Femoral Condyles Tangential Views： An Effective Method to Detect the Screw Penetration of Femoral Condyles After Retrograde Nailing

Background： Postoperative knee soft tissue irritation is a common complication after retrograde nail fixation of femoral fractures. Distal locking screw prominence is one of the causes for soft tissue irritation. This study aimed to determine whether the use of the femoral condyles tangential views improve the diagnostic accuracy compared with anteroposterior （A-P） view in detecting distal locking screw penetrations during retrograde femoral nailing. Methods： The angle between the sagittal plane and lateral aspect of the condyle and the angle between the sagittal plane and medial aspect of condyle were measured on computed tomography （CT） images. After the angles were measured and recorded, cadaveric femurs were used in a simulated surgical procedure. The retrograde femoral nail was inserted into the femur and placed distal locking screws, which were let1 2, 4, and 6 mm proud of the medial and lateral condyles for each femur. A-P view, lateral condyle tangential view and medial condyle tangential view were obtained. All fluoroscopic images were recorded and sent to three observers blinded to the experimental procedure to determine whether screws penetrated the condyle cortex or not. Results： According to the results of CT scan, the lateral condyle view was 20.88 ＋ 0.98± and the medial condyle view was 40.46 ± 3.14°. In the A-P view, we detected 0% at 2 mm penetration, 16.7% （lateral condyle screw） and 25.0% （medial condyle screw） at 4 mm, and 41.7% （lateral condyle screw） and 58.3% （medial condyle screw） at 6 mm. In the lateral tangential view, we detected 91.7% at 2 mm penetration of the lateral condyle and 100% at 4 mm and 6 ram. In the medial tangential view, we detected 66.7% at 2 mm penetration of the medial condyle and 100% at 4 mm and 6 ram. The femoral condyle tangential views provided significant improvement in detecting screw penetrations at all lengths （2, 4, and 6 mm） compared with the A-P view （P 〈 0.05）. Conclusions： The femoral condyles tangential views increased the accuracy of detecting screw penetrations on the medial and lateral condyles. Routine clinical use of the femoral condyles tangential views has the potential to increase accuracy in detecting distal locking screw penetration during retrograde femoral nailing.

Evaluation of the performance of Ca-deficient hydroxyapatite(CDHA)/MgF_(2)bilayer coating on biodegradable high-purity magnesium in a femoral condyle defect model in rabbits

The two most critical factors in promoting the clinical translation of magnesium(Mg)are reducing its degradation rate and improving its osteogenesis.In this study,a Ca-deficient hydroxyapatite(CDHA)/MgF_(2)bilayer coating was prepared on high-purity magnesium(HP Mg)rods by fluorination and hydrothermal treatment.Scanning electron microscope showed that the thickness of the bilayer coating was 3.78 lm and that the surface morphology was nanoscale.In an in vivo experiment on femoral condyle defects in rabbits,the serum magnesium ion levels of rabbits were always in the normal range after surgery,and the liver and kidney functions were not abnormal,which indicated that the CDHA/MgF_(2)bilayer coating has good biosafety.Micro-CT showed that the CDHA/MgF_(2)bilayer coating significantly reduced the degradation rate of the HP Mg rods and enhanced the promotion of bone formation.Hard tissue sections showed that the CDHA/MgF_(2)bilayer coating gave the bone tissue a tight contact interface with the HP Mg rod and improved the bone mass.Immunohistochemistry showed that the expression of vascular endothelial growth factor and BMP-2 was more obvious.These results confirm that the CDHA/MgF_(2)bilayer coating can improve the properties of HP Mg and provide a basis for the further transformation of HP Mg in the future.It also provides a new reference for the surface modification of magnesiummetal.

Anatomic variability of the vascularized composite osteomyocutaneous fl ap from the medial femoral condyle: an anatomical study

Aim:The anatomical study and clinical application for the vascularized corticoperiosteal fl ap from the medial femoral condyle have been performed and described previously.Although prior studies have described the composite osteomyocutaneous fl ap from the medial femoral condyle,a detailed analysis of the vascularity of this region has not yet been fully evaluated.Methods:This anatomical study described the variability of the arteries from the medial femoral condyle in 40 cadaveric specimens.Results:The descending genicular artery(DGA)was found in 33 of 40 cases(82.5%).The superomedial genicular artery(SGA)was present in 10 cases(25%).All 33 cases(100%)of the DGA had articular branches to the periosteum of the medial femoral condyle.Muscular branches and saphenous branches of the DGA were present in 25 cases(62.5%)and 26 cases(70.3%),respectively.Conclusion:The current study demonstrates that the size and length of the vessels to the medial femoral condyle are suffi cient for a vascularized bone fl ap.A careful preoperative vascular assessment is essential prior to use of the vascularized composite osteomyocutaneous fl ap from the medial femoral condyle,because of the considerable anatomical variations in different branches of the DGA.

