➢ Argentine orthopaedics was shaped by the influence of Dr. Vittorio Putti (Rizzoli Institute, Bologna, Italy). Dr. Carlos E. Ottolenghi, one of Dr. Putti's most distinguished disciples, together with Dr. José Valls, founded the Instituto de Ortopedia y Traumatología at Hospital Italiano de Buenos Aires in 1926. Prof. Ottolenghi transformed the Orthopaedic Service into a leading academic center and pioneer of subspecialization, serving as a foundational driver of orthopaedic development in Argentina and Latin America, while establishing strong international academic connections and collaborations.➢ Major milestones include the establishment of one of the earliest institutional bone banks and the performance of one of the world's first reported massive bone allograft reconstructions (1948); the performance of the first Charnley total hip replacement in the Americas (1967) and the first total knee replacement in Argentina (1970); and the early adoption of intramedullary nailing (1972), knee arthroscopy (1976), and femoral bone impaction allografting (1987). These contributions helped to define modern orthopaedic practice across Latin America and influenced global reconstructive strategies.➢ Advances such as surgical navigation (2010) and augmented reality (2025) have strengthened its role as a regional and globally connected center of excellence, particularly in musculoskeletal oncology.➢ Over the past 25 years, 180 residents and 160 fellows have been trained in our institute, and more than 500 indexed publications have been produced in the last 10 years, with alumni holding leadership roles across major orthopaedic centers worldwide, amplifying our institute's global footprint.➢ A merit-based, highly selective system based on excellence determines who becomes a staff surgeon. Currently, 85% of the actual staff surgeons completed residency training in our department, fostering a unique sense of institutional identity and perceived belonging. This experience reinforces the concept that excellence in orthopaedics transcends geographic boundaries and can emerge as a global reference from any setting committed to innovation, mentorship, and academic rigor.
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To translate and culturally adapt the Unité Rhumatologique des Affections de la Main (URAM) scale, a specific instrument for functional assessment in Dupuytren's disease (DD), into Brazilian Portuguese. Following the methodology of Beaton (2000), the scale underwent five stages: translation, synthesis, back-translation, expert committee, and pre-testing. After adaptation, the Brazilian version of the scale (URAM-BR) was administered to 40 patients with Dupuytren's contracture. Internal consistency was tested using Cronbach's alpha, reproducibility was analyzed using the intraclass correlation coefficient (ICC), and construct validity was analyzed by correlation with the Brazilian version of QuickDASH. The URAM-BR showed excellent internal consistency (α = 0.930-0.938), significant reproducibility (ICC > 0.89), and moderate-to-strong construct validity (r = 0.69, p < 0.001). The adapted version proved to be clear, reliable, and appropriate to the Brazilian cultural context. The URAM-BR is a valid, reliable, and reproducible instrument for functional assessment of patients with DD in Brazil. Level of evidence IV; Observational cross-sectional instrument validation study. Traduzir e adaptar culturalmente para o português do Brasil a escala Unité Rhumatologique des Affections de la Main (URAM), instrumento específico para avaliação funcional na Doença de Dupuytren (DD). Seguindo a metodologia de Beaton (2000), a escala passou por cinco etapas: tradução, síntese, retrotradução, comitê de especialistas e pré-teste. Após a adaptação, a versão brasileira da escala (URAM-BR) foi aplicada em 40 pacientes com contratura de Dupuytren. A consistência interna foi testada pelo alfa de Cronbach, a reprodutibilidade foi analisada pelo Coeficiente de Correlação Intraclasse (ICC), e a validade de construto pela correlação com a versão brasileira da QuickDASH. O URAM-BR apresentou excelente consistência interna (α = 0,930–0,938), reprodutibilidade significativa (ICC > 0,89) e validade de construto moderada-forte (r = 0,69, p < 0,001). A versão adaptada demonstrou ser clara, confiável e adequada ao contexto cultural brasileiro. O URAM-BR é um instrumento válido, confiável e reprodutível para avaliação funcional de pacientes com DD no Brasil. Nível de evidência IV; estudo observacional transversal de validação de instrumento.
