Comparative Study of 2 Bone Anchors Using a Limited Open Procedure for the Management of Distal Radioulnar Joint Instability

Background: Arthroscopic and open surgical procedures are commonly used to repair distal radioulnar joint (DRUJ) instability. Both may result in patient dissatisfaction and recurrence of DRUJ instability. An alternative treatment that yields improved outcomes is a limited open approach using a bone anchor to support the DRUJ. Methods: A retrospective chart review of 58 patients (59 extremities) aged 18 to 60 years with type 1B Palmer rupture (3 months or more after injury) of the triangular fibrocartilage complex (TFCC) without distal radius fracture was conducted. Inclusion criteria are: 3 to 12 months after injury, clinical DRUJ instability, and minimum of 6 months of postoperative follow-up. Operative fixation with Stryker Sonic or Depuy Mitek anchor was done by the same surgeon using a limited open procedure. Preoperative and postoperative assessments included Disability of the Arm, Shoulder, and Hand; Brief Pain Inventory; Wong-Baker FACES Pain Rating Scale; Numeric Pain Scale; range of motion; and recurrence of instability. A multivariate analysis of variance model was fit to imputed data to assess the effect of both anchors. Results: Clinical and statistical differences were found in preoperative and postoperative assessments for either the Stryker Sonic or the Depuy Mitek anchor but not between anchor types. There was no recurrence after 3 years with either anchor. Conclusion: Patients requiring TFCC repair using the Stryker Sonic or Depuy Mitek anchor experienced: (1) significant clinical and statistical improvement in postoperative assessments; (2) patient satisfaction; and (3) corrected DRUJ instability. Consequently, major determinants in deciding which bone anchor to use may be based on cost or surgeon’s preference.

Bone suture anchor repair and functional outcome of a triceps tendon rupture, a rare clinical entity

Triceps tendon rupture is rare and easily missed on presentation. A 58-year-old man was seen in our accident and emergency department with an inability to extend his right elbow against gravity after he fell. Ultrasound and MRI confirmed the suspected diagnosis of a traumatic triceps tendon rupture and excluded additional injuries. Surgical repair was carried out by a bone anchor suture reinsertion of the tendon to the olecranon. After 2 weeks of cast immobilisation, an early active range of motion (ROM) rehabilitation schedule was followed, resulting in excellent elbow function at 12 weeks postoperatively.In conclusion, it is important to suspect this rare injury and use additional studies to confirm the diagnosis of triceps tendon rupture. Also, good clinical outcome with regards to function can be achieved using bone anchor suture repair and an early active ROM rehabilitation schedule.

Avian extremity reconstruction via osseointegrated leg-prosthesis for intuitive embodiment

For large avians such as vultures, limb loss leads to loss of ambulation and eventually death from malnutrition. Prosthetic devices may replace the limb, however, conventional prosthetic sockets are not feasible in feathered limbs and the extreme stress and strain of unreflected daily use in animals. Osseointegration is a novel technique, where external prosthetic parts are connected directly to a bone anchor to provide a solid skeletal-attachment. This concept provides a high degree of embodiment since osseoperception will provide direct intuitive feedback allowing natural use of the limb in gait and feeding. Here we demonstrate for the first time an osseointegrated bionic reconstruction of a limb in a vulture after a tarsometatarsal amputation with a longterm follow-up.

Comparison of Extracapsular Stabilization Techniques Using an Ultrasonically Implanted Absorbable Bone Anchor (Weldix) after Cranial Cruciate Ligament Rupture in Cats—An In Vitro Study

Background: This study evaluated joint stability after surgical repair of cranial cruciate ligament (CrCL)-deficient stifle joints in cats using a novel absorbable polylactide bone anchor in an ex vivo model. Methods: Thirty-six hindlimbs from cats with intact (Gi group) and transected CrCLs were treated with fabellotibial suture alone (GFW group), suture combined with an absorbable polylactide bone anchor (GWD group), or suture combined with a nonabsorbable bone anchor (GFT group), positioned in a limb press with predefined joint angles (stifle joint: 120 ± 5°; hock joint: 120 ± 5°) and loaded with 10%, 20%, and 30% of body mass (BM). Predefined points were measured on lateral radiographs and with a coordinate measurement machine. Distances on radiographs (mm) were measured and angles (°) were calculated to represent the craniocaudal movement and the internal rotation of the tibia. Results: There were no differences for craniocaudal movement between Gi and GFW or GFT, but for GWD regarding angle measurement at 30% BM. For internal rotation, there was no significant difference between Gi and GFW or GWD, but for GFT. Conclusion: The used absorbable polylactide bone-anchor was able to stabilize the stifle joint regarding internal rotation and craniocaudal movement as calculated from distance measurements.

