptic cup loosening, joint instability, dislocations, and the theoretical risk of femoral implant fracture. We report a primary case of a 35-year-old female who experienced impingement and femoral notching following DM THA and subsequently underwent revision due to these complications. This case is part of a series of 4 patients with similar complications. Following revision, all patients experienced symptom relief. Further studies are needed to determine the incidence of this issue, identify risk factors, and evaluate the outcomes of revision versus nonsurgical management for both symptomatic and asymptomatic cases.

Shaam Achudan^*, Kevin Anthony Jing Ming Chong, Remesh Kunnasegaran

Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore

Background: Knee osteoarthritis is a debilitating condition affecting up to 11% of individuals in Singapore. Total knee arthroplasty (TKA) is one of the most effective treatments for this condition. However, it is also associated with significant post-operative pain that can limit post-operative rehabilitation and outcomes. Preemptive analgesia (PA) is a proactive approach to pain management and has shown promising outcomes.

Objective: To study the short-term outcomes of preemptive analgesia in patients undergoing TKA.

Method: A retrospective review of a database from January 2022 to December 2022 identified all TKA cases performed by one senior orthopaedic surgeon. Eligible patients were divided into those who received PA and those who did not receive PA. The PA group received oral medications consisting of 50 mg tramadol, 200 mg celecoxib, 1000 mg paracetamol, and 300 mg gabapentin one hour before surgery. No preoperative analgesia was given in the non-PA group. Outcome assessments included VAS scores at 6 and 24 hours postoperatively, degree of active range of motion (ROM) of the knee and the ability to perform a straight leg raise (SLR) 24 hours after surgery, requirement of breakthrough analgesia and length of stay (LOS) in the hospital.

Results: 104 patients were identified, with 53 patients in the PA group and 51 patients in the non-PA group. The PA group had lower VAS scores at 6 hours (1.94 vs. 2.24), but higher VAS scores at 24 hours compared to the non-PA group (3.75 vs. 3.43). Differences in VAS scores were not statistically significant. The ROM and SLR were similar between the PA and the non-PA group (83.4° vs. 81.3°, P = 0.44) and (77.4% vs. 68.6%, P = 0.25). There was no significant difference in requirements of breakthrough analgesia between both groups. LOS was comparable between both groups as well.

Conclusion: The use of preemptive analgesia with a combination of tramadol, celecoxib, paracetamol, and gabapentin did not significantly reduce postoperative pain after TKA.

Andres Chahin Ferreyra^1,2, Diego Villagrán Prado³, Per Trobisch⁴, Juliana Mauad^5*, Rafael Lindi Sugino⁵

¹Clínica Meds, Santiago, Chile

²Hospital Dirpreca, Santiago, Chile

³Clínica Las Condes - Universidad de Chile, Santiago, Chile

⁴Eifelklinik St. Brigida, Simmerath, Germany

⁵Hospital Israelita Albert Einstein, São Paulo, Brazil

Present: Present our experience with the vertebral body tethering (VBT) technique in surgical treatment for scoliosis. Analyze its advantages, disadvantages, and complications.

Methods: A prospective case series, submitted to the VBT technique by our surgical team from September 2020 to March 2022 with a minimum follow-up of six months. Patients with flexible curves between 35º and 65º were operated on. The main thoracic and thoracolumbar/lumbar curves were evaluated with the Cobb method preoperatively, postoperatively, and at the last follow-up.

Results: In our series of 60 patients, 90% were female, with a mean age of 15.1 ± 2.9 years, and follow-up was 10.1 ± 4.7 months. The VBT technique was used to treat 53 (88%) patients with adolescent idiopathic scoliosis, 6 (10%) syndromic scoliosis, and 1 (2%) neuromuscular scoliosis. The mean preoperative main thoracic curve was 48.2º ± 9.4º and thoracolumbar/lumbar 47.8º ± 9.7º. The mean Cobb in the immediate postoperative was 19.2º ± 9.0º for the main thoracic curve and 9.4º ± 8.9º for the thoracolumbar/lumbar curve. The mean Cobb in the last follow-up was 22.8º ± 11.0º for the main thoracic curve and 12.7º ± 11.1º thoracolumbar/lumbar. Giving a final correction of 54% (p < 0.0001) in main thoracic curves and 71% (p < 0.0001) in thoracolumbar/lumbar curves. A 10% of complications (6) were reported, and hemothorax (4) was the most common.