Recalcitrant lateral elbow pain is often associated with minor lateral elbow instability, involving laxity of the radial band of the lateral collateral ligament and the annular ligament. To date, the role of coronoid morphology in this pathology has never been studied. This study aims to investigate the potential relationship between lateral elbow pain and specific morphometric measurements of the coronoid process using flexion computed tomography arthrography. All elbow flexion computed tomography arthrography from the hospital server was retrospectively analyzed. A total of 133 patients were enrolled and divided into 2 groups: 108 with lateral elbow pain and 25 controls. Coronoid flange and width were measured and compared to the radioulnar articular width in both groups. No significant morphometric differences in the coronoid process were found between patients with chronic lateral elbow pain and controls. Other factors, such as capsuloligamentous structures, may have a greater impact on recalcitrant lateral elbow pain compared to the bony morphology of the medial structure of the elbow.
To evaluate bilateral isokinetic performance symmetry of knee extensors and flexors 6 months after anterior cruciate ligament reconstruction using a rectus femoris tendon autograft. This retrospective case series included patients consecutively recruited at a single tertiary sports medicine center between January 2023 and July 2024. Inclusion required primary anterior cruciate ligament reconstruction with a rectus femoris autograft, no prior knee surgeries, and a minimum 6-month follow-up; patients with revision or multiligamentous procedures were excluded. Isokinetic testing was performed at 6 months using a computerized dynamometer. The nonoperative limb was tested first, followed by the operative limb. Patients performed 5 maximal effort trials at 60°/s for both extension and flexion. Measured outcomes included peak torque (PT), PT normalized to body weight, angle at PT, total work (TT), and mean power (PM) for both knee extension and flexion. Paired t-tests compared operated and nonoperated limbs. Statistical significance was set at P ≤ .05. Thirty-one male patients (mean age, 26.3 ± 4.7 years) were included, with a mean follow-up of 6.2 ± 0.4 months. At 6 months, the operated limb achieved 71% of contralateral PT and 75% of contralateral PM, with significant deficits in extension PT (P < .001), PT normalized to body weight (P < .001), TT (P  < .001), and PM (P = .002), while no significant difference was found for angle at PT (P = .457). Flexor performance showed near-complete recovery, with the operated limb reaching 93% of contralateral peak torque and 90% of TT, with P = .355, .340, .902, .153, and .316 for PT, PT normalized to body weight, angle at PT, TT, and PM, respectively. At 6 months, anterior cruciate ligament reconstruction with a rectus femoris autograft was associated with complete recovery of knee flexor performance but persistent deficits in knee extensor performance. Level IV, retrospective case series.
Chronic low back pain is one of the most prevalent health conditions, with significant social and economic impact. Its increasing incidence has driven the demand for new, effective therapeutic alternatives. This study compared the efficacy of platelet-rich plasma (PRP) and corticosteroid injections in the treatment of chronic low back pain of facet joint origin. This was a randomized clinical trial involving patients with chronic low back pain of facet joint origin, selected through a positive response to medial branch block. Epidemiological data and clinical outcomes were analyzed, including disability questionnaires (Roland-Morris Disability Questionnaire) and the visual analog scale (VAS) for pain. Assessments were conducted at baseline, one month, and three months post-procedure. A total of 59 patients were included, with 32 in the corticosteroid group and 27 in the PRP group. No significant differences were found between the treatments in terms of disability scores or the Roland-Morris Questionnaire. However, a significant interaction between treatment and time was observed (p = 0.038). Regarding pain scores, no significant differences were found between groups at any of the assessed time points. The study found no evidence of superiority of platelet-rich plasma over corticosteroid injections in terms of pain reduction and functional outcomes for the treatment of lumbar facet syndrome. Level of evidence: I; Randomized clinical trial. A dor lombar crônica é uma das condições de saúde mais prevalentes, com significativo impacto social e econômico. A sua crescente incidência tem gerado a necessidade de novas opções terapêuticas eficazes. Este estudo comparou a eficácia das infiltrações de plasma rico em plaquetas (PRP) e corticosteroides no tratamento da dor lombar crônica de origem facetária. Trata-se de um ensaio clínico randomizado que avaliou pacientes com dor lombar crônica de origem facetária, selecionados por resposta positiva ao bloqueio do ramo medial, em relação aos efeitos dos tratamentos. Foram analisados dados epidemiológicos e desfechos clínicos, incluindo o Questionário de Incapacidade Roland-Morris e a escala visual analógica (EVA) de dor, com avaliações antes, 1 mês e 3 meses após o procedimento. Foram incluídos 59 pacientes, 32 no grupo corticoide e 27 no grupo PRP. Não houve diferença significativa entre os tratamentos nos questionários de incapacidade e Roland Morris, embora tenha sido observada uma interação significativa entre tratamento e tempo (p=0,038). Na escala de dor, não houve diferença entre os tratamentos em nenhum dos tempos avaliados. O estudo evidenciou ausência de superioridade do Plasma Rico em Plaquetas em comparação ao corticoide na avaliação de dor e escores de função no tratamento da síndrome facetária lombar. Nível de evidência I; Estudo clínico randomizado.
