This document describes a new technique for indirectly reducing depressed tibial plateau fractures using percutaneous balloon-guided inflation osteoplasty. The technique involves inserting an inflatable bone tamp through a small incision to elevate and anatomically restore the depressed fracture fragment under fluoroscopic guidance. Balloons are inflated to restore the joint surface, then deflated. K-wires are placed to maintain the reduction, and a fluid bone substitute is injected to fill the void, followed by application of a lateral buttress plate. This minimally invasive technique aims to achieve anatomic reduction of depressed tibial plateau fractures with less soft tissue disruption compared to open procedures.
The document discusses the design of implants for unstable extracapsular proximal femur fractures. It notes the limitations of current implant designs, which fail to provide adequate stability and allow fracture collapse and implant failure. New implant designs need to control factors like bone quality, fracture geometry, reduction quality, implant choice, and placement. Computer modeling is used to simulate fractures, apply cyclic loading, and test the stability of various implant designs, including a proposed new indigenous nail design. The finite element analysis provides data on implant migration and the number of load cycles implants withstand before failure.
This document summarizes the treatment of intertrochanteric hip fractures, which occur between the greater and lesser trochanters. It discusses the demographics, mechanisms of injury, surgical and non-surgical treatment options including sliding hip screws, intramedullary nails, and hemiarthroplasty. It also outlines complications rates between different implant choices and emphasizes the importance of anatomic reduction and tip-apex distance when using implants.
Trochanteric and subtrochanteric non union dr mahmoud hadhoudMahmoud Hadhoud
This document discusses the evaluation and treatment of trochanteric and subtrochanteric femoral nonunions. It notes that nonunion must be considered for persistent pain after fixation or hardware failure. CT can help differentiate nonunion from malunion when hardware obscures radiographs. Treatment depends on factors like age, hardware status, and femoral head/neck quality. Younger patients may be treated with bone grafting or hardware revision while older patients may be candidates for arthroplasty. Various fixation methods are discussed like intramedullary nails, blade plates, and locking plates. Hardware failure, malreduction, and deformity correction are also addressed.
This document provides an overview of balloon kyphoplasty as an orthopaedic treatment for vertebral compression fractures. It describes how balloon kyphoplasty can stabilize fractures and correct spinal deformity by using an inflatable balloon to restore height to a fractured vertebra before injecting bone cement. Clinical studies discussed show that balloon kyphoplasty provides significant pain reduction, mobility improvements, and a low complication rate compared to alternative treatments like vertebroplasty.
Intertrochanteric fractures / hip fractureMannan Ahmed
This document discusses intertrochanteric hip fractures, including:
- Risk factors like age, comorbidities, and prior fractures.
- Mechanisms of injury, usually a fall in elderly patients.
- Signs and symptoms ranging from ambulatory to severe pain.
- Classification systems including Evans and OTA.
- Treatment options including nonoperative management, sliding hip screws, and intramedullary devices. Operative treatment is usually indicated to reduce complications from prolonged immobilization.
Periprosthetic fractures are the third most common reason for revision total hip arthroplasty. Surgical treatment of periprosthetic fractures belongs to the most difficult procedures due to the extensive surgery, elderly polymorbid patients and the high frequency of other complications. The aim of this study was to evaluate the results of operatively treated periprosthetic femoral fractures after total hip arthroplasty.
We evaluated 47 periprosthetic fractures in 40 patients (18 men and 22 women) operated on between January 2004 and December 2010. The mean follow-up period was 27 months (within a range of 12-45 months). For the clinical evaluation, we used modified Merle d'Aubigné scoring system.
In group of Vancouver A fractures, 3 patients were treated with a mean score of 15,7 points (good result). We recorded a mean score of 14,2 points (fair result) in 6 patients with Vancouver B1 fractures, 12,4 points (fair result) in 24 patients with Vancouver B2 fractures and 12,8 points (fair result) in 7 patients with Vancouver B3 fractures. In group of Vancouver C fractures, we found a mean score of 16,2 points (good result) in 7 patients.
Therapeutic algorithm based on the Vancouver classification system is, in our opinion, satisfactory. Accurate differentiation of B1 and B2 type of fractures is essential. Preoperative radiographic images may not be reliable and checking the stability of the prosthesis fixation during surgery should be performed.
The document discusses the design of implants for unstable extracapsular proximal femur fractures. It notes the limitations of current implant designs, which fail to provide adequate stability and allow fracture collapse and implant failure. New implant designs need to control factors like bone quality, fracture geometry, reduction quality, implant choice, and placement. Computer modeling is used to simulate fractures, apply cyclic loading, and test the stability of various implant designs, including a proposed new indigenous nail design. The finite element analysis provides data on implant migration and the number of load cycles implants withstand before failure.
This document summarizes the treatment of intertrochanteric hip fractures, which occur between the greater and lesser trochanters. It discusses the demographics, mechanisms of injury, surgical and non-surgical treatment options including sliding hip screws, intramedullary nails, and hemiarthroplasty. It also outlines complications rates between different implant choices and emphasizes the importance of anatomic reduction and tip-apex distance when using implants.
Trochanteric and subtrochanteric non union dr mahmoud hadhoudMahmoud Hadhoud
This document discusses the evaluation and treatment of trochanteric and subtrochanteric femoral nonunions. It notes that nonunion must be considered for persistent pain after fixation or hardware failure. CT can help differentiate nonunion from malunion when hardware obscures radiographs. Treatment depends on factors like age, hardware status, and femoral head/neck quality. Younger patients may be treated with bone grafting or hardware revision while older patients may be candidates for arthroplasty. Various fixation methods are discussed like intramedullary nails, blade plates, and locking plates. Hardware failure, malreduction, and deformity correction are also addressed.
This document provides an overview of balloon kyphoplasty as an orthopaedic treatment for vertebral compression fractures. It describes how balloon kyphoplasty can stabilize fractures and correct spinal deformity by using an inflatable balloon to restore height to a fractured vertebra before injecting bone cement. Clinical studies discussed show that balloon kyphoplasty provides significant pain reduction, mobility improvements, and a low complication rate compared to alternative treatments like vertebroplasty.
Intertrochanteric fractures / hip fractureMannan Ahmed
This document discusses intertrochanteric hip fractures, including:
- Risk factors like age, comorbidities, and prior fractures.
- Mechanisms of injury, usually a fall in elderly patients.
- Signs and symptoms ranging from ambulatory to severe pain.
- Classification systems including Evans and OTA.