Conclusion: We propose VBT as a safe and effective option, with good results, for treating scoliosis. To our knowledge, our study is the largest case series in Latin America and is the first published study using this surgical technique.

Level of Evidence: IV, Therapeutic Studies, Case Series

Chunliang Guo, Tao Ding^*, Jianqing Zheng, Xiule Fang, Zhiyun Feng, Yuntao Xue

Nanjing Medical University Affiliated Wuxi People's Hospital, Wuxi, Jiangsu province, China

Objective: To assess the efficacy of C-arm oblique radiography-assisted percutaneous kyphoplasty (PKP) in the treatment of osteoporotic vertebral compression fractures (OVCF) and its impact on radiation exposure for both surgeons and patients.

Methods: In total, 192 patients with single-segment OVCF were included. Traditional anteroposterior (AP) and lateral fluoroscopy were used for puncture positioning in 86 cases (AP-lateral group), whereas C-arm oblique fluoroscopy was used in 106 cases (oblique group). the surgical time and the number of fluoroscopies were recorded. DR radiography was used to measure vertebral height, differences in vertebral compression and Cobb angle before and after surgery were compared. Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) scores were recorded to assess surgical efficacy.

Results: The oblique group had fewer intraoperative fluoroscopies (18.02±5.86) compared to the AP-lateral group (29.09±7.67); and shorter surgery time (29.67±11.32 min vs. 36.35±9.32 min), with both differences being statistically significant (P<0.05). Three months post-surgery, the VAS pain scores in the AP-lateral group were 2.19±1.30 and 2.26±1.30 in the oblique group, both significantly lower than pre-surgery scores, with statistical significance (P<0.05). However, there were no significant differences between the groups (P>0.05).

Conclusion: C-arm oblique view assisted PKP can reduce surgery time, improve puncture accuracy, and decrease ionizing radiation exposure, effectively treating OVCF.

Manuel Bondi^*, Laura Piotto, Andrea Pizzoli

Department of Orthopaedics and Traumatology, ASST - Mantova, Carlo Poma Hospital, Mantova, Italy

Background: Bone substitutes are increasing in orthopaedic surgery. The ideal bone substitute should be biocompatible and not evoke any adverse inflammatory response.

Material and Methods: In this mini review we have considered the bone substitutes that are most used in orthopedic surgery, observing their advantages and disadvantages, trying to define the characteristics of the ideal bone substitute.

Results - State of the art: Literature related to orthopaedic surgery reports about the use of autologous bone, allograft, Xenograft based HA ceramics, Synthetic bone substitutes, Growth factor-based substitutes and Polymethyl methacrylate.

Conclusion: The integration of a defect filler into a new bone and its influence on bone healing depend on the osteoconductive, osteoinductive or osteogenic properties of the material. Ideally, bone void filler materials should combine all of these properties.

Ahmed H. Alhussain, Fay A. Alotaibi^*, Nouf A. Almagushi, Wafa S. Alotaibi

King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia

King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia

Introduction: Rotator cuff repair is a widely performed orthopedic surgical procedure to ease pain and restore shoulder movement in individuals with tears in the rotator cuff. This meta-analysis examined the relationship between preoperative HbA1c levels and susceptibility to postoperative complications following rotator cuff tear repair surgery.

Methods: A systematic review and meta-analysis were conducted following PRISMA guidelines. Relevant studies published until July 2023 were identified across multiple databases.

Results: The meta-analysis included 14 articles (3 prospective, 11 retrospective) with 113,286 diabetic and 342,895 non-diabetic patients. Diabetic patients were slightly older on average. There were more males and smokers in the non-diabetic group, while the diabetic group had more hypertensive patients. Diabetic patients had worse outcomes, including higher rates of rotator cuff retears (RR 1.62;95%1.27, 2.06; P<0.001). Non-diabetic patients generally achieved better healing (OR;2.68;95%CI;1.45,4.95;P=0.002), pain, and range of motion improvements. Diabetes did not significantly impact infection risk or hospital utilization.