BackgroundDigital speech analysis affords robust markers of Parkinson's disease (PD). However, most studies target late-onset PD (LOPD), neglecting early-onset PD (EOPD) -an increasingly prevalent subtype. This proof-of-concept study tackles such gap.MethodsWe used machine learning to discriminate persons with EOPD (with symptom onset before age 50) and LOPD (with symptom onset after age 50) from healthy controls (HCs) through prosodic and articulatory features from natural speech.ResultsMaximal classification between patients and HCs was afforded by combined prosodic and articulation features in LOPD (AUC = 0.90) and by articulation alone in EOPD (AUC = 0.79), with chance-level discrimination between patient groups (AUC = 0.55). Motor severity (MDS-UPDRS-III) scores predicted by these features correlated with actual motor severity scores in both LOPD (r = 0.52, p < 0.001) and EOPD (r = 0.27, p < 0.001).ConclusionsDigital speech markers offer markers of PD irrespective of age of onset. Voice recordings capture motor symptoms in Parkinson's disease irrespective of age of onsetPlain language summaryOne of the earliest symptoms in Parkinson's disease is abnormal speech. Most people living with this disorder present a softer voice, unclear pronunciation, or reduced variation in pitch. These changes can impact communication, confidence, and everyday life. New digital tools now allow researchers to measure speech automatically and objectively, offering a simple and affordable way to monitor these problems. However, most studies have focused on people whose Parkinson's symptoms begin after age 50 (late-onset Parkinson's disease). Little is known about speech changes in people whose symptoms begin earlier in life, before age 50 (early-onset Parkinson's disease).In this study, we recorded natural speech samples from adults with early-onset Parkinson's, late-onset Parkinson's, and healthy adults. Participants were asked to describe what they had done since waking up—an easy, conversational task similar to everyday speaking. We then used computer-based methods to measure two aspects of speech: prosody (pitch, loudness, timing) and articulation (how clearly sounds are produced). Using machine-learning techniques, we tested whether these speech features could help distinguish people with Parkinson's from healthy adults and whether they could estimate the severity of movement symptoms.Our results showed that speech could reliably identify people with Parkinson's in both groups. For the late-onset group, disease detection was maximal when combining prosodic and articulatory features. For the early-onset group, articulation alone worked best, though accuracy was somewhat lower. Importantly, speech features also related to the severity of patients' motor symptoms in both groups.This study suggests that simple speech recordings can provide valuable insights into Parkinson's disease regardless of the age at which symptoms begin. With further research, digital speech analysis could support earlier detection, personalized care, and improved tracking of symptoms over time.