- Treatment options including nonoperative management, sliding hip screws, and intramedullary devices. Operative treatment is usually indicated to reduce complications from prolonged immobilization.
Periprosthetic fractures are the third most common reason for revision total hip arthroplasty. Surgical treatment of periprosthetic fractures belongs to the most difficult procedures due to the extensive surgery, elderly polymorbid patients and the high frequency of other complications. The aim of this study was to evaluate the results of operatively treated periprosthetic femoral fractures after total hip arthroplasty.
We evaluated 47 periprosthetic fractures in 40 patients (18 men and 22 women) operated on between January 2004 and December 2010. The mean follow-up period was 27 months (within a range of 12-45 months). For the clinical evaluation, we used modified Merle d'Aubigné scoring system.
In group of Vancouver A fractures, 3 patients were treated with a mean score of 15,7 points (good result). We recorded a mean score of 14,2 points (fair result) in 6 patients with Vancouver B1 fractures, 12,4 points (fair result) in 24 patients with Vancouver B2 fractures and 12,8 points (fair result) in 7 patients with Vancouver B3 fractures. In group of Vancouver C fractures, we found a mean score of 16,2 points (good result) in 7 patients.
Therapeutic algorithm based on the Vancouver classification system is, in our opinion, satisfactory. Accurate differentiation of B1 and B2 type of fractures is essential. Preoperative radiographic images may not be reliable and checking the stability of the prosthesis fixation during surgery should be performed.
Vertebroplasty and kyphoplasty are minimally invasive procedures used to treat painful vertebral compression fractures. Vertebroplasty involves injecting bone cement into the fractured vertebra to stabilize it, while kyphoplasty first uses an inflatable balloon to restore vertebral height before cement injection. Both procedures provide effective pain relief, though kyphoplasty may reduce risks of new fractures and cement leakage compared to vertebroplasty. Candidate selection, technical execution, and post-procedure management are important to achieve optimal outcomes and minimize complications.
The document discusses the decision between limb salvage and amputation for severely injured extremities. It outlines factors to consider like injury classification, soft tissue damage, vascular and nerve injury. Scoring systems like MESS, LSI and PSI are mentioned but have limitations. With advances in wound care, fixation and reconstruction, more limbs can now be salvaged that would have previously required amputation. The optimal decision involves a multidisciplinary team at an experienced trauma center tailored to each patient's injuries and prognosis.
The document discusses limb salvage surgery for both trauma and tumor cases. For traumatic injuries, it discusses the decision making process around whether to attempt limb salvage or perform amputation. It presents several scoring systems used to evaluate the likelihood of successful salvage. For tumors, it discusses options for reconstruction after limb salvaging resections, including allografts, endoprostheses, and allograft-prosthetic composites. It also outlines techniques for resections and reconstructions of various parts of the upper and lower extremities.
This document discusses intertrochanteric fractures, including definition, epidemiology, classification systems, treatment options, and complications. It provides an overview of fracture anatomy, mechanisms of injury, evaluation with x-rays, and classifications including Boyd & Griffin, Evans, and AO. Treatment options discussed include non-operative management, internal fixation with devices like the dynamic hip screw and intramedullary nails, and prosthetic replacement. Post-operative rehabilitation and complications of treatment are also summarized.
The document discusses the Proxima hip implant, a conservative neck-sparing prosthesis designed to address issues with traditional stemmed implants like stress shielding and thigh pain. It has shown good long-term results up to 13 years with a revision rate of 0.59% across thousands of implants. The Proxima's anatomical design and circumferential loading aim to preserve bone stock and have wider implantation criteria than other conservative options.
This document discusses principles of limb salvage surgery for bone and soft tissue tumors. Key points include defining limb salvage as resection of tumor with acceptable oncological, functional and cosmetic results while preserving the limb. Patient selection, historical background, surgical principles for different tumor stages and sites are covered. Reconstruction options including allografts, prostheses and arthrodesis are summarized for different skeletal defects involving joints, the diaphysis and epiphysis.
Treatment modality of non union fracture neck of femurAvik Sarkar
The document discusses treatment modalities for non-union of femoral neck fractures. It describes causes of non-union and investigatory imaging. For the elderly, replacement arthroplasty is recommended, while for young adults a classification system is used to determine treatment. Type I involves bone grafting and fixation, Type II an osteotomy to change shear to compressive forces, and Type III drilling and fixation. Rehabilitation includes restricted weight bearing and physiotherapy. Osteotomies can correct alignment and reduce shearing forces at the non-union site.
Distraction osteogenesis is a biological process used to treat craniofacial deformities. It involves separating bone segments gradually through incremental traction to stimulate new bone formation. Historically, it has been used since the early 1900s to lengthen limbs, and was first applied to the craniofacial skeleton in the 1980s. The process involves osteotomy, latency, distraction, consolidation, and remodeling phases. Both internal and external devices can be used uni-directionally or multi-directionally. Factors like age, site of surgery, rate and rhythm of distraction influence outcomes. The orthodontist plays a key role in planning distraction vectors and post-treatment orthodontics.
Fractures of the femoral neck are common injuries, especially in the elderly population. There are several classification systems for femoral neck fractures based on location and displacement. Treatment depends on factors like patient age and fracture characteristics. Undisplaced fractures may be treated conservatively with immobilization, while displaced fractures generally require surgical fixation or replacement of the femoral head. Complications can include nonunion, avascular necrosis, and thromboembolism.
This study retrospectively reviewed 29 patients (32 feet) who underwent dorsal anatomic plantar plate repair (DAPPR) in conjunction with a Weil osteotomy to treat instability of the second metatarsophalangeal joint. Post-operatively, patients had significantly reduced pain based on VAS and improved function based on AOFAS scores. Complications included three cases each of painful stiffness and painful hardware, and one painful scar, but there were no cases of floating toes or recurrence of instability. The authors conclude that DAPPR enhances visualization and repair of plantar plates compared to plantar approaches, with favorable post-operative outcomes.
This document discusses the anatomy, biomechanics, causes of stiffness, classification, and surgical and non-surgical treatment options for elbow contractures. It covers the relevant bones and joints, range of motion, causes of stiffness like trauma and arthritis, physical therapy approaches like splinting and motion, and surgical procedures for releasing soft tissues and reconstructing the joint surface.
The Ilizarov method provides an effective treatment for infected fractures and non-unions, especially those that have failed previous internal fixation attempts. It allows for stabilization, deformity correction, bone lengthening and regeneration through distraction osteogenesis. Key advantages include minimal invasiveness, immediate weight bearing, and stimulation of new bone formation. The document outlines principles, indications, techniques and advantages of the Ilizarov method for managing complex cases of infected non-union.