The Complexity of Joint Regeneration: How an Advanced Implant could Fail by Its In Vivo Proven Bone Component

Articular cartilage damage is a major challenge in healthcare due to the lack of long-term repair options. There are several promising regenerative implant-based approaches for the treatment, but the fixation of the implant remains a significant challenge. This study evaluated the potential for repair of an osteochondral implant produced through a novel combined bioprinting-based chondral-bone integration, with and without cells, in an equine model. Implants consisted of a melt electrowritten polycaprolactone (PCL) framework for the chondral compartment, which was firmly integrated with a bone anchor. The bone anchor was produced by extrusion-based printing of a low-temperature setting bioceramic material that had been proven to be effective for osteo-regeneration in an orthotopic, non-load bearing and non-articular site in the same species in an earlier in vivo study. Articular cartilage-derived progenitor cells were seeded into the PCL framework and cultured for 28 days in vitro in the presence of bone morphogenetic protein-9 (BMP-9), resulting in the formation of abundant extracellular matrix rich in glycosaminoglycans (GAGs) and type II collagen. The constructs were implanted in the stifle joints of Shetland ponies with cell-free scaffolds as controls. Clinical signs were monitored, and progression of healing was observed non-invasively through radiographic examinations and quantitative gait analysis. Biochemical and histological analyses 6 months after implantation revealed minimal deposition of GAGs and type II collagen in the chondral compartment of the defect site for both types of implants. Quantitative micro-computed tomography showed collapse of the bone anchor with low volume of mineralized neo-bone formation in both groups. Histology confirmed that the PCL framework within the chondral compartment was still present. It was concluded that the collapse of the osteal anchor, resulting in loss of the mechanical support of the chondral compartment, strongly affected overall outcome, precluding evaluation of the influence of BMP-9 stimulated cells on in vivo cartilage regeneration.

Hybrid laparoscopic and open repair of post-nephrectomy flank hernia

Surgical repair of flank hernia is not routinely performed, due to perceived technical difficulties with the surgery and risk of recurrence, or the misconception that flank hernia is solely due to a denervation injury. Due to the rareness of flank hernia in the literature, there is no general consensus on the best method of surgical repair. We present the case of a patient with a symptomatic large flank hernia following open nephrectomy, in which a hybrid technique of open and laparoscopic flank hernia repair with sublay mesh and bone anchor fixation was successfully performed with good outcome. This case highlights the benefits of the hybrid approach, which allowed a laparoscopic assessment of the defect and adhesiolysis, followed by the open repair which enabled adequate mesh overlap, fixation to surrounding tissues and bone anchor fixation.

Assessment of Flexion Elongation Relation and Type of Failure after Capsulodesis

Background Injury of the scapholunate interosseous ligament is the most frequently diagnosed cause of carpal instability and can be treated with a Mayo capsulodesis procedure. During this procedure, a radially based flap of the dorsal radiocarpal complex is attached to the lunate. The procedure attempts to reduce flexion of the scaphoid and restore the scapholunate relationship by crossing the scapholunate interval. To obtain a better understanding of the biomechanical properties and possibly improve the postoperative rehabilitation process, a better understanding of the reconstructions biomechanics is needed. Methods Ten dorsal intercarpal ligament capsulodesis were performed on embalmed wrists to assess the flexion elongation relation at the dorsal intercarpal reconstruction, the dorsal intercarpal complex, and the type of failure during flexion of the wrist. Results The mean elongation of the dorsal intercarpal reconstruction at 70-degree flexion was 0.8 mm. During flexion, the dorsal intercarpal reconstruction showed no ligament tears or failure of the bone anchor. The mean elongation of the dorsal intercarpal complex was 3.9 mm at 70 degrees. During subsequent repeated flexion, four sutures to connect the dorsal intercarpal complex to the surrounding tissue loosened between 55 and 60 degrees. Conclusions These findings suggest that capsulodesis can safely withstand flexion of the wrist until 50 degrees. Clinical Relevance Clinicians should consider the opportunity to start early with controlled active motion. Level of Evidence Not applicable.