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Orthopade 2021 May 3. Epub 2021 May 3.

Klinik und Poliklinik für Unfallchirurgie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland.

Background: The coating of intramedullary rods with polymethyl methacrylate (PMMA) bone cement containing antibiotics ensures a high concentration of antibiotics locally and stability in fractures that are not yet consolidated. However, bone cement can detach when the implant is removed and remain in the medullary cavity of the long bones.

Case Report: After a periprosthetic knee infection, a 56-year-old patient suffered from a painful reinfection of Staphylococcus epidermidis. Read More

BMJ Open 2021 May 3;11(5):e044627. Epub 2021 May 3.

Department of Pediatric Orthopedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Uusimaa, Finland.

Introduction: Medial epicondyle fracture of the humerus is a common injury in childhood. There is uniform agreement that minimally displaced fractures (dislocation ≤2 mm) can be treated nonoperatively with immobilisation. Open fractures, fractures with joint incarceration or ulnar nerve dysfunction require surgery. Read More

Clin Orthop Relat Res 2021 04 29. Epub 2021 Apr 29.

J. Stolberg-Stolberg, M. J. Raschke, J. C. Katthagen, Department of Trauma, Hand, and Reconstructive Surgery, University Hospital Muenster, Muenster, Germany.

Background: Currently, there seems to be a paradigm change in the surgical treatment of proximal humeral fractures in patients aged 65 years and older, with a considerable increase in the use of reverse total shoulder arthroplasty (RTSA) compared with angular stable internal fixation (locking plate fixation). However, even among shoulder specialists there is controversy regarding the best treatment strategy.

Questions/purposes: To evaluate for (1) a greater risk of in-hospital major adverse events, (2) a greater risk for in-hospital surgical complications, and (3) a greater risk of 30-day mortality, locking plate fixation and RTSA were compared for the treatment of proximal humerus fractures of patients aged 65 years and older after controlling for potentially confounding variables in a large-database analysis. Read More

OTA Int 2020 Sep 4;3(3):e082. Epub 2020 Aug 4.

Department of Orthopedics and Rehabilitation.

The authors present the case of a patient who developed an () superficial cutaneous infection which was identified at the time of cast removal, 2 weeks after immobilization of a closed distal third humerus fracture. Clinical and microbiological findings, as well as the treatment of this patient, are reported. An otherwise healthy 27-year-old male presented to the orthopaedic surgery clinic 2 weeks after a closed distal humerus fracture, which was initially immobilized with a functional removable brace. Read More

Rev Bras Ortop (Sao Paulo) 2021 Apr 31;56(2):230-234. Epub 2021 Mar 31.

Departamento de Ortopedia, All India Institute of Medical Sciences, Rishikesh, Índia.

 The present study aims to identify preoperative characteristics of the patient, of the injury, as well as of imaging, which would point towards a type IV fracture. The present study shall help the operating team to predict more accurately the type IV pattern preoperatively, leading to improved counselling of the caregivers, planning of surgery, as well as preparedness regarding open reduction, if such situation arises.  A retrospective study was conducted, including patients that met the following criteria: 1) age < 16 years old; 2) Gartland type-III and type-IV supracondylar fractures; and 3) with complete records. Read More

J Hand Surg Asian Pac Vol 2021 Jun;26(2):218-222

Division of Orthopaedic Surgery, Department of Surgical Specialties, National Center for Child Health and Development, Tokyo, Japan.

Lateral humeral condylar fractures often heal with some residual elbow deformity. However, details of angulation or tilting angle of the lateral condyle after the fracture have not been evaluated so far. Between 2008 and 2016, we followed up 80 mild fractures of the lateral humeral condyle for more than a year. Read More

J Hand Surg Asian Pac Vol 2021 Jun;26(2):284-289

Department of Hand Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.

We report two pediatric cases of radial nerve palsy caused by supracondylar fracture of the humerus requiring nerve exploration. The children had comparable conditions, palsy types (complete motor and partial sensory) and radiographic findings. The fracture in the first case was managed conservatively with closed reduction and percutaneous pinning but, while the patient eventually recovered from the partial sensory palsy, her motor palsy remained unchanged. Read More

J Hand Surg Asian Pac Vol 2021 Jun;26(2):280-283

Division of Hand Surgery, Department of Orthopedic Surgery, Nara Medical University, Nara, Japan.