The document describes a new surgical technique called biplane double-supported screw fixation (BDSF) for treating femoral neck fractures in patients with osteoporosis. BDSF involves placing two screws in different coronal planes to provide stronger fixation than conventional methods. It establishes two supporting points - the femoral calcar and proximal diaphysis cortex - to better distribute loads. Early results found BDSF achieved bone union in 97.6% of patients and had a lower failure rate compared to conventional fixation. The technique provides improved stability and is particularly suitable for unstable fractures in osteoporotic bone.
This document discusses strategies for improving pedicle screw fixation in osteoporotic bone. It describes the advantages of pedicle screw constructs but notes their risk of failure in osteoporosis due to poor bone quality compromising screw fixation. It then presents a novel technique of using fenestrated, cement-augmented pedicle screws that allows cement injection through the screw after placement to strengthen fixation. Comparative studies show this technique increases pullout strength while decreasing the risks of cement leakage compared to traditional cement augmentation. The document concludes by discussing other approaches like expansive screws, bicortical purchase, and multiple levels of fixation that can further improve construct stability in osteoporotic patients.
Percutaneous fixation of bilateral anterior column acetabular fractures: A ca...Apollo Hospitals
The treatment of displaced acetabular fractures with open
reduction and internal fixation has gained general acceptance. This is done either by anterior, posterior or combined approaches depending on the location of these fractures. These procedures may be associated with various complications like significant blood loss, infection, lengthy operative times, heterotopic ossification and neurovascular complications.
There are clinical situations where open reduction is either
not feasible (due to associated medical problems) or when the fractures are not significantly displaced, then minimal invasive means of internal fixation of these fractures seems to be an attractive option. Percutaneous screw fixation of the anterior column of the acetabulum has been a challenging task because of its unique anatomy (narrow corridor of bone) and risk of intra-articular penetration.
Split Pectorales Major and Teres Major Tendon Transfers for Reconstruction of...Peter Millett MD
Isolated ruptures of the subscapularis and anterosuperior rotator cuff lesions are encountered more rarely than supraspinatus or anteroposterior rotator cuff tears. In certain circumstances, reconstruction of the tendon may not be possible due to fatty degeneration and atrophy of the subscapularis muscle or poor tendon quality. Tendon transfer may represent the only surgical option for treatment. A pectoralis major tendon transfer is an acceptable salvage option for irreparable subscapularis tendon ruptures. Although limited functional goals may be expected in most cases, the majority of patients obtain a good pain relief, which improves their function below chest level. Addition of the teres major component to the transfer may be beneficial in cases where both the upper and lower portion of the subscapularis muscle is irreparable. For more shoulder surgery and rotator cuff studies, visit Dr. Millett, The Steadman Clinic, Vail Colorado http://drmillett.com/shoulder-studies
orthodontic biomechanics of skeleta deformities part 3MaherFouda1
1) Maxillary advancement can be done with a device attached directly to the maxilla and cranial bones, or with a rigid frame fixed to the cranium from which a screw device advances the maxilla forward and downward.
2) Errors in maxillary or mandibular positioning can occur during surgery and be difficult to correct, such as the maxilla being placed too high or low in the vertical dimension.
3) "Condylar sag" describes problems where the condyle is not properly seated in the glenoid fossa after surgery, which can result in occlusal discrepancies if not addressed. Precise placement of the condyles during surgery is important for postoperative stability.
An adolescent male football player presented with heel pain that had worsened over a year. Initial conservative treatment provided temporary relief but the pain intensified. Imaging revealed an osteoid osteoma, a benign bone tumor, in the calcaneus. Surgical excision of the tumor completely resolved the athlete's pain. Osteoid osteomas are rare in athletes but should be considered for persistent hindfoot pain atypical of common conditions like tendinitis.
This document provides an overview of minimally invasive surgery techniques in orthopedics. It discusses the history and basic principles of minimally invasive surgery. Key areas where minimally invasive techniques are used include minimally invasive spine surgery using tubular retractors, arthroscopy of joints like the shoulder, knee, hip and ankle, minimally invasive surgeries for fracture management using techniques like IM nailing and MIPO, and minimally invasive joint replacements like knee and hip arthroplasty. Benefits of minimally invasive surgeries include minimal tissue trauma, reduced pain and morbidity, shorter hospital stays and faster recovery.
This document describes a new surgical technique for treating mallet fractures using a modified 1.3mm hook plate. Key points:
- The technique involves using a hook plate modified with two hooks that are passed through small incisions in the tendon and grab the dorsal fracture fragment.
- A screw is used to reduce the fragment and provide compression at the fracture site, employing the tension band principle.
- The plate provides anatomic reduction and stable fixation, allowing early mobilization of the DIP joint.
- The technique is described as providing good clinical and radiographic outcomes for mallet fractures involving over 30% of the articular surface.
1) Periprosthetic femur fractures around hip implants are increasingly common as more elderly patients maintain active lifestyles with hip replacements.
2) Evaluation involves plain radiographs and surgery is usually needed except for non-displaced Vancouver type A and some B/C patterns.
3) Surgical treatment follows plate fixation principles to restore length, alignment and rotation without disrupting fracture fragments. Bridge plating is preferred over anatomic reduction. Long locking plates provide stable fixation, especially in osteoporotic bone.
Management of recurrent dislocation of patella by reconstructing2Jitesh Jain
The document discusses patterns of patellar dislocation including recurrent dislocation, recurrent subluxation, and habitual dislocation. It then summarizes the anatomy and biomechanics of the medial patellofemoral ligament (MPFL), which is the primary soft tissue restraint preventing abnormal lateral displacement of the patella. Surgical reconstruction of the MPFL has gained popularity for treating recurrent patellar instability due to studies showing good postoperative outcomes with normalization of patellofemoral tracking and no recurrence of instability. The document presents the technique and results for MPFL reconstruction in 14 patients with patellar instability.
Vertebroplasty and kyphoplasty are minimally invasive procedures used to treat painful vertebral compression fractures. Vertebroplasty involves injecting bone cement into the fractured vertebra to stabilize it, while kyphoplasty first uses an inflatable balloon to restore vertebral height before cement injection. Both procedures provide effective pain relief, though kyphoplasty may reduce risks of new fractures and cement leakage compared to vertebroplasty. Candidate selection, technical execution, and post-procedure management are important to achieve optimal outcomes and minimize complications.