To evaluate the association between sagittal femoral morphology and coronal alignment phenotypes. It was hypothesised that sagittal femoral morphology is not associated with coronal phenotype classifications. This retrospective study analysed a prospectively maintained institutional database including patients who underwent primary total knee arthroplasty (TKA) between January 2021 and November 2022. Preoperative radiographic assessment included standardised lateral and full-length weight-bearing radiographs. Coronal alignment parameters included mechanical hip-knee-ankle angle (mHKA), arithmetic hip-knee-ankle angle (aHKA), lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA) and joint line obliquity (JLO). Sagittal femoral morphology was assessed using anterior femoral offset (AFO), posterior femoral offset (PFO) and anteroposterior femoral size (AP size). Patients were classified according to the coronal plane alignment of the knee (CPAK) classification and functional knee phenotypes (FKPs). A total of 212 patients were included. No significant associations were observed between sagittal femoral morphology and coronal phenotypes. AFO, PFO and AP size did not differ across CPAK types (p = 0.779, p = 0.127 and p = 0.124, respectively) or FKP groups (p = 0.622, p = 0.409 and p = 0.196, respectively). No significant differences were found when stratifying patients according to aHKA or JLO categories. Interaction analyses showed no significant effects between coronal phenotypes and sagittal morphology (all p > 0.05), with low explanatory power (R 2 ≤ 0.14). Sagittal femoral morphology is not associated with coronal alignment phenotypes, indicating that sagittal and coronal knee characteristics represent independent anatomical domains. Coronal phenotype classifications alone may therefore be insufficient to characterise patient-specific femoral morphology during preoperative TKA planning. Level III.
Cup protrusion has been recognized as the most sensitive and specific radiological parameter to predict iliopsoas (IP) impingement after total hip arthroplasty (THA): it is a necessary but not sufficient factor. We aimed to investigate the following: (1) whether radiological differences exist between protruding cups associated with symptomatic IP impingement and asymptomatic ones; (2) which positional parameters correlate with symptomatic IP impingement in THA with cup protrusion. This retrospective case-control study included 35 noncemented THAs with CT-confirmed IP impingement (clinical, radiographic, and arthroscopic diagnosis) and 17 asymptomatic noncemented THAs with comparable protrusion and ≥5 years of follow-up. Postoperative CT scans were evaluated for cup protrusion in all planes, inclination, anteversion, cup tilt, femoral and acetabular offsets, eccentric reaming, leg length discrepancy (LLD), and stem antetorsion. Groups were comparable for age, sex, side, diagnosis, and protrusion magnitude. Symptomatic hips showed markedly greater acetabular diameter mismatch (1.7 mm vs-1.8 mm; Cohen's d = 1.16), higher cup anteversion (19.8° vs 11.5°; d = 0.88), greater sagittal tilt (19.9° vs 11.2°; d = 0.81), and smaller LLD (1.4 vs 6.8 mm; d = 0.73). In the exploratory Firth penalized logistic regression model, acetabular diameter mismatch was the only variable associated with symptomatic IP impingement (OR 1.33, 95% CI, 1.09 to 2.26), whereas anteversion, tilt, and LLD did not retain independent associations. Among THAs with comparable cup protrusion, cup oversizing showed the strongest and most consistent association with symptomatic IP impingement, whereas increased anteversion and sagittal tilt appeared to modulate the mechanical consequences of protrusion. Level of Evidence: III.
Objective This study aimed to determine the short-term effects of a research methodology course (intervention) on knowledge enhancement of participants from economically emerging (cohort 1) and economically developed (cohort 2) countries; and to determine the long-term publication trajectory of course participants from the time of intervention (timepoint 1 (T1)) to 10 years post-course (timepoint 2 (T2)). Participants/setting Residents/fellows/junior staff from academic institutions of cohorts 1 and 2 completed a four-day research course divided into research design (M1) and statistics (M2) modules. Intervention A 30-item multiple-choice pre-test was provided at the beginning and end of the course for M1 and M2. Pre-/post-test scores assessed knowledge enhancement. A PubMed search (1966-2024) was conducted to evaluate the number, impact factor (IF), and authorship of publications until T1 and T2. Results  In cohort 1, 21 (100%) participants (male-to-female ratio: 11:10; six residents and 15 fellows/junior staff) aspired to an academic career; in cohort 2 (male-to-female ratio: 12:7), 12/19 (63%) (seven residents and five fellows/junior staff) did. At T1, differences were noted between pre- and post-test scores for cohort 1 in M1 (p=0.0005) and M2 (p=0.001), but only for M2 (p=0.01) for cohort 2. For aspiring academicians, whereas the mean number of publications/person was similar between cohort 1 (N=1.1) and cohort 2 (N=2.75) at T1 (p=0.12), it was higher for cohort 2 (N=27.4 vs. N=8.95) at T2 (p=0.03), with similar mean IF of publications for cohorts 1 and 2 at T1 and T2 (p>0.05). Conclusion In the short term, radiology trainees from both countries benefited from the educational research program, particularly in statistics. Over a decade, whereas the quality (IF) of publications remained stable for academicians of both countries, the publication output/person remained stable for cohort 2 participants but declined for cohort 1 participants.