Conclusions: The findings suggest that optimizing glycemic control in diabetic patients may be important for improving outcomes following rotator cuff repair. This opens new avenues for research to understand the mechanisms driving the differences in outcomes between diabetic and non-diabetic patients. Developing strategies to minimize the negative impact of diabetes on rotator cuff injuries and repair procedures could be beneficial.

Gavin David O'Connor

School of Medicine, University College Cork, Cork, Ireland

Introduction: Elective total hip arthroplasty is a common surgery performed around the world. Many patients undergoing elective total hip arthroplasty are elderly, with a large proportion being anaemic preoperatively. The aim of this mini-review is to discuss the numerous factors associated with blood transfusions after total hip arthroplasty, with particular emphasis on preoperative anaemia.

Methods: This is a mini-review of the literature regarding factors associated with increased rates of postoperative blood transfusions and methods and strategies to reduce the incidence of postoperative blood transfusions after elective total hip arthroplasty.

Results: Preoperative anaemia is a common condition in patients undergoing elective total hip arthroplasty. Preoperative anaemia, age, and increasing ASA score are all associated with increased rates of postoperative blood transfusions.

Conclusion: Preoperative anaemia, increased age and ASA score are all associated statistically with increased rates of postoperative blood transfusions in patients undergoing elective total hip arthroplasty.

Clary J. Foote¹, Chirag Soni², Shaun P. Patel³, Derek Moore^4,5, Jan P Szatkowski^2,4*

¹McMaster University, Hamilton, Canada

²Department of Orthopedics, Indiana University Health, Indianapolis, USA

³Department of Orthopedics, Southern California Permanente Medical Group, Irvine, USA

⁴Orthobullets, Santa Barbara, California, USA

⁵Santa Barbara Orthopedic Associates, Santa Barbara, USA

Purpose: The growing geriatric population has led to a sharp rise in geriatric displaced femoral neck fractures (DFNF). Global reporting is pivotal in deciphering surgeons' decision-making, managing geriatric DFNF. This study aims to further analyze the nuanced utilization preferences and stratifies these across various subspecialities, practice environments, and countries.

Methods: A longitudinal survey from 2020 to 2023 was conducted online via Orthobullets Case Studies, a global orthopaedic collaboration platform, to ascertain treatment preferences for geriatric DFNF. Standardized peer-reviewed polls were used to capture surgeon preferences for total hip arthroplasty (THA). A multivariable regression analysis assessed THA utilization odds across practice environments, subspecialities, and geographic factors, followed by a robust analysis to furnish precise estimates of THA preferences to represent the general population.

Results: Among the 2606 respondents surveyed, 51.5% expressed a preference for THA. Subspecialty preferences were distributed as follows: Arthroplasty (63.4%), Trauma (53.4%), General orthopaedics (51.4%), and Sports (40.2%). Notably, hospitals exhibited a higher inclination towards THA (53.3%) compared to private practices (41.2%) (i.e. one additional THA for every seven fractures managed in a hospital setting). Regression analyses unveiled a significant 3-fold odds difference in THA rates across diverse practice environments and subspecialties. Academic arthroplasty surgeons displayed a 5.4 times higher inclination for THA (i.e. two additional THAs for every five fractures encountered).

Conclusion: Practice environment profoundly influences THA utilization for geriatric DFNF. The study findings underscore the critical need for future trials, advocating for randomized evaluations across subspecialties, geographical regions, and varied practice settings to holistically inform best practices in orthopaedic care.

Level of Evidence

Level III Surgical Practice Survey (Global Practice Trends).

Rashed Salem Alqudhaya¹, Saleh Yousef Alyami^2*, Salem Mohammed AlHashel², Hidar Salem Alqudhaya², Eibraheim Ahmad AlMardef², Nemer Nasser AlMardef², Mohammed Nasser AlMutlaq², Ali Salem AlShaiban², Ashjan Saeed AlMansour², Yunus Salem Alyami³

¹King Khalid Hospital, Najran city, Saudi Arabia

²College of Medicine, Najran University, Najran City, Saudi Arabia

³Medical Laboratory, Najran University, Najran city, Saudi Arabia

Introduction: Osteoporosis is characterized by a decrease in bone mass. Fractures due to osteoporosis are associated with chronic pain, limited mobility, increased mortality, and financial burdens. While osteoporosis is common in both genders, postmenopausal women are at increased risk. This study aims to evaluate the awareness of osteoporosis among postmenopausal women in the Najran region, Saudi Arabia, and to identify its associated factors.