The document discusses the decision between limb salvage and amputation for severely injured extremities. It outlines factors to consider like injury classification, soft tissue damage, vascular and nerve injury. Scoring systems like MESS, LSI and PSI are mentioned but have limitations. With advances in wound care, fixation and reconstruction, more limbs can now be salvaged that would have previously required amputation. The optimal decision involves a multidisciplinary team at an experienced trauma center tailored to each patient's injuries and prognosis.
The document discusses limb salvage surgery for both trauma and tumor cases. For traumatic injuries, it discusses the decision making process around whether to attempt limb salvage or perform amputation. It presents several scoring systems used to evaluate the likelihood of successful salvage. For tumors, it discusses options for reconstruction after limb salvaging resections, including allografts, endoprostheses, and allograft-prosthetic composites. It also outlines techniques for resections and reconstructions of various parts of the upper and lower extremities.
This document discusses intertrochanteric fractures, including definition, epidemiology, classification systems, treatment options, and complications. It provides an overview of fracture anatomy, mechanisms of injury, evaluation with x-rays, and classifications including Boyd & Griffin, Evans, and AO. Treatment options discussed include non-operative management, internal fixation with devices like the dynamic hip screw and intramedullary nails, and prosthetic replacement. Post-operative rehabilitation and complications of treatment are also summarized.
The document discusses the Proxima hip implant, a conservative neck-sparing prosthesis designed to address issues with traditional stemmed implants like stress shielding and thigh pain. It has shown good long-term results up to 13 years with a revision rate of 0.59% across thousands of implants. The Proxima's anatomical design and circumferential loading aim to preserve bone stock and have wider implantation criteria than other conservative options.
This document discusses principles of limb salvage surgery for bone and soft tissue tumors. Key points include defining limb salvage as resection of tumor with acceptable oncological, functional and cosmetic results while preserving the limb. Patient selection, historical background, surgical principles for different tumor stages and sites are covered. Reconstruction options including allografts, prostheses and arthrodesis are summarized for different skeletal defects involving joints, the diaphysis and epiphysis.
Treatment modality of non union fracture neck of femurAvik Sarkar
The document discusses treatment modalities for non-union of femoral neck fractures. It describes causes of non-union and investigatory imaging. For the elderly, replacement arthroplasty is recommended, while for young adults a classification system is used to determine treatment. Type I involves bone grafting and fixation, Type II an osteotomy to change shear to compressive forces, and Type III drilling and fixation. Rehabilitation includes restricted weight bearing and physiotherapy. Osteotomies can correct alignment and reduce shearing forces at the non-union site.
Distraction osteogenesis is a biological process used to treat craniofacial deformities. It involves separating bone segments gradually through incremental traction to stimulate new bone formation. Historically, it has been used since the early 1900s to lengthen limbs, and was first applied to the craniofacial skeleton in the 1980s. The process involves osteotomy, latency, distraction, consolidation, and remodeling phases. Both internal and external devices can be used uni-directionally or multi-directionally. Factors like age, site of surgery, rate and rhythm of distraction influence outcomes. The orthodontist plays a key role in planning distraction vectors and post-treatment orthodontics.
Fractures of the femoral neck are common injuries, especially in the elderly population. There are several classification systems for femoral neck fractures based on location and displacement. Treatment depends on factors like patient age and fracture characteristics. Undisplaced fractures may be treated conservatively with immobilization, while displaced fractures generally require surgical fixation or replacement of the femoral head. Complications can include nonunion, avascular necrosis, and thromboembolism.
This study retrospectively reviewed 29 patients (32 feet) who underwent dorsal anatomic plantar plate repair (DAPPR) in conjunction with a Weil osteotomy to treat instability of the second metatarsophalangeal joint. Post-operatively, patients had significantly reduced pain based on VAS and improved function based on AOFAS scores. Complications included three cases each of painful stiffness and painful hardware, and one painful scar, but there were no cases of floating toes or recurrence of instability. The authors conclude that DAPPR enhances visualization and repair of plantar plates compared to plantar approaches, with favorable post-operative outcomes.
This document discusses the anatomy, biomechanics, causes of stiffness, classification, and surgical and non-surgical treatment options for elbow contractures. It covers the relevant bones and joints, range of motion, causes of stiffness like trauma and arthritis, physical therapy approaches like splinting and motion, and surgical procedures for releasing soft tissues and reconstructing the joint surface.
The Ilizarov method provides an effective treatment for infected fractures and non-unions, especially those that have failed previous internal fixation attempts. It allows for stabilization, deformity correction, bone lengthening and regeneration through distraction osteogenesis. Key advantages include minimal invasiveness, immediate weight bearing, and stimulation of new bone formation. The document outlines principles, indications, techniques and advantages of the Ilizarov method for managing complex cases of infected non-union.
The document describes a new surgical technique called biplane double-supported screw fixation (BDSF) for treating femoral neck fractures in patients with osteoporosis. BDSF involves placing two screws in different coronal planes to provide stronger fixation than conventional methods. It establishes two supporting points - the femoral calcar and proximal diaphysis cortex - to better distribute loads. Early results found BDSF achieved bone union in 97.6% of patients and had a lower failure rate compared to conventional fixation. The technique provides improved stability and is particularly suitable for unstable fractures in osteoporotic bone.
This document discusses strategies for improving pedicle screw fixation in osteoporotic bone. It describes the advantages of pedicle screw constructs but notes their risk of failure in osteoporosis due to poor bone quality compromising screw fixation. It then presents a novel technique of using fenestrated, cement-augmented pedicle screws that allows cement injection through the screw after placement to strengthen fixation. Comparative studies show this technique increases pullout strength while decreasing the risks of cement leakage compared to traditional cement augmentation. The document concludes by discussing other approaches like expansive screws, bicortical purchase, and multiple levels of fixation that can further improve construct stability in osteoporotic patients.
Percutaneous fixation of bilateral anterior column acetabular fractures: A ca...Apollo Hospitals
The treatment of displaced acetabular fractures with open
reduction and internal fixation has gained general acceptance. This is done either by anterior, posterior or combined approaches depending on the location of these fractures. These procedures may be associated with various complications like significant blood loss, infection, lengthy operative times, heterotopic ossification and neurovascular complications.
There are clinical situations where open reduction is either
not feasible (due to associated medical problems) or when the fractures are not significantly displaced, then minimal invasive means of internal fixation of these fractures seems to be an attractive option. Percutaneous screw fixation of the anterior column of the acetabulum has been a challenging task because of its unique anatomy (narrow corridor of bone) and risk of intra-articular penetration.