Acute plastic deformation of long bones is more common in young children. We report a case of an acute plastic deformation of a pediatric radius via magnetic resonance imaging (MRI) evaluation. A 15-year-old boy fell on landing after a jump while practicing soccer, which injured his right forearm. Read More

Int J Environ Res Public Health 2021 Apr 16;18(8). Epub 2021 Apr 16.

Department of Rehabilitation, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, 85-094 Bydgoszcz, Poland.

Diagnosis of the cause of massive edema of the lower limbs in patients after spinal cord injury (SCI) can be difficult because of loss of pain sensation, commonly occurring in this group of patients. This paper reviews several different pathologies that can lead to lower-limb edema and the associated diagnostic difficulties. We present four cases of patients with massive edemas of lower limbs at different times after SCI undergoing treatment in the Department of Rehabilitation, University Hospital in Bydgoszcz, Poland. Read More

BMC Musculoskelet Disord 2021 Apr 28;22(1):396. Epub 2021 Apr 28.

Department of Orthopaedic Surgery, VieCuri Medical Center, Venlo, The Netherlands.

Background: Convertible stem designs allow for stem retention during revision from anatomical to reverse shoulder arthroplasty. In some cases conversion is not possible for example due to excessive soft tissue tensioning. In these cases a total revision is necessary. Read More

J Am Acad Orthop Surg 2021 Apr 26. Epub 2021 Apr 26.

From the Rothman Orthopaedic Institute, Thomas Jefferson University Hospitals, Philadelphia, PA (Hill), the Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN (Thomas, Schroder, and Cole), the Department of Orthopaedic Surgery, Regions Hospital, St. Paul, MN (Thomas, Schroder, and Cole), and the HealthPartners Orthopaedics & Sports Medicine, Bloomington, MN (Cole).

Minimally invasive plate osteosynthesis is a surgical technique that is becoming increasingly common because radiographic images and implant technologies advance in capabilities. It is imperative for surgeons to enhance their understanding of the surgical anatomy related to new approaches for fracture fixation. While performing minimally invasive plate osteosynthesis, there is a danger of injuring structures in the common percutaneous and submuscular pathways. Read More

Int J Surg Case Rep 2021 Apr 16;82:105896. Epub 2021 Apr 16.

Department of Orthopaedics and Traumatology, Faculty of Medicine of Hasanuddin University, Makassar, Indonesia. Electronic address:

Introduction And Importance: Traumatic laceration of the radial nerve following supracondylar humerus fracture in the pediatric population is highly uncommon. Transection of the radial nerve is rare, and approximately 12.7% of all nerve injuries are categorized as neurapraxia that will resolve spontaneously. Read More

Cureus 2021 Mar 22;13(3):e14043. Epub 2021 Mar 22.

Department of Orthopaedic, International Islamic University Malaysia, Kuantan, MYS.

Introduction This appears to be the first biomechanical study that compares the stability of various locations of the crossing points in crossed pinning Kirschner wiring (K-wire) construct in treating pediatric supracondylar humerus fracture (SCHF). Additionally, this study compared the biomechanical stability between crossed pinning K-wire construct and the three-lateral divergent K-wire construct. Methods For the study purpose, 30 synthetic humerus bones were osteotomised at mid-olecranon fossa, anatomically reduced, and pinned using two 1. Read More

Shoulder Elbow 2021 Apr 10;13(2):188-194. Epub 2020 Jan 10.

Department of Bone and Soft Tissue Tumors, Tata Memorial Hospital, Mumbai, India.

Aim: Reconstructing locally aggressive benign bone tumours of the proximal humerus after intralesional curettage is a challenge. We present a novel reconstruction technique '' where a femoral head and a strut allograft are combined to reconstruct the cavity. Complications, graft incorporation time, functional (Musculoskeletal Tumor Society score [MSTS]) and oncological outcomes were evaluated. Read More

J Hand Surg Am 2021 Apr 22. Epub 2021 Apr 22.