Methods: This cross-sectional study was conducted from April to June 2024. It evaluated osteoporosis awareness among 313 postmenopausal women in Najran, Saudi Arabia, excluding postmenopausal women who work as healthcare providers on hormone replacement therapy and with mental limitations. An online questionnaire assessed demographic and osteoporosis-related characteristics using the Osteoporosis Knowledge Assessment Tool (OKAT), an Arabic valid and reliable tool, had 20 questions rated on a three-point Likert scale (true, false, and I don’t know).

Results: Out of 701 women, only 313 postmenopausal women were included. The median age was 53 years. Seventy-five percent (236) were married,145 (46%) had a university education or higher and 162 (52%) were housewives. Thirty-six percent (114) and 98 (31%) had a personal and family history of osteoporosis, respectively. The median age at puberty was 13 years, and 226 (72%) reported a history of regular menses previously. The mean knowledge score was 8.965±3.406. Among the participants, 43.5% had good knowledge of osteoporosis. Higher education levels were significantly associated with better knowledge (p=0.030), with those with a university education scoring higher than those with lower education levels.

Conclusion: Although 43.5% of participants demonstrated good knowledge of osteoporosis, the majority had poor knowledge, highlighting a significant gap in awareness that needs to be addressed through targeted educational interventions

Abiy Misganaw¹, Worku Belay², Getachew Hailu³, Tadesse Misganaw^4*

¹Department of Surgery, Dessie Comprehensive Specialized Hospital, Ethiopia

²Department of Orthopedics & Trauma Surgery, School of Medicine, College of Medicine and Health Sciences, Bahir Dar University, Ethiopia

³Department of Epidemiology, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Ethiopia

⁴Department of Medical Laboratory Sciences, College of Health Sciences, Woldia University, Ethiopia

Background: The definitive treatment of open tibial shaft fractures remains challenging and nonunion after treatment of open tibial shaft fractures with external fixation complicates a significant proportion of cases. There are varying rates of occurrence of nonunion and the prevalence is not well known in Ethiopia. The objective of the study is to assess the prevalence and associated factors of nonunion in open tibial shaft fractures treated with EX FIX in TGSH.

Methods: The study was conducted using a cross-sectional study in patients with open tibial shaft fractures who were admitted and treated with external fixation in the Tibebe Ghion Specialized Hospital orthopedics department from January 1, 2019, to January 29, 2021. The study involved 75 patients, which was the total number of cases in the study period and fulfilled the inclusion criteria. Bivariate and multiple variable logistic regression analyses were used to analyze the association between variables. The degree of association between variables was determined at the p-value of <0.05.

Results: The overall prevalence of nonunion in open tibial shaft fractures treated with external fixation in TGSH was 21.3%. The severity of the injury, presence of wound infection, and treatment factors affect the occurrence of nonunion. It occurs in 9 of 19 (47.4%) Gustilo-Anderson grade IIIB fractures and 6 of 48 (12.5%) Gustilo-Anderson grade IIIA fractures. A delay in soft tissue covering of Gustilo-Anderson grade IIIB fracture of 15 days or more increases the nonunion rate to 72.7%. Nonunion occurred in 41.7% of cases with SSI and 11.8% of cases without SSI. Gustilo-Anderson grade (AOR=4.85, CI 95%: 1.31-18.01), surgical site infection (AOR=4.12, CI 95%: 1.11-15.26), and time until coverage of bone of Gustilo-Anderson grade IIIB fracture (AOR=18.23, CI 95%: 1.17-284.8) have statistically significant association with nonunion.