Split Pectorales Major and Teres Major Tendon Transfers for Reconstruction of...Peter Millett MD
Isolated ruptures of the subscapularis and anterosuperior rotator cuff lesions are encountered more rarely than supraspinatus or anteroposterior rotator cuff tears. In certain circumstances, reconstruction of the tendon may not be possible due to fatty degeneration and atrophy of the subscapularis muscle or poor tendon quality. Tendon transfer may represent the only surgical option for treatment. A pectoralis major tendon transfer is an acceptable salvage option for irreparable subscapularis tendon ruptures. Although limited functional goals may be expected in most cases, the majority of patients obtain a good pain relief, which improves their function below chest level. Addition of the teres major component to the transfer may be beneficial in cases where both the upper and lower portion of the subscapularis muscle is irreparable. For more shoulder surgery and rotator cuff studies, visit Dr. Millett, The Steadman Clinic, Vail Colorado http://drmillett.com/shoulder-studies
orthodontic biomechanics of skeleta deformities part 3MaherFouda1
1) Maxillary advancement can be done with a device attached directly to the maxilla and cranial bones, or with a rigid frame fixed to the cranium from which a screw device advances the maxilla forward and downward.
2) Errors in maxillary or mandibular positioning can occur during surgery and be difficult to correct, such as the maxilla being placed too high or low in the vertical dimension.
3) "Condylar sag" describes problems where the condyle is not properly seated in the glenoid fossa after surgery, which can result in occlusal discrepancies if not addressed. Precise placement of the condyles during surgery is important for postoperative stability.
An adolescent male football player presented with heel pain that had worsened over a year. Initial conservative treatment provided temporary relief but the pain intensified. Imaging revealed an osteoid osteoma, a benign bone tumor, in the calcaneus. Surgical excision of the tumor completely resolved the athlete's pain. Osteoid osteomas are rare in athletes but should be considered for persistent hindfoot pain atypical of common conditions like tendinitis.
This document provides an overview of minimally invasive surgery techniques in orthopedics. It discusses the history and basic principles of minimally invasive surgery. Key areas where minimally invasive techniques are used include minimally invasive spine surgery using tubular retractors, arthroscopy of joints like the shoulder, knee, hip and ankle, minimally invasive surgeries for fracture management using techniques like IM nailing and MIPO, and minimally invasive joint replacements like knee and hip arthroplasty. Benefits of minimally invasive surgeries include minimal tissue trauma, reduced pain and morbidity, shorter hospital stays and faster recovery.
This document describes a new surgical technique for treating mallet fractures using a modified 1.3mm hook plate. Key points:
- The technique involves using a hook plate modified with two hooks that are passed through small incisions in the tendon and grab the dorsal fracture fragment.
- A screw is used to reduce the fragment and provide compression at the fracture site, employing the tension band principle.
- The plate provides anatomic reduction and stable fixation, allowing early mobilization of the DIP joint.
- The technique is described as providing good clinical and radiographic outcomes for mallet fractures involving over 30% of the articular surface.
1) Periprosthetic femur fractures around hip implants are increasingly common as more elderly patients maintain active lifestyles with hip replacements.
2) Evaluation involves plain radiographs and surgery is usually needed except for non-displaced Vancouver type A and some B/C patterns.
3) Surgical treatment follows plate fixation principles to restore length, alignment and rotation without disrupting fracture fragments. Bridge plating is preferred over anatomic reduction. Long locking plates provide stable fixation, especially in osteoporotic bone.
Management of recurrent dislocation of patella by reconstructing2Jitesh Jain
The document discusses patterns of patellar dislocation including recurrent dislocation, recurrent subluxation, and habitual dislocation. It then summarizes the anatomy and biomechanics of the medial patellofemoral ligament (MPFL), which is the primary soft tissue restraint preventing abnormal lateral displacement of the patella. Surgical reconstruction of the MPFL has gained popularity for treating recurrent patellar instability due to studies showing good postoperative outcomes with normalization of patellofemoral tracking and no recurrence of instability. The document presents the technique and results for MPFL reconstruction in 14 patients with patellar instability.
Arthroscopic Management of Anterior, Posterior, and Multidirectional Shoulder...Peter Millett MD
Arthroscopic treatment of the unstable shoulder has evolved rapidly and significantly in recent years. Better understanding of the pathoanatomy, advancements in technology, and improved surgical techniques have led to dramatic improvements in outcome. An arthroscopic approach includes significant advantages. Arthroscopy provides better identification of concomitant pathology, lower morbidity, less soft tissue dissection, maximal preservation of motion, shorter surgical time, and improved cosmesis. There is less pain, and many patients have an easier functional recovery, with greater returns in motion compared with traditional open techniques. Finally, some of the inherent risks of open procedures, such as postoperative subscapularis rupture, are virtually eliminated. Surgeons can now routinely expect results that are at least comparable, if not better than, those achieved with open techniques. For more shoulder surgery and instability studies, visit Dr. Millett, Orthopedic Surgeon, Vail Colorado http://drmillett.com/shoulder-studies
Complications of internal fixation in a distal femurramachandra reddy
This document discusses the complications encountered in a patient who underwent internal fixation for a distal femur fracture. The patient initially had ORIF with plates which failed, requiring a second surgery. Years later, the patient presented with nonunion, implant loosening, and deformity. The failed hardware was removed and retrograde nailing with bone grafting was performed, but the patient later developed a stress fracture around the nail. Various treatment options for distal femur nonunion are discussed, and the patient ultimately underwent ORIF with a derotational plate to augment healing.
This document provides an overview of mandibular orthognathic procedures. It begins with an introduction to orthognathic surgery and the history of mandibular osteotomies. It then discusses anatomical and physiological considerations, timing of osteotomies, and various osteotomy techniques including vertical ramus, sagittal split, horizontal ramus, subapical, and total alveolar osteotomies. It also briefly touches on soft tissue changes and complications that can occur with mandibular osteotomies. The document is intended as a reference for various mandibular orthognathic procedures.
1) The document describes a case of an intra-articular distal radius fracture with significant deformity and displacement seen on radiographs.
2) Several techniques are discussed for surgical treatment including mobilizing fracture fragments, using intact structures like the ulnar head to help rebuild support, and building the fracture back to the volar locking plate which can help achieve and maintain reduction.
3) Volar locked plating provides adequate stability for early range of motion rehabilitation and typically leads to excellent healing and functional outcomes, though care must be taken to ensure the locking screws are placed just below the subchondral bone to avoid joint penetration.