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Digital technologies increasingly shape postgraduate medical education, yet orthopedic and trauma training face unique challenges because of the tactile, procedurally focused skills involved. Digital tools partially address these needs, but gaps remain, particularly across diverse European contexts. Our primary aim was to quantitatively assess predictors of digital learning technology acceptance (e-learning, distance education, and virtual reality [VR] and augmented reality [AR]) among European orthopedic and trauma trainees, drawing on the technology acceptance model (TAM) and the unified theory of acceptance and use of technology (UTAUT) as conceptual guides. Specifically, we examined how perceived usefulness and perceived ease of use (TAM), alongside performance expectancy, effort expectancy, social influence, and facilitating conditions (UTAUT), related to trainees' acceptance of digital technologies. These constructs guided variable selection and grouping, attitudinal scale design, and interpretation of how individual and contextual factors shape acceptance of digital learning tools in orthopedic training. Secondary aims were to describe adoption and attitude patterns, identify attitudinal trainee profiles, and examine contextual associations (eg, workplace type and national gross domestic product [GDP]). We distributed a multinational survey via European trainee federations and used validated scales to assess digital competence and attitudes and gathered demographic data (n=217 across 29 European countries). We administered the questionnaire in English; however, respondents who self-reported English proficiency below the intermediate level were excluded from the analyses to minimize potential comprehension-related bias. The survey assessed digital experience, self-reported digital competence, and attitudes toward e-learning, distance education, and VR/AR, and collected detailed demographic and workplace data. Expert review, cognitive pretesting, and pilot testing ensured validity and clarity. Analytical methods included Wilcoxon tests, ANOVA, clustering, multinomial logistic regression, and factor analysis to ensure the reliability and validity of attitudinal measures. e-Learning technologies were the most widely adopted, whereas VR/AR tools were less frequently used despite high average attitude ratings (mean 4.07, SD 0.88). Cluster analysis identified 3 distinctive groups-enthusiastic, supportive, and hesitant-that differed significantly in digital competence and acceptance profiles. Digital competence and national GDP emerged as significant predictors of group membership, consistent with TAM/UTAUT expectations that perceived capability and contextual facilitating conditions shape acceptance. Variation in attitudes was further associated with workplace type and regional resource disparities, underscoring the influence of contextual factors on technology adoption. European orthopedic trainees show broad support for digital innovations, preferring VR/AR despite low use. Preliminary evidence supports digital competence as a key mediator of acceptance, with GDP and workplace disparities predicting profiles (hesitant vs enthusiastic). Competence-first strategies and targeted resource equity (eg, low-GDP subsidies), together with policy adjustments, may address regional disparities. Future longitudinal and multimethod studies are needed to test causal pathways implied by TAM and UTAUT and to evaluate the generalizability of these findings across specialties and educational contexts.