Conclusion and Recommendation: External fixation use for definitive treatment of open tibial fractures should be disfavored as the prevalence of nonunion in open tibial shaft fractures treated with EX FIX is higher than other previous studies done in European and Asian countries. Gustilo-Anderson grade of injury, surgical site infection, and time from injury to bone coverage of Gustilo-Anderson grade IIIB fractures were found to be statistically significantly associated with the occurrence of nonunion. Therefore, attention should be given to early soft tissue reconstruction of exposed bones to establish a favorable environment for bone healing and to make treatment with internal fixations possible. Better management of wounds to minimize surgical site infections is required for better healing of open tibial shaft fractures. Prospective studies are also recommended on the issue.

Henry Kuechly^*, Sarah Kurkowski, John Bonamer, Brian Johnson, Richard Smith, Nihar Shah, Augusto Roca, Jacob Meyer, Richard Laughlin

Department of Orthopedic Surgery and Sports Medicine, University of Cincinnati, Cincinnati, OH, USA

Background: Fitness trackers have been used to measure postoperative mobility following arthroplasty procedures, but there is no published research using fitness tracker data to compare mobilization following screw fixation versus dynamic fixation for syndesmotic ankle injuries. The objective of this study was to measure steps and activity levels following syndesmotic fixation with either endobutton fixation or screw fixation using a wearable fitness tracker.

Methods: Patients that underwent operative management of ankle fractures with syndesmotic disruption using either a transfixation screw or endobutton were provided a Fitbit Inspire to electronically track their steps and activity level.

Results: Patients treated with endobutton fixation device had statistically significantly more mean daily steps and more mean daily very active minutes than patients treated with screw fixation at the 3, 4, 5, and 6-month time points and 4, 5, and 6 month time points respectively (p<0.05).

Conclusion: Patients with ankle fractures treated with endobutton device for syndesmotic fixation have earlier and higher levels of mobilization during the first 6 postoperative months than those treated with transfixation screw as measured by a fitness tracker. Fitness trackers are increasing in popularity and the data gathered from these devices contains significant potential for creating patient specific rehabilitation guidelines that may ultimately improve patient functional outcomes postoperatively.

Cameron G Thomson^1,2, Henry A Kuechly^1*, Garrett Gordon¹, Jorge Figueras^1,3, Tristian Epley⁴, Richard Laughlin¹

¹Department of Orthopaedic Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA

²Department of Orthopaedics, Warren Alpert Medical School at Brown University, Providence, RI, USA

³Department of Orthopaedic Surgery, Keck School of Medicine at University of Southern California, Los Angeles, CA, USA

⁴Ohio University College of Osteopathic Medicine, Cleveland, OH, USA

Background: Recovery from open reduction internal fixation of the ankle frequently involves a decrease in activity level and some limitations in weightbearing. The purpose of this study was to evaluate weight changes during the postoperative period following ankle fracture surgery.

Methods: Hospital billing records were retrospectively reviewed to identify all patients who underwent open reduction internal fixation of bimalleolar and trimalleolar ankle fractures at our hospital system between January 1, 2018 and June 30, 2021. Weight data from outpatient encounters coinciding with the 3-month, 6-month, and 1-year postoperative time points were recorded and analyzed.

Results: 56 patients had complete weight data. The mean age at surgery was 44.6±16.2 years. There were 27 women and 29 men. At time of surgery, the mean weight was 197.2.3±53.9 lbs and BMI was 30.3±7.1 kg/m². At 1 year postoperative, the mean weight was 219.2±51.6 lbs and BMI was 33.8±7.0 kg/m², representing statistically significant increases of 22.0 lbs and 3.4 BMI points compared to preoperative (p=0.0491 and 0.0330, respectively). On subgroup analysis of different preoperative BMI groups (<25, 25-29, 30-34, and ≥35), only those patients with a pre-operative BMI of <25 experienced statistically significant increases in weight and BMI, 27.9 lbs and 4.8 kg/m² respectively (p=0.029 and p=0.001).

Conclusion: This is the first study to evaluate weight changes following ankle fracture. This study showed that at 1 year patients recovering from ankle open reduction internal fixation gain an average of 22 lbs and 3.4 BMI points. Patients with a pre-operative BMI of <25 are subject to statistically significant increases in weight. We recommend monitoring patients’ weight and counseling them on the risks of weight gain. Further research is necessary to better characterize the risk of weight gain following orthopedic surgery.