The document discusses the anatomy and treatment of condylar fractures of the mandible. It describes the anatomy of the condyle and temporomandibular joint. Various types of condylar fractures are defined, including simple, displaced, comminuted, and pathological fractures. Treatment approaches include closed or open reduction, and fixation methods like plating, wiring, and screws. Post-treatment care involves jaw immobilization, exercises to regain motion, and monitoring for complications like malunion, nerve injury, or joint dysfunction.
Intertrochentric femur fracture by DR.NAVEEN RATHORDR.Naveen Rathor
The document discusses intertrochanteric hip fractures, which occur between the greater and lesser trochanters of the proximal femur. It describes the anatomy, mechanisms of injury, classification systems used, treatment options including internal fixation with devices like the sliding hip screw or intramedullary nails, and postoperative management. Complications of treatment like fixation failure, nonunion, and avascular necrosis are also mentioned.
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shoulder dislocation treatment,
The document discusses internal derangement of the temporomandibular joint (TMJ) and its management. It defines internal derangement as an abnormal positional relationship between the articular disc and mandibular condyle. The broad etiologic categories resulting in internal derangement are macrotrauma, microtrauma, and systemic arthropathy. Management options include non-surgical, minimally invasive, and surgical treatments. Non-surgical options involve splint therapy, medications, and physical therapy. Minimally invasive options include arthrocentesis, arthroscopy, and injections. Surgical options involve procedures to reposition or replace the disc such as discectomy, disc repair/replacement, and condyl
This technical note describes an arthroscopic technique for addressing both a rotator cuff tear and a cyst within the greater tuberosity. The authors debrided the cyst cavity to create a socket, then implanted a resorbable scaffold to provide structure and promote bone ingrowth. This allowed the standard rotator cuff repair to then be performed. MRI at 6 months showed healing of both the cyst and rotator cuff tear. The technique provides a readily available option for surgeons facing this clinical challenge.
orthodontic biomechanics andtreatment of skeletal deformitiesMaherFouda1
1) Maxillary advancement can be done with a device attached directly to the maxilla and cranial bones, or with a rigid frame fixed to the cranium from which a screw device advances the maxilla forward and downward.
2) Errors in maxillary or mandibular positioning can occur during surgery and be difficult to correct, such as the maxilla being placed too high or low in the vertical dimension.
3) "Condylar sag" describes problems where the condyle is not properly seated in the glenoid fossa after surgery, which can result in occlusal discrepancies if not addressed. Precise placement of the condyles during surgery is important for postoperative stability.
This document summarizes an original research paper that studied the radiological and functional outcomes of unstable bimalleolar ankle fractures treated surgically using the Baird-Jackson scoring system. The study involved 26 patients between ages 18-60 who underwent open reduction internal fixation surgery using a lateral locking plate and medial malleolar screw(s). Patients were followed for a minimum of 6 months and up to 12 months to assess union, complications, and functional outcomes using the Baird-Jackson scoring system. The majority of patients had good to excellent functional outcomes, with only a few cases of minor complications like infection or stiffness.
Panfacial fractures involve multiple facial bones, including the frontal bones, zygomaticomaxillary complex, naso-orbitoethmoid region, maxilla and mandible. Due to the complex nature of these injuries, management requires careful planning and sequencing of treatment to restore facial functions, features and symmetry. Key goals are to reestablish occlusion, stabilize major facial supports to restore three-dimensional contour, and provide a stable scaffold for soft tissue healing. Proper imaging, surgical approaches and attention to anatomical landmarks are important to achieve accurate reduction and fixation.
This document discusses the treatment of distal radius fractures through plating. It begins with an overview of distal radius anatomy and the columnar classification system used to guide treatment. It then discusses the pathophysiology of distal radius fractures and associated injuries. Treatment options range from closed reduction to open reduction with plating or other internal fixation. Plating allows for anatomic restoration and stable fixation, enabling early return of wrist function. Factors such as fracture pattern, displacement, and patient needs help determine the appropriate treatment. Complications of plating include tendon issues and potential need for plate removal.
High tibial osteotomy (HTO) is a surgical procedure that involves correcting angular deformities of the tibia. It has been used to treat conditions like osteoarthritis, osteochondritis dissecans, and malalignment. There are several techniques for HTO including lateral closing wedge osteotomy, medial opening wedge osteotomy, and dome osteotomy. HTO can help relieve pain from unicompartmental osteoarthritis and delay the need for knee replacement in young, active patients. Potential complications include fracture, nonunion, nerve palsy, and issues that can make later knee replacement more difficult. Precise surgical planning and fixation are important for achieving good outcomes from HTO.
An isolated ulna fracture with less than 20% displacement and 5 degrees of angulation can be treated non-operatively in an otherwise healthy adult. Fractures involving the radial diaphysis or both bones of the forearm carry a high risk of displacement and malunion/nonunion and are generally treated with open reduction internal fixation. Maintaining radial bow is important for functional outcomes with surgical treatment of forearm fractures.
1. n tips & techniques
Section Editor: Steven F. Harwin, MD
Percutaneous Inflation Osteoplasty for
Indirect Reduction of Depressed Tibial
Plateau Fractures
Jens Hahnhaussen, MD; David J. Hak, MD, MBA; Sebastian Weckbach, MD; Jake P. Heiney, MD;
Philip F. Stahel, MD, FACS
ing the indirect joint reduc- allowed to use crutches with
Abstract: Anatomic reduction of articular depression tibial tion of distal radius, calcaneus, touch-down weight bearing to
plateau fractures is challenging. The authors describe a new cuboid, tibial pilon, and tibial the left lower extremity. She
technique using percutaneous balloon-guided inflation os- plateau fractures.6-10 However, was scheduled for elective sur-
teoplasty for a depressed lateral tibial plateau fracture. The
until now, no long-term out- gical fracture fixation within 10
fluoroscopy-guided inflation osteoplasty restores the joint
come has been described for days after injury.