Anterior tibial tuberosity avulsion fracture (ATF) is a rare injury in adolescents, usually associated with sports activities, ranging from mild to complex cases. Early diagnosis and appropriate treatment are essential to recover knee function and avoid complications. This study analyzed updates and innovations in the treatment of ATF in adolescents, highlighting recent therapeutic approaches and their efficacy. A narrative review of the literature was performed in the Lilacs, PubMed and Capes Periodicals databases. Treatment should be individualized, with a conservative approach for stable fractures and surgical fixation for severe cases. Advances such as fluoroscopy-guided percutaneous fixation have optimized recovery, allowing better joint assessment and less invasiveness. Postoperative management emphasizes early mobilization and physiotherapeutic rehabilitation, favoring functional recovery and a safe return to sports. The prognosis is generally favorable, provided the diagnosis is accurate and the follow-up is rigorous. Rehabilitation is essential to restore muscle strength and prevent relapses. Despite advances, the scarcity of long-term studies highlights the need for more research to standardize protocols and improve clinical outcomes. Level of Evidence II, Review Study. A fratura-avulsão da tuberosidade anterior da tíbia (FATAT) é uma lesão rara em adolescentes, geralmente associada a atividades esportivas, variando de casos leves a complexos. O diagnóstico precoce e o tratamento adequado são fundamentais para recuperar a função do joelho e evitar complicações. Este estudo analisou as atualizações e inovações no tratamento da FATAT em adolescentes, destacando abordagens terapêuticas recentes e sua eficácia. Foi realizada uma revisão narrativa da literatura nas bases Lilacs, PubMed e Periódicos Capes. O tratamento deve ser individualizado, com abordagem conservadora para fraturas estáveis e fixação cirúrgica para casos graves. Avanços como a fixação percutânea guiada por fluoroscopia têm otimizado a recuperação, permitindo melhor avaliação articular e menor invasividade. O manejo pós-operatório enfatiza mobilização precoce e reabilitação fisioterapêutica, favorecendo a recuperação funcional e o retorno seguro ao esporte. O prognóstico é geralmente favorável, desde que o diagnóstico seja preciso e o acompanhamento rigoroso. A reabilitação é essencial para restaurar a força muscular e prevenir recidivas. Apesar dos avanços, a escassez de estudos de longo prazo evidencia a necessidade de mais pesquisas para padronizar protocolos e aprimorar os resultados clínicos. Nível de Evidência II, Estudo de Revisão.
The definitive management of fractures is not completely unhazardous, with fracture-related infection (FRI) being one of the complications. The main objective of this study was to determine the prevalence of FRI in patients with closed femur fractures treated with initial external fixation followed by definitive fixation at a reference hospital. A cross-sectional observational study was conducted over a seven-year period. Patients aged 18 to 65 years with closed diaphyseal femoral fractures were included. FRI was defined according to the international consensus of Metsemakers et al. Demographic, clinical, and microbiological variables were analyzed using descriptive statistics with STATA v16.0. A total of 32 patients were evaluated, with a mean age of 33.9 years; 81.3% were male. Traffic accidents accounted for 87.5% of the cases, most frequently involving motorcycles (84.3%). The most common AO classification was 32B (53.1%). Conversion to internal fixation was performed between 4 and 21 days after the trauma. The prevalence of FRI was 12.5%, appearance of infection signs in the femur was between 3 and 16 days, and the predominant bacterial isolate was gram-negative bacteria. The prevalence of early infection was higher than that reported in other settings, with a predominance of Gram-negative bacteria. Studies with larger sample sizes are needed to identify risk factors and to guide region-specific prevention strategies.
Radial tears of the lateral meniscus have limited healing potential and unfavorable biomechanics, and current suture constructs that use capsular rip-stop stitches may increase meniscal extrusion and constrain native motion. This technical note describes an all-inside, crossed, meniscus-based repair for complete or near-complete radial tears of the lateral midbody using a percutaneous needle. Key steps, indications, and rehabilitation are detailed. This construct aims to balance stability with preservation of meniscal mobility and vascularity; prospective clinical studies are required to confirm its long-term efficacy.
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Soft tissue chondroma, also known as extraskeletal chondroma or soft tissue osteochondroma, is a rare benign tumor composed of chondrocytes and a hyaline cartilage matrix. Imaging plays a fundamental role in its diagnosis, with the primary finding being a soft tissue mass devoid of any adjacent bone connections. Calcifications or ossifications are typically observed, although they are not mandatory for diagnosis. In this article, we present three cases of this rare entity manifesting in the hand, accompanied by comprehensive imaging findings obtained through radiography, ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI), as well as the corresponding macroscopic and histopathological examinations. We will describe the key clinical, imaging, and pathological features of this condition.
