Aims. Assessment of bone health is a multifaceted clinical process, incorporating biochemical and diagnostic tests that should be accurate and reproducible. Dual-energy X-ray absorptiometry (DXA) is the reference standard for evaluation of bone mineral density, but has known limitations. Alternatives include quantitative CT (q-CT), MRI, and peripheral quantitative ultrasound (QUS). Radiofrequency echographic multispectrometry (REMS) is a new generation of ultrasound technology used for the assessment of bone mineral density (BMD) at axial sites that is as accurate as quality-assured DXA scans. It also provides an assessment of the quality of bone architecture. This will be of direct value and significance to orthopaedic surgeons when planning surgical procedures, including fracture fixation and surgery of the hip and spine, since BMD alone is a poor predictor of fracture risk. Methods. The various other fixed-site technologies such as high-resolution peripheral q-CT (HR-pQCT) and MRI offer no further significant prognostic advantages in terms of assessing bone structure and BMD to predict fracture risk. QUS was the only widely adopted non-fixed imaging option for bone health assessment, but it is not considered adequately accurate to provide a quantitative assessment of BMD or provide a prediction of fracture risk. In contrast, REMS has a robust evidence base that demonstrates its equivalence to DXA in determining BMD at axial sites. Fracture prediction using REMS, combining the output of fragility information and BMD, has been established as more accurate than when using BMD alone. Conclusion. The practice parameters described in this protocol provide a framework for clinicians who provide REMS services that will, to the greatest possible extent, ensure the most accurate assessment possible from this diagnostic technology. Cite this article: Bone Jt Open 2025;6(3):291–297

Introduction

Unplanned reoperations (UROs) following corrective surgery for adult spinal deformity (ASD) present significant challenges for both patients and surgeons. Understanding the specific UROs types is crucial for improving patient outcomes and refining surgical strategies in ASD correction.

Abstract. Objectives. to evaluate the efficacy and safety of topically applied tranexamic acid (TXA) in thoracolumbar spinal tuberculosis surgery, posterior approach. Methods. Thoracolumbar spine tuberculosis patients who requiring debridement, pedicle screw fixation and fusion surgery were divided into two groups. In the TXA group (n=50), the wound surface was soaked with TXA (1 g in 100 mL saline solution) for 3 minutes after exposure, after decompression, and before wound closure, and in the control group (n=116) using only saline. Intraoperative blood loss, drain volume 48 hours after surgery, amount of blood transfusion, transfusion rate, the haemoglobin, haematocrit after the surgery, the difference between them before and after the surgery, incision infection and the incidence of deep vein thrombosis between the two groups. Results. EBL for the control group was 783.33±332.71 mL and for intervention group 410.57±189.72 mL (p<0.001). The operative time for control group was 3.24±0.38 hours and for intervention group 2.99±0.79 hours (p<0.695). Hemovac drainage on days1 and 2 for control group was 167.10±53.83mL and 99.33±37.5 mL, respectively, and for intervention group 107.03±44.37mL and 53.38±21.99mL, respectively (p<0.001). The length of stay was significantly shorter in the intervention group (4.8±1.1 days) compared to control group (7.0±2.3 days). There was bo different in incision side infection and DVT. Conclusions. Topical TXA is a viable, cost-effective method of decreasing perioperative blood loss in major spine surgery with fewer overall complications than other methods. Further studies are required to find the ideal dosage and timing

Aims

The aim of this study was to describe services available to patients with periprosthetic femoral fracture (PPFF) in England and Wales, with focus on variation between centres and areas for care improvement.

Aims

A variety of surgical methods and strategies have been demonstrated for Andersson lesion (AL) therapy. In 2011, we proposed and identified the feasibility of stabilizing the spine without curettaging the vertebral or discovertebral lesion to cure non-kyphotic AL. Additionally, due to the excellent reunion ability of ankylosing spondylitis, we further came up with minimally invasive spinal surgery (MIS) to avoid the need for both bone graft and lesion curettage in AL surgery. However, there is a paucity of research into the comparison between open spinal fusion (OSF) and early MIS in the treatment of AL. The purpose of this study was to investigate and compare the clinical outcomes and radiological evaluation of our early MIS approach and OSF for AL.