surface anatomically in a minimally invasive fashion. The
tibial plateau fractures treated
metaphyseal void is filled with a fast-setting fluid-phase bone
substitute, and a lateral buttress plate is applied with less inva-
by inflation osteoplasty. Surgical Technique
Standard precautions are
sive incisions. This technique is a valid alternative for indirect
reduction of depressed articular tibial plateau fractures. Case Report applied regarding identification
A 51-year-old woman sus- and marking of the correct sur-
tained a lateral tibial plateau gical site and ensuring a stan-
D epressed tibial plateau
fractures remain chal-
lenging with regard to resto-
comes.1-3 The concept of in-
direct fracture reduction by
balloon-guided inflation ky-
depression fracture after a low-
energy trauma when falling
and twisting her left knee. The
dardized preverification pro-
cess according to the Universal
Protocol, prior to bringing the
ration of anatomic joint con- phoplasty has been established patient was otherwise healthy patient to the operating room.11
gruency, adequate grafting of for many years in the manage- and had no preexisting medi- The surgical procedure is per-
the metaphyseal bone defect, ment of osteoporotic verte- cal conditions. On clinical ex- formed while the patient is
stable fracture fixation, and bral compression fractures.4,5 amination, she had a left knee under general anesthesia and
allowing early knee range of Recently, this technique was joint effusion and tenderness placed on a radiolucent operat-
motion to achieve excellent extrapolated to its application on palpation on the lateral side. ing table in the supine position.
long-term functional out- for other indications, includ- The knee was stable to varus/ A thigh tourniquet is applied
valgus stress examination and but not inflated during the bal-
Lachman testing, and she had a loon osteoplasty part of the
Drs Hahnhaussen, Hak, Weckbach, and Stahel are from the Department
normal neurovascular status to procedure.
of Orthopaedics, Denver Health Medical Center, University of Colorado,
School of Medicine, Denver, Colorado; and Dr Heiney is from the Depart- the left lower extremity. Plain Under fluoroscopic guid-
ment of Orthopaedics, University of Toledo Medical Center, Toledo, Ohio. radiographs and a computed ance, the trocar for the inflatable
Drs Hahnhaussen, Hak, and Weckbach have no relevant financial rela- tomography scan of the left bone tamp is placed in a medial-
tionships to disclose. Dr Heiney is a consultant for Kyphon, Inc. Dr Stahel’s
knee demonstrated a Schatzker to-lateral fashion, using a small
spouse was a salaried employee with Medtronic, Inc, which is the parent
company of Kyphon, Inc, during this study. type III (AO/OTA 41-B2.2)– percutaneous skin incision on
Correspondence should be addressed to: Philip F. Stahel, MD, FACS, equivalent lateral tibial plateau the medial side. The tip of the
Department of Orthopaedics, Denver Health Medical Center, University of depression fracture (Figure trocar is placed center-center
Colorado, School of Medicine, 777 Bannock St, Denver, CO 80204 (philip.
1). The patient was placed in approximately 2 to 3 mm below
stahel@dhha.org).
doi: 10.3928/01477447-20120822-04 a knee immobilizer and was the depression, in the anteropos-
768 ORTHOPEDICS | Healio.com/Orthopedics
3. n tips & techniques
2A 2B
Figure 2: Anteroposterior (A) and later (B) fluoroscopic images showing per-
cutaneous placement of the trocar for the inflatable bone tamp. The ideal posi-
tion of the trocar tip is located centrally, approximately 2 to 3 mm below the
1A 1B peak of depression.
fashion to avoid displacement ensuring anatomic reduction, 2
of the lateral split fracture frag- subchondral 1.6-mm K-wires
ment during inflation of the bal- are placed to hold the articular
loons (Figure 4). Attention must reduction and avoid a second-
be paid not to overcompress ary subsidence as the balloons
the lateral condyle because this are deflated and withdrawn
1C may lead to entrapment of the (Figure 5).
depressed fragment and the in- After applying a lateral
ability to achieve an anatomic buttress plate of choice, the
articular congruence (so-called metaphyseal void is filled
trap door effect). with a fluid-phase hydroxy-
1D In the current case, 2 bal- apatite (eg, Hydroset; Stryker,
loons with a volume of 15 Mahwah, New Jersey) injected
and 20 cc, respectively, were through the trocars. Three
deemed appropriate, using to 4 rafting screws should be
the KyphX Xpander Inflatable placed as a subchondral raft
Bone Tamp system (Kyphon, to hold the articular reduction
Inc, Sunnyvale, California). (Figure 5). The authors recom-
As a trial, the balloons are in- mend filling the residual canal
flated to approximately 50 psi. of the removed trocar with the
1E 1F
The stepwise inflation is then bone substitute as the trocars
Figure 1: Anteroposterior (A) and lateral (B) radiographs of the left knee show-
ing a depressed lateral tibial plateau fracture. The extent of central depression performed under fluoroscopic are withdrawn, although no
is emphasized on coronal (C), sagittal (D), sagittal (E), and axial (F) sections guidance (Figure 3), until the data suggest that this minor
computed tomography scans. depressed fragment is ana- void could be a potential stress
tomically reduced, without ex- riser (Figure 6A, arrows).
terior and lateral planes (Figure thors have recommended plac- ceeding a maximal pressure of
2). To avoid subsidence of the ing 2 or 3 rafting K-wires just 250 to 300 psi. Results
inflatable tamp away from the below the balloon to achieve the Fluoroscopic images should Postoperatively, the patient
depressed fragment into the same effect and avoid subsid- be taken every 0.5 to 1.0 cc was mobilized with touch-
cancellous metahpyseal bone, a ence of the bone tamp pressure (or 30 to 50 psi) of progres- down weight bearing on the
second trocar can be placed with into the weaker metaphyseal sive inflation to ensure proper affected lower extremity and
the tip just adjacent to the other bone, particularly in young pa- positioning of the balloon, and allowed knee range of motion
trocar (Figure 3), which allows tients (C Mauffrey, oral com- adequate metaphyseal void as tolerated. She was followed
for the lower balloon to support munication, January 2012). A formation and to avoid over- up at 2 weeks for a wound
the reduction pressure from the large, pointed reduction clamp correction of the articular frag- check and staple removal. At
more cranial balloon. Other au- is applied in a percutaneous ment into the joint space. After 6 weeks, radiographs demon-
770 ORTHOPEDICS | Healio.com/Orthopedics
4. n tips & techniques
3A 3B 3C
Figure 3: Fluoroscopy-guided indirect reduction of the depressed fragment in the lateral tibial plateau by stepwise balloon inflation (A, B), until achieving an
anatomic articular reduction (C).
strated a maintained anatomic ther advantage, as described for
articular reduction (Figures balloon-guided kyphoplasty
6A, B). The patient was then al- for vertebral fractures,5,12 is
lowed to progressively increase the creation of a cancellous
her weight-bearing status to bone void, which allows an
weight bearing as tolerated by improved fluid-phase bone ce-
10 weeks. She had an excellent ment distribution.