The distal femur is the most common site for bone sarcoma in children. Expandable prostheses may be used to overcome the resultant limb length discrepancy due to the sacrifice of the growth plate in children who undergo resection of primary bone tumors in the distal femur. Few studies analyzed the complications in children treated with expandable prostheses. Furthermore, to date, no studies evaluated the association between medial tibial plateau deformity and the use of constrained versus rotating hinges expandable prostheses in children who underwent primary bone resection of the distal femur. This study aimed to evaluate the complications and reconstruction survival rates associated with expandable prostheses for the distal femur in children with primary bone tumours, with a particular focus on the risk of tibial plateau deformity related to the use of constrained versus rotating hinge expandable prostheses. We performed a retrospective single-centre study of 25 children who underwent distal femur reconstruction with expandable prostheses after resection of primary bone tumours between 2001 and 2024. Eleven children had rotating hinge expandable prosthesis, 14 children had constrained hinge expandable prosthesis, nine children had mechanical expandable prosthesis, and 16 children had magnetic expandable prosthesis. Eight out of 25 children had expandable prosthesis with uncemented femoral stem, and 17 out of 25 children had cemented femoral stem. All 25 children had expandable prosthesis with uncemented tibial smooth stem. The median age of children was nine years (range, 5-14 years). The median follow-up was 9.4 years (range, 1.1-16.5 years). Twelve out of 25 children (48%) presented complications. The mean number of complications per child was 1.0 (range, 0-2). Aseptic loosening of the femoral stem was observed in four out of 25 children (16%). Periprosthetic fracture occurred in one out of 25 children (4%). Breakage of the hinge component of the prosthesis occurred in one out of 25 children (4%). Infection occurred in two out of 25 children (8%). None of the 14 children with constrained hinged prosthesis presented medial tibial plateau deformity. In contrast, seven out of 11 children (63%) who underwent reconstruction with rotating hinge expandable prostheses presented medial tibial plateau deformity. Overall, nine of the 25 children (36%) had to replace their temporary expandable prosthesis with a definitive standard prosthesis. Reconstruction survival was 79.3% at five years (95% confidence interval 53.7 to 91.7%) and 59.5% at ten years (95% confidence interval 28.3% to 80.1%). Rotating hinge prosthesis showed a high risk of medial tibial plateau deformity compared to constrained hinged prosthesis. We may recommend the preferential use of constrained hinge expandable prosthesis in children who undergo primary bone tumour resection of the distal femur to reduce the risk of tibial deformity.
Distal radial and ulnar fractures in miniature- and toy-breed dogs are associated with high rates of delayed union, non-union, and refracture. This retrospective observational study evaluated the outcomes of simple distal radial and ulnar fractures treated by open reduction and internal fixation using a locking plate in a non-rigid configuration. Ten fractures in eight dogs weighing less than 5 kg were included. Cases were selected according to predefined biomechanical construct criteria, including a plate bridge ratio > 0.7, plate span ratio > 10, plate working length > 40% of the plate length, and screw density < 0.6. The median radiographic follow-up was 224 days (range, 46-408 days). Radiographic bone healing was achieved in all cases, with a mean time to union of 53 days (range, 28-113 days), and healing occurred faster in skeletally immature dogs. Indirect bone healing with callus formation was observed in 7 of 10 fractures. Minor postoperative complications occurred in three cases and resolved with local treatment. No implant failures or refractures associated with previous screw holes were observed. A reduction in ulnar thickness was identified in evaluable cases, although this finding remained stable during follow-up and did not appear clinically relevant. These findings suggest that locking plate fixation in a non-rigid configuration provides reliable bone healing with a low complication rate in simple distal radial and ulnar fractures of miniature- and toy-breed dogs.
There is no standardized treatment for multifragmentary fractures of the anterior tibial tuberosity (ATT) in adult patients, with or without concomitant metaphyseal fractures of the proximal tibia. This technical note aims to demonstrate the results of using a minifragment plate positioned horizontally according to the tension band principle in two patients with multifragmentary fractures of ATT. Não existe padronização de tratamento para as fraturas multifragmentares da tuberosidade anterior da tíbia (TAT) nos pacientes adultos, com ou sem associação com fraturas metafisárias da tíbia proximal. O objetivo desta nota técnica é demonstrar os resultados da utilização da placa de minifragmentos colocada segundo o princípio da banda de tensão, de forma horizontal, em dois pacientes portadores de fratura multifragmentar da TAT.