Aims

The optimal management of posterior malleolar ankle fractures, a prevalent type of ankle trauma, is essential for improved prognosis. However, there remains a debate over the most effective surgical approach, particularly between screw and plate fixation methods. This study aims to investigate the differences in outcomes associated with these fixation techniques.

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This study intended to investigate the effect of vericiguat (VIT) on titanium rod osseointegration in aged rats with iron overload, and also explore the role of VIT in osteoblast and osteoclast differentiation.

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This study aimed to evaluate the effectiveness of the induced membrane technique for treating infected bone defects, and to explore the factors that might affect patient outcomes.

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To identify a core outcome set of postoperative radiographic measurements to assess technical skill in ankle fracture open reduction internal fixation (ORIF), and to validate these against Van der Vleuten’s criteria for effective assessment.

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The primary objective was to determine the incidence of COVID-19 infection and 30-day mortality in patients undergoing foot and ankle surgery during the global pandemic. Secondary objectives were to determine if there was a change in infection and complication profile with changes introduced in practice.

Aim. To evaluate the clinical outcome of a new absorbable, gentamycin loaded calcium sulfate/hydroxyapatite biocomposite (CERAMENT. ™. /G) as cavity filler after debridement and removal of infected metalwork in chronic osteomyelitis. Methods. We report the retrospective study of prospectively collected data from 36 patients with chronic osteomyelitis from implant infection. Treatment included a single stage protocol with removal of the metalwork, debridement augmented with application of CERAMENT. ™. /G, stabilization, culture-specific antibiotics and primary skin closure or flap. The biocomposite was used for dead space filling after resection of Cierny-Mader (C-M) stage III and IV chronic osteomyelitis. Data were collected on patient age, comorbidities, operation details, microbiology, postoperative complications and type of fixation or plastic surgery. Primary measure of outcome was recurrence rate. Results. According to the C-M classification 22 patients (63%) were defined as Type III and 13 (37%) as Type IV. A total of 26 (72%) patients were Class B hosts. In 9 cases (25%), there was an infected non-union and 1 patient had septic arthritis. Mean age was 52 years (range 22 to 81). Patients were followed for a mean of 20 months (range 6 to 36). Infection was eradicated in 32 patients. There were three (8.3%) recurrences (two cases of osteomyelitis and one of soft tissue/flap infection). Two of them were successfully managed with repeat surgery (one Class B and one Class A host) and one (Class B host) with suppressive antibiotic therapy as per patient's choice. In one infected nonunion the infection was eradicated but the nonunion persisted. Thirteen patients (36.6%) had a local or free fascio-cutaneus flap. Staphylococci (50%) and Enterococci (15%) were the most common microorganisms. Pseudomonas aeruginosa was more common in polymicrobial infection usually with Staphylococcus aureus. Conclusions. A multidisciplicary approach including augmented debridement with CERAMENT. ™. /G is effective for treatment of chronic osteomyelitis with infected metalwork

Aims

To compare results of institutional preferences with regard to treatment of soft tissues in the setting of open tibial shaft fractures.

Statement: This is the first report of a supracondylar femoral fracture following ACL reconstruction using a transfixation pin. Methods: A 38 yr old secretary was admitted for an elective ACL reconstruction. The operative procedure involved harvesting of the hamstrings, with drilling of an 8 mm tibial tunnel and the graft fixed with a 10 × 35mm screw. Femoral tunnel placement was performed arthroscopically and fixation of the graft in the tunnel was using the Arthrex system. No untoward events were recorded in the notes. Post-operatively, the patient was mobilised according to the surgeons standard guidelines. At 6 week review, the patient complained of increasing pain, inability to fully weight bear and a decreased range of movement. 35 fixed flexion deformity, 30 degrees external rotation and 20 degrees of valgus of the leg. Radiographs revealed a transverse supracondylar fracture extending through the level of the pin fixation. Subsequent surgery involved an osteotomy to correct the deformity and application of a lateral femoral plate After fixation direct inspection of the retained anterior cruciate ligament, revealed and intact graft that functioned through the full range of movement. At nine months, the patient is fully weight bearing has returned to her pre-injury sporting level and has a range of movement of 0–110 degrees. There was no objective knee instability and the patient is satisfied with the outcome. Femoral fractures have rarely been reported in the literature following ACL reconstruction and these are usually associated with drilling of an enlarged femoral tunnel. We report a rare case of a transverse supracondylar femoral fracture following ACL reconstruction, with the fracture occurring through the fixation tract not the femoral tunnel