Department of Orthopedic Surgery, Southern California Permanente Medical Group, Harbor City, CA.

Purpose: Total elbow arthroplasty (TEA) can be used, with varying degrees of success, for the treatment of rheumatoid arthritis, osteoarthritis, and distal humerus fractures and their sequelae in elderly patients. Some of the largest studies of TEA have included data from more than 20 years ago and may not reflect the current practice of TEA. We sought to describe a modern cohort of patients who underwent TEA in a United States integrated health care system. Read More

J Orthop Surg (Hong Kong) 2021 May-Aug;29(2):23094990211010520

Department of Orthopaedic Surgery and Traumatology, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain.

Purpose: Several studies have been carried out, and there is no classification for proximal humeral fractures (PHF) exempted from variability in interpretation and with questioned reliability. In the present study, we investigated the 'absolute diagnostic reliability' of the most currently used classifications for PHFs on a single anterior-posterior X-ray shoulder image.

Methods: Six orthopaedic surgeons, with varying levels of experience in shoulder pathology, evaluated radiographs from 30 proximal humeral fractures, according to the 'absolute reliability' criteria. Read More

Int Orthop 2021 Apr 23. Epub 2021 Apr 23.

IULS CHU de Nice, UR2CA, UCA, 30 voie Romaine, 06000, Nice, France.

Purpose: The goal of this study was to assess the clinical outcomes associated with anatomic healing of the greater tuberosity in patients treated for proximal humerus fractures with reverse shoulder arthroplasty. Our hypothesis was that anatomic healing of the greater tuberosity leads to less complications and better functional outcomes.

Methods: RESULTS: Patients from the GT+ group presented better functional outcomes than the GT- group in all evaluated outcomes. Read More

Asian J Surg 2021 Apr 19. Epub 2021 Apr 19.

Department of Orthopedics, The Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia Autonomous Region, China.

Int J Surg Case Rep 2021 Apr 22;81:105806. Epub 2021 Mar 22.

Department of Orthopaedics and Traumatology, Cipto Mangunkusumo National Central Hospital and Faculty of Medicine, Universitas Indonesia, Jalan Diponegoro No. 71, Jakarta Pusat, Jakarta 10430, Indonesia.

Introduction And Importance: Fracture with a critical bone loss is associated with a profound burden of disease impact. Although there are several options exist for its treatment, but still those reconstructive procedures are technically demanding, relatively expensive and sometimes the result is less than what was expected. The objective of this study is to report a rare case of spontaneous healing of a critical radial bone defect in an adolescent. Read More

JBJS Case Connect 2021 04 22;11(2). Epub 2021 Apr 22.

The Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland.

Case: We present a 62-year-old left-hand-dominant woman with history of renal failure, osteoporosis, and 4-part proximal humerus fracture malunion with subsequent post-traumatic arthritis of the left glenohumeral joint. After conservative treatments failed to relieve her symptoms, the patient underwent stemless total shoulder arthroplasty (TSA) because of concerns that her proximal humerus could not accommodate a stemmed implant. At 2 and a half-years postoperative, the patient demonstrated significant improvement of symptoms without signs of radiographic loosening. Read More

Hand (N Y) 2021 Apr 21:1558944721998008. Epub 2021 Apr 21.

Division of Hand Surgery and Microsurgery, ABC Medical School, Sto. André, SP, Brazil.

Background: The external rotation and abduction of shoulder are considered one of the priorities of reconstruction in brachial plexus injury. The aim of this study was to evaluate the functional results and complications of shoulder arthrodesis in patients with brachial plexus injury to better comprehend the benefits of this procedure.

Methods: Between 2015 and 2019, 15 shoulder arthrodesis were performed in patients with long-standing brachial plexus injury. Read More

Eur J Orthop Surg Traumatol 2021 Apr 20. Epub 2021 Apr 20.

Division of Surgery, Orthopaedic Department, Oslo University Hospital, Ullevål, Norway.

