PurposeTo evaluate the degree of biological healing response that occurs between the anterior horn of the medial meniscus (MM) and the tibial plateau and investigate the biological healing response after injection of human bone marrow stem cells (hBMSCs) in a rabbit model.Materials and MethodsTwenty-five rabbits with a mean body weight of 2.5 kg were chosen for this study. On the left knee, a complete radial tear was made at the anterior tibial attachment site of MM and after removal of tibial cartilage, pullout repair of the torn MM was performed on the tibial plateau. On the right knee, the same procedure was performed, and a scaff old (matrix gel) that contained human bone marrow stem cell was implanted between MM and the tibial plateau. A biopsy was performed at 2 (group 1), 4 (group 2), and 8 (group 3) weeks postoperatively. The authors compared the differences in the degree of biological healing of each group and investigated the degree of biologic healing after hBMSC implantation by comparing the left knee with the right knee.ResultsOn the biopsy of 40 knees of 20 rabbits that survived after operation, all groups did not show the healing response between the undersurface of MM and the tibial plateau. There was no significant difference in terms of the pathological criteria such as fibroblasts and fibrochondrocytes etc., with and without hBMSC implantation.ConclusionsThere was no attachment between the repaired MM and the tibial plateau after complete radial tear on MM and the authors could not identify the effect of hBMSC.

Purpose: We wanted to analyze and report on the radiologic and clinical results of prospective Hook plate fixation for unstable distal clavicle fractures after a minimum of 2 years follow up. Materials and Methods: We followed up 17 out of 20 cases that underwent prospective Hook plate fixation from 2008 to 2009. We performed radiologic follow up at 2 weeks, 6 weeks, 3 months, 6 months, 18 months and 24 months postoperatively. The clinical results were evaluated at 12 months and 24 months postoperatively. Results: The mean period for bony fusion was 14.5 weeks and the plate was removed after an average of 20.2 weeks. The VAS pain scores were 0.7 and 0.8, the UCLA scores were 33.5 and 33.3, the ASES scores were 92.8 and 92.5, the Constant-Murley scores were 81.5 and 77.0, the KSS scores were 92.5 and 94.3 and the ranges of motion were 173.3 and 173.7 of flexion, 56.0 and 54.5 of external rotation, 62.3 and 63.5 of the internal rotation, 172.0 and 172.6 of abduction and 43.3 , and 42.9 of extension at 1 and 2 years follow-up, respectively. There was no statistically significant difference of clinical outcomes and the range of motion at 1 year and 2 year postoperatively (p>0.05). There was no other complication except 1 case of delayed union. Conclusion: For Hook plate fixation at 2 years postoperatively, the complications will be decreased and excellent clinical results should occur.

Introduction: Iatrogenic fractures remain a complication during intramedullary (IM) nailing for atypical femoral fractures (AFFs). The risk factors for iatrogenic fractures remain unclear, although excessive femoral bowing and osteoporosis are hypothesized to be contributing factors. The present study aimed to determine risk factors for iatrogenic fracture occurrence during IM nailing in patients with diaphyseal AFFs.Patients and methods: This retrospective cross-sectional study investigated 95 diaphyseal AFF patients (all female; age range, 49–87 years) who underwent IM nailing between June 2008 and December 2017. The patients were divided into two groups: group I (with iatrogenic fracture; n = 20) and group II (without iatrogenic fracture; n = 75). Background characteristics were collected from medical records and radiographic measurements were taken. Univariate and multivariate logistic regression analyses were performed to identify risk factors for intraoperative iatrogenic fracture occurrence. A receiver operating curve (ROC) analysis was carried out to determine a cutoff value for prediction of iatrogenic fracture occurrence.Results: Iatrogenic fractures occurred in 20 patients (21.1%). The two groups did not differ significantly in age and other background characteristics. Group I had significantly lower mean femoral bone mineral density (BMD) and significantly greater mean lateral and anterior femoral bowing angles than group II (all p < 0.05). There were no significant differences in diaphyseal AFF location, nonunion, and IM nail diameter, length, or nail entry point between the two groups. In the univariate analyses, femoral BMD and lateral bowing of the femur differed significantly between the two groups. On multivariate analysis, only lateral bowing of the femur remained significantly associated with iatrogenic fracture occurrence. The ROC analysis determined a cutoff value of 9.3° in lateral bowing of the femur for prediction of iatrogenic fracture occurrence during IM nailing for diaphyseal AFF treatment.Conclusions: Lateral bowing angle of the femur is an important predictive factor for intraoperative iatrogenic fracture occurrence in patients undergoing IM nailing for diaphyseal AFF treatment. Level of evidence: III, retrospective comparative study.

Background and objectives: Iatrogenic fractures are potential complications during intramedullary (IM) nailing for atypical femoral fractures (AFFs). The risk factors associated with iatrogenic fractures remain unclear, although excessive femoral bowing and osteoporosis are hypothesized to be contributing factors. The present study aimed to determine the risk factors for the occurrence of iatrogenic fractures during IM nailing in patients with AFFs. Materials and Methods: This retrospective cross-sectional study evaluated 95 patients with AFF (all female; age range: 49–87 years) who underwent IM nailing between June 2008 and December 2017. The patients were divided into two groups: Group I (with iatrogenic fracture: n = 20) and Group II (without iatrogenic fracture: n = 75). Background characteristics were retrieved from medical records and radiographic measurements were obtained. Univariate and multivariate logistic regression analyses were performed to identify risk factors for the occurrence of intraoperative iatrogenic fractures. Receiver operating curve (ROC) analysis was conducted to determine a cut-off value for the prediction of iatrogenic fracture occurrence. Results: Iatrogenic fractures occurred in 20 (21.1%) patients. The two groups exhibited no significant differences regarding age and other background characteristics. Group I exhibited significantly lower mean femoral bone mineral density (BMD) and significantly greater mean lateral and anterior femoral bowing angles than Group II (all p < 0.05). There were no significant differences in AFF location, nonunion, and IM nail diameter, length, or nail entry point between the two groups. In the univariate analysis, femoral BMD and lateral bowing of the femur differed significantly between the two groups. On multivariate analysis, only lateral bowing of the femur remained significantly associated with iatrogenic fracture occurrence. The ROC analysis determined a cut-off value of 9.3° in lateral bowing of the femur for prediction of iatrogenic fracture occurrence during IM nailing for AFF treatment. Conclusions: The lateral bowing angle of the femur is an important predictive factor for intraoperative iatrogenic fracture occurrence in patients undergoing IM nailing for AFF treatment.

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