Level of Evidence: 4 (retrospective cohort)

Oliver Miles^1*, Eugenia Koulaeva², Sally Ng^1,2

¹Department of Plastic and Reconstructive Surgery, Austin Health, Heidelberg, Australia

²Department of Plastic and Reconstructive Surgery, Eastern Health, Box Hill, Australia

Objectives: The Prevena Restor Bella.Form^TM is a novel closed incisional negative pressure wound therapy with a 14 day lifespan and a large contact area. This study aims to demonstrate the utility of the Prevena Restor Bella.Form^TM in high risk lower limb traumatic wounds.

Methods: 4 consecutive patients with complex traumatic lower limb wounds were included. The Prevena Restor Bella.Form^TM was applied as a primary therapy or an adjunct to soft tissue reconstruction. Wounds were monitored fortnightly, limb circumference measured and patient satisfaction assessed by a questionnaire. All 4 patients healed within 6 weeks of Prevena application.

Results: No cases developed wound complications. Limb oedema, assessed by circumference, decreased in all patients within 2 weeks. All patients were satisfied with the Prevena Restor Bella.Form^TM with regards to comfort and mobility.

Conclusions: Prevena Restor Bella.Form^TM demonstrated clinical effectiveness in all patients, and was universally well tolerated.

Level of Evidence: IV

Brian Johnson, Rajul Gupta, Bret Betz, Henry Kuechly^*, Sarah Kurkowski, Brian Grawe

Department of Orthopaedic Surgery and Sports Medicine, University of Cincinnati, Cincinnati, Ohio, USA

Context: Some studies have shown promising results with adipose-derived stem cell treatments for orthopaedic problems as a nonsurgical treatment option or an augmentation of surgical treatment.

Purpose: Review of the history and background, preparation methods, and current applications of adipose-derived stem cells in orthopedics. Provide critical appraisal of the available evidence for the use of Adipose Derived Stem Cells.

Results: Most of the studies utilizing adipose-derived stem cells are case series or meta-analyses with a small number of studies, therefore presenting a risk of selection bias. In cases of femoral head avascular necrosis and meniscal repair, no systematic review or meta-analysis has been published and available evidence is derived from smaller studies. Almost every review article concluded that large, multicenter, randomized control trials are needed to establish the value of adipose-derived stem cells in orthopaedics.

Conclusion: There is a need in orthopaedics for treatment modalities that increase biological healing potential for some pathologies and adipose derived stem cells represent a potential modality for such a purpose. However, there is a lack of high quality and robust evidence regarding the efficacy and safety of this treatment modality in orthopaedic applications. The use of adipose derived stem cells in orthopaedics requires additional studies of higher quality before they can be considered an appropriate treatment option.

Strength of Recommendation: Level C for use of Adipose-derived stem cells in orthopaedics.

Sean T. Gerlach^*, Dillon J. MacIntyre, Tim P. Gregg

Wellington Regional Hospital, Wellington, New Zealand

Purpose: The aim of this study was to look into the New Zealand Joint Registry (NZJR) data on total hip arthroplasty (THA) in paediatric and adolescent patients aged 20 and under. Specifically, indications for THA, trends in implants and outcome data.

Methods: An analysis of all patients aged 20 and under, recorded in the NZJR from December 1999 until January 2021. Review of similar international reports and NZ adult data undertaken.

Results: We identified 115 THA performed in patients aged 20 and under in the NZJR. Mean age at primary surgery is 17.9 years. Indications included avascular necrosis (24%), fracture (6%), tumour (3.5%), inflammatory conditions (16.4%), post-infective (6.1%), SUFE (8.7%) and various other disorders. A total of 9/115 THA were reported as being revised in the study period with a revision rate per 100 component years of 0.69. Bearing surface has trended towards ceramic heads. Cementless implants have been the most commonly utilized. The approach is almost exclusively posterior (79%). Head size has increased from formerly being 28 or less to now 32 and above.

Conclusions: Rates of THA in this population remain very low, in keeping with international data. Indications are similar to those seen in other registry studies. Trends mimic those seen internationally and in adult cohorts with cementless implants and larger ceramic heads being favored. Revisions were recorded in 9/115 patients with polywear being the most common indication. Outcome measures were excellent with a mean Oxford hip score of 37.4 at 6 months post operatively.