Purpose: The use of telescopic nails has enabled a reduction in the rate of re-operation during growth from 51% observed with non-telescopic nails to 27%. This difference is less pronounced in the long term due to mechanical complications and secondary joint problems. We report our experience with the telescopic nail developed for osteogenesis imperfecta of the femur. This nail is inserted antegrade via a small superior incision, avoiding the problems associated with surgical approach via the knee joint. The distal and proximal fixation are achieved by screwing the nail into the epiphysis. Material and methods: The telescopic nail was used for 43 femurs and 1 humerus in 29 children (osteogenesis imperfecta in 28, skeletal dysplasia in 1) who were reviewed at a mean 34 months. Mean age at surgery was 47 months (range 13 months – 11 years). Results: The telescopic nail deployed normally in 93.2% of the children. Complications not requiring re-operation were observed in 20.5% of the patients: migration of the proximal part of the nail (n=3), material deformation or stress fracture (n=4), loss of distal epiphyseal fixation (n=1). Surgery was required because of complications in three children: intra-articular protrusion of the male part of the nail requiring repositioning, proximal migration of the female part of the nail into the buttocks subsequent to weight-bearing too early, and loss of distal epiphyseal fixation due to inappropriate intra-operative manipulation. Discussion: These early results (follow-up less than three years) demonstrate that this new implant is useful in osteogenesis imperfecta. It enables minimally invasive treatment and reduces the rate of complications without the risk of knee arthrotomy

We compared the radiographs, clinical outcomes, and complications of two techniques used for treatment of unstable distal radius fractures in young adults. Fifty patients were randomized to percutaneous pinning or augmented external fixation. At one year follow-up, the external fixator did not improve the parameters of radial length, radial angulation or volar tilt. Reduction of intra-articular steps was slightly improved. No differences in DASH scores or functional outcomes were observed, but more complications were noted with the fixator. While articular restoration can be slightly improved with use of the external fixator, a higher incidence of complications and patient dissatisfaction was noted. Two common techniques for treatment of unstable distal radius fractures in young adults include percutaneous pinning combined with plaster cast, and application of an external fixator, frequently with adjunctive pinning. The objective of this study was to:. 1. To compare the short and mid-term radiographic and clinical outcomes of these two common fixation techniques. 2. To compare the complications of the two techniques. Fifty patients (< 65 yrs) with unstable fractures of the distal radius were recruited. Patients were randomized pre-operatively to percutaneous pinning or external fixation. All surgery was performed by one of three surgeons. Patients were followed for one year with radiographs and an independent clinical exam including DASH questionnaires. 86% of fractures were AO classification C2 or C3, with an equal distribution of all types in both treatment groups. Use of an external fixator did not improve the parameters of radial length, radial angulation or volar tilt. However, reduction of intra-articular steps was slightly improved with its’ use. No differences in mean DASH scores, total ROM or grip strength were observed. More pin complications were noted with the fixator, and all three patients diagnosed with RSD received external fixation. While external fixation represents a popular first line treatment for unstable distal radius fractures, this study suggests that similar gross radiographic and clinical results can be obtained with percutaneous pinning. While articular restoration can be slightly improved with use of the external fixator in highly comminuted fractures, this must be balanced by a higher incidence of complications and patient dissatisfaction. Funding: Stryker-Howmedica-Osteonics

Introduction. Slipped upper femoral epiphysis (SUFE) predominantly affects males in early adolescence. Severe slips occur with an estimated incidence of 1 per 100,000 children. Controversy exists over optimal treatment of severe slips with debate between in-situ fixation versus corrective surgery. We report on our management of a large series of such patients using a sub-capital cuneiform osteotomy. Patients/Methods. Between 2001–2011, 57 patients (35M: 22F) with an average age of 13.1 years were referred to our tertiary referral institution with a severe slip. This was defined as an epiphyseal-metaphyseal displacement greater than half the width of the femoral neck on a Billing lateral radiograph. The affected limb was rested in slings and springs prior to corrective surgery which was performed via an anterior Smith-Petersen approach. More recently our series has included pre-operative MRI to look for avascular necrosis of the epiphysis. Data was analysed to compare complication rate with time to surgery and surgeon's experience. Results. 50 patients (88%) were complication free at a mean follow up of 7 years and their average Oxford Hip Score was 44 (range: 37–48) and median visual analogue pain score was 0 (out of 10). 6 patients (10.5%) developed AVN requiring further surgery and one patient developed chondrolysis (1.8%) but declined further intervention. Complication rate was closely related to time to surgery with 100% AVN rate for surgery within 1 weeks of symptoms onset or 5–7% thereafter. A learning curve was identified with fewer complications seen as the series progressed. Discussion/Conclusion. This is a technically demanding operation with variable outcomes reported in the literature. We have demonstrated good results but feel it should be reserved for specialist centres exposed to higher volumes of these rare cases