long-term outcome and was To the current authors’
free of symptoms with full ac- knowledge, this report is the
tive range of motion of her left first of a patient with a 1-year
knee (0°-140°) at 3 months. follow-up after successful
The patient was last seen for management of a depressed
a scheduled 1-year follow-up tibial plateau fracture using
(14 months postoperatively), at this novel technique. As out-
which point final radiographs lined in this case report, the 4
demonstrated a maintained technique is minimally inva- Figure 4: Photograph of the medial portals for the balloon trocars and place-
long-term reduction and fixa- sive, safe, accurate, and as- ment of a percutaneous pointed reduction clamp to avoid a breach of the lat-
eral wall or displacement of a lateral split fragment.
tion (Figures 6C, D). sociated with excellent radio-
logical and clinical long-term
Discussion results. The percutaneous re- accuracy of inflation osteo- may warrant an unplanned
Recently, balloon-guided duction technique spares the plasty-guided articular reduc- return to the operating room
reduction techniques for can- soft tissue envelope, which is tion, as outlined in the current for revision surgery, may off-
cellous bone fractures have usually compromised by the report (Figure 3), may facilitate set the overall cost factor. The
emerged in various indica- trauma and associated inflam- the ease and quality of reduc- latter notion is of particular
tions, including vertebral frac- matory response. Also, the tion and may contribute to im- importance in the current age
tures, foot and wrist injuries, open operative time is short- proved long-term outcomes. of nonreimbursable never
and tibial plafond and plateau ened, which decreases the risk Some potential limitations events, such as postoperative
fractures.4-10,12,13 For articu- of a postoperative infection. of this new technique must be infections.18 Finally, as for
lar depression fractures of the Posttraumatic osteoarthritis addressed. Incontestably, the any newly introduced tech-
proximal tibia, the technique is a common sequelae of de- costs related to the single-use nique, an individual learning
of fluoroscopy-guided percu- pressed tibial plateau fractures, instruments for the balloon in- curve will be associated with
taneous inflation osteoplasty leading to long-term morbidity flation technique, as opposed an increased complication rate
appears to have several advan- and the potential need for revi- to using a conventional bone in the early phase until a pro-
tages over conventional open sion surgery and joint replace- tamp, are drastically increased. vider’s proficiency is achieved.
reduction techniques. These in- ment.14,15 A residual articular However, a lack of data exists
clude minimal soft tissue com- step-off in the tibial plateau has that analyze whether indirect Conclusion
promise, improved accuracy of been recognized as a major risk costs related to decreased op- The new technique of
articular reduction, and a lower factor for developing posttrau- erative time and reduced inci- balloon-guided inflation osteo-
risk of joint penetration. A fur- matic knee arthritis.16,17 The dence of complications, which plasty represents an improved,
SEPTEMBER 2012 | Volume 35 • Number 9 771
5. n tips & techniques
fractures: description of a new
technique. Eur J Orthop Surg
Traumatol. 2010; doi: 10.1007/
s00590-010-0692-7
9. Heiney JP, O’Connor JA. Bal-
loon reduction and minimally
invasive fixation (BRAMIF) for
extremity fractures with the ap-
plication of fast-setting calcium
phosphate. J Orthopaedics.
2010; 7:e8.
5A 5B
1
0. Heim KA, Sullivan C, Parekh
Figure 5: Intraoperative fluoroscopy images. After ensuring anatomic reduction, 2 SG. Cuboid reduction and fixa-
temporary K-wires are placed to avoid a secondary subsidence once the balloons are tion using a kyphoplasty bal-
deflated (A, B). The metaphyseal void is filled with a fast-setting fluid-phase bone sub- loon: a case report. Foot Ankle
stitute injected through the trocars (B). A lateral buttress plate is applied and subchon- Int. 2008; 29:1154-1157.
dral rafting screws are placed to support the articular reduction (B, C). 5C 1
1. Stahel PF, Mehler PS, Clarke TJ,
Varnell J. The 5th anniversary of
the “Universal Protocol”: pit-
falls and pearls revisited. Patient
Saf Surg. 2009; 3:14.
1
2. Anselmetti GC, Muto M, Gug-
lielmi G, Masala S. Percutane-
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plasty. Radiol Clin North Am.
2010; 48:641-649.
1
3. Ishiguro S, Oota Y, Sudo A,
Uchida A. Calcium phosphate
cement-assisted balloon osteo-
plasty for a Colles’ fracture on
arteriovenous fistula forearm
of a maintenance hemodialysis
patient. J Hand Surg Am. 2007;
32:821-826.
14.
Papagelopoulos PJ, Part-
6A 6B 6C 6D sinevelos AA, Themistocleous
GS, Mavrogenis AF, Korres DS,
Figure 6: Follow-up anteroposterior (A) and lateral (B) radiographs showing a maintained anatomic articular reduction at Soucacos PN. Complications af-
6 weeks. The previous trocar path was filled with fluid-phase bone substitute to avoid a potential stress riser (arrows). ter tibia plateau fracture surgery.
Follow-up anteroposterior (C) and lateral (D) radiographs showing a maintained anatomic articular reduction at 14 months. Injury. 2006; 37:475-484.
15. Marti RK, Kerkhoffs GM,
plateau. J Bone Joint Surg Br. Complications and safety as- Rademakers MV. Correction
safe, and accurate modality for 2009; 91:426-433. pects of kyphoplasty for osteo- of lateral tibial plateau depres-
anatomic restoration of articu- 2. Newman JT, Smith WR, Ziran
porotic vertebral fractures: a sion and valgus malunion of the
prospective follow-up study in proximal tibia. Oper Orthop
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6. Barei DP, Nork SE, Mills WJ,
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6. Coles CP, Henley MB, Be-
proved radiological and clinical treating tibial plateau fracture Clinical and radiological results nirschke SK. Functional out-
with bone loss. Orthopedics. of calcium phosphate cement- comes of severe bicondylar
outcomes. Future prospective 2008; 31:649. assisted balloon osteoplasty for tibial plateau fractures treated
controlled studies are needed to Colles’ fractures in osteoporotic with dual incisions and medial
3. Stahel PF, Smith WR, Morgan
compare the safety and effi- senile female patients. J Orthop and lateral plates. J Bone Joint
SJ. Posteromedial fracture frag-
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ciency of this new modality ments of the tibial plateau: an
unsolved problem? J Orthop 7. Mauffrey C, Bailey JR, Hak DJ, 17. Giannoudis PV, Tzioupis C,
with established conventional Trauma. 2008; 22:504. Hammerberg ME. Percutane- Papathanassopoulos A, Obak-
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