Background: Randomized controlled trials (RCT) are regarded as the gold standard for effect evaluation in clinical interventions. However, RCTs may not produce relevant results to all patient groups. We aimed to assess the external validity of a multicenter RCT (DelPhi trial). Read More

Cureus 2021 Mar 15;13(3):e13903. Epub 2021 Mar 15.

Department of Orthopaedics and Rehabilitation, Penn State Health Milton S. Hershey Medical Center, Hershey, USA.

Purpose: Supracondylar humerus (SCH) fractures are the most common elbow fracture in children; however, they rarely occur as open injuries. Open fractures are associated with higher rates of infection, neurovascular injury, compartment syndrome, and nonunion. The purpose of this study was to evaluate the treatment and outcomes of open SCH fractures in children. Read More

Malays Orthop J 2021 Mar;15(1):119-123

Department of Orthopaedics, International Medical University, Seremban, Malaysia.

Introduction: Reverse total shoulder arthroplasty provides a surgical alternative to standard total shoulder arthroplasty for the treatment of cuff tear arthropathy, arthritis and fracture sequelae. This study aimed to assess the short-term outcomes following reverse total shoulder arthroplasty for patients in a large public hospital in Malaysia.

Materials And Methods: We identified and performed five primary reverse total shoulder arthroplasties between 1 May 2019 and 1 June 2020. Read More

JBJS Case Connect 2021 04 20;11(2). Epub 2021 Apr 20.

Orthopaedic Clinic, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy.

Case: We present 2 case reports: the first, a diaphyseal fracture of the humerus treated with a Marchetti nail resulting in a nonunion in 2017. The second, a fracture of the femur treated with a Kuntscher nail in 1989. A gunshot injury to that femur in 2014 evolved in nonunion and displacement. Read More

Arch Orthop Trauma Surg 2021 Apr 20. Epub 2021 Apr 20.

Faculty of Medicine and University Hospital, Center for Orthopedic and Trauma Surgery, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.

Introduction: Radial head fractures account for the majority of bony elbow injuries. The individual treatment options have been described in detail. In some cases, however, an unusual concomitant injury occurs, which can significantly impede primary osteosynthesis and healing. Read More

Bone 2021 Jul 14;148:115960. Epub 2021 Apr 14.

Women's Health and Perinatalogy Research Group, Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway; Department of Gynecology and Obstetrics, University Hospital of North Norway, Tromsø, Norway; Norwegian Research Centre for Women's Health, Oslo University Hospital, Oslo, Norway. Electronic address:

Purpose: Patients with end-stage kidney disease have an increased fracture risk. Whether mild to moderate reductions in kidney function is associated with increased fracture risk is uncertain. Results from previous studies may be confounded by muscle mass because of the use of creatinine-based estimates of the glomerular filtration rate (eGFRcre). Read More

Cureus 2021 Mar 12;13(3):e13861. Epub 2021 Mar 12.

Department of Radiology, National Cancer Institute, Nagpur, IND.

A 47-year-old female presented with a minimally displaced fracture of proximal one-third of the shaft of the humerus that she suffered two months before and managed conservatively with a Plaster of Paris (POP) slab. An X-ray performed after six weeks showed complete vanishing of the proximal third portion of humerus due to massive osteolysis and generalized osteopenia. On examination, there was a soft tissue swelling over the proximal part of the left arm with painful and limited range of motion of the left shoulder. Read More

BMJ Case Rep 2021 Apr 15;14(4). Epub 2021 Apr 15.

Manipal Academy of Higher Education, Manipal, Karnataka, India.

Orthop Traumatol Surg Res 2021 Apr 15:102933. Epub 2021 Apr 15.

Department of Orthopaedic Surgery, National University Hospital, 1E, Kent Ridge Road, 119228, Singapore.

Aims: Non-union is a known and much-dreaded complication of paediatric lateral condyle fractures. This systematic review aims to pool together individual studies to find out if the timing of fixation and method of fixation impacts surgical outcomes (postoperative union and elbow ROM) in paediatric lateral condyle non-union.

Methods: A systematic review and individual patient data meta-analysis was conducted according to PRISMA guidelines. Read More