During the last decade or more, the anchors used for instrumentation in scoliosis surgery are predominantly transpedicular screws, according to Suk. The long term radiographical feature of screw fixation after scoliosis surgery is not previously studied. A consecutive series of 81 cases with AIS operated on with an all screw construct has been studied by means of low dose CT postoperatively and at 2 years postoperatively. There were 67 females and 14 males, with a mean age of 18.3 ± 3 years. In 26 / 81 (32 %) there were signs of loosing of one or more screws, at a maximum 3 screws. We observed loosened screws in the upper thoracic region in 16 cases, in the thoracolumbar 6 and in lumbar area in 4. Mean pre-op Cobb angle was 56 in cases of loosening and 53 of intact screw fixation (n.s.), the correction rate was 69% in loosened vs 70% among intact screws (n.s.). In males there were signs of loosening in 8/14 (57%) and in females 18/67 (27%). Among cases with loosening, 14% had suboptimal screw positioning postoperatively, in intact cases it was observed in 11% (n.s.). In the whole group there were signs of suboptimal screw positioning 12%. Clinically, 1 case had a loosened L4 screw replaced; and at all 21/26 had no complaints and 5/26 reported minor pain or discomfort. 1/26 had a minor proximal junctional kyphosis about 10°, in 3/26 there was a pull-out of some few mms. With plain radiography loosening could be observed in 11/26 cases; 5 were in the lumbar region. In a consecutive series of 81 adolescents with idiopathic scoliosis who had underwent scoliosis surgery according to Suk, one third showed, 2 years after the intervention, some minor screw loosening, assessed by low dose CT. One patient had one lumbar screw replaced and only 5 patients reported minor discomfort. Males were more prone to develop screw loosening

Objective: To assess whether hemicortical excision and biological reconstruction instead of the conventional wide resection for selected cases of malignant surface tumors, may give adequate oncologic clearance with less morbidity and better function. Methods: From January 2000 to June 2007 a total of 29 malignant surface tumors were managed at our institute. Fifteen of these were treated with hemicortical excision and reconstruction. They consisted of 10 parosteal osteosarcomas, 1 periosteal osteosarcoma, 1 high grade surface osteosarcoma, 1 adamantinoma and 2 surface chondrosarcomas. Nine were in the distal femur, 3 in tibia, 2 in the humerus and 1 in the radius. Four of these were residual/recurrent lesions following earlier intervention. After hemicortical excision with adequate margins the bone defect was reconstructed with allograft/autograft and suitable internal fixation where indicated. Results: Margins were reported free in all cases. There were no infections. Three of five patients who did not have fixation with a plate at index surgery sustained a subsequent fracture which was then reduced and fixed. Follow up duration was from 24 to 90 months. Two patients had isolated soft tissue recurrences. Both underwent re excision and are currently disease free at 36 and 38 months respectively after recurrence. Eleven patients had a maximum possible score of 30 (MSTS functional scoring); other four had a score of 29. None of the cases have developed distant metastasis. Discussion: Early results indicate that in selected cases, hemicortical excision is an oncologically sound procedure. The ability to do a biological reconstruction with bone helps avoid some of the serious complications of a megaprosthetic reconstruction while permitting full active loading of the extremity and near normal function. Internal fixation at index surgery permits early mobilization and minimises the incidence of subsequent fractures

The June 2013 Trauma Roundup³⁶⁰ looks at: open foot fractures; the diagnostic accuracy of continuous compartment pressure monitoring; conservative treatment for supracondylar fractures; high complication rates in patellar fractures; vitamin D and fracture; better function with K-wires; and tensionless bands.