Site-Dependent Osseointegration of Biodegradable High-Purity Magnesium for Orthopedic Implants in Femoral Shaft and Femoral Condyle of New Zealand Rabbits

Magnesium （Mg） has been widely accepted as osteoconductive biomaterial, but osseointegration of Mg device at different implantation sites is still unclear. In the present study, high-purity magnesium （HP Mg） pins were implanted into femoral shaft and condyle of New Zealand rabbits concurrently. 2, 8, 12 and 16 weeks after surgery, rabbit femurs were harvested for micro-computed tomography （micro-CT） scanning and subsequent histological examinations. HP Mg pins were retrieved for scanning electron microscope and energy dispersive spectrum （SEM/EDS） analyses. HP Mg pins at both implantation sites performed stable corrosion with mineral deposition and bone incorporation on surface. However, difference in distribution of contact osteogenesis centers and biological properties of peri-implant bone tissues was detected between femoral shaft and femoral condyle. In femoral condyle, contact osteogenesis centers originated from both periosteum and cancellous bones and the whole HP Mg pin was encapsuled in trabecular bone at 16 weeks. Meanwhile, bone volume to total bone volume （BV/TV） and bone mineral density （BMD） of peri-implant bone tissues were above those of normal bone tissues. In femoral shaft, contact osteogenesis centers were only from periosteum and direct bone contact was confined in cortical bone, while BV/TV and BMD kept lower than normal. Furthermore, new formation of peri-implant bone tissues was more active in femoral condyle than in femoral shaft at 16 weeks. Therefore, although HP Mg performed good biocompatibility and corrosion behavior in vivo, its bioadaption of osseointegration at different implantations sites should be taken into consideration. Bone metaphysic was suitable for Mg devices where peri-implant bone tissues regenerated rapidly and the biological properties were close to normal bone tissues.

Enhanced Biocompatibility and Osseointegration of Calcium Titanate Coating on Titanium Screws in Rabbit Femur

This study aimed to examine the biocompatibility of calcium titanate(CaTiO3) coating prepared by a simplified technique in an attempt to assess the potential of CaTiO3coating as an alternative to current implant coating materials. CaTiO3-coated titanium screws were implanted with hydroxyapatite(HA)-coated or uncoated titanium screws into medial and lateral femoral condyles of 48 New Zealand white rabbits. Imaging, histomorphometric and biomechanical analyses were employed to evaluate the osseointegration and biocompatibility 12 weeks after the implantation. Histology and scanning electron microscopy revealed that bone tissues surrounding the screws coated with CaTiO3were fully regenerated and they were also well integrated with the screws. An interfacial fibrous membrane layer, which was found in the HA coating group, was not noticeable between the bone tissues and CaTiO3-coated screws. X-ray imaging analysis showed in the CaTiO3coating group, there was a dense and tight binding between implants and the bone tissues; no radiation translucent zone was found surrounding the implants as well as no detachment of the coating and femoral condyle fracture. In contrast, uncoated screws exhibited a fibrous membrane layer, as evidenced by the detection of a radiation translucent zone between the implants and the bone tissues. Additionally, biomechanical testing revealed that the binding strength of CaTiO3coating with bone tissues was significantly higher than that of uncoated titanium screws, and was comparable to that of HA coating. The study demonstrated that CaTiO3coating in situ to titanium screws possesses great biocompatibility and osseointegration comparable to HA coating.

Hoffa's fracture in a five-year-old child diagnosed and treated with the assistance of arthroscopy:A case report

BACKGROUND Hoffa’s fracture is a coronal-oriented fracture of the femoral condyle.It is rarely observed in pediatric patients that isolated coronal fracture of the medial femoral condyle accompanies an intact lateral femoral condyle.Only a few cases involving Hoffa’s fracture of the medial femoral condyle have been reported in patients with undeveloped skeletons.Such a fracture cannot be observed by routine imaging examinations,thus resulting in possible misdiagnosis and further treatment challenges.CASE SUMMARY A 5-year-old boy with Hoffa’s fracture of the medial femoral condyle suffered from right knee pain and severe swelling after being hit by a heavy object.The patient was misdiagnosed and initially treated in a local primary healthcare center.No improvement in his right knee’s extension was observed following conservative treatment for 2 wk.The patient was transferred to our hospital,rediagnosed using arthroscopy,and underwent open reduction and internal fixation.The therapeutic outcome was satisfactory with the screws removed 7 mo after fixation.At the final follow-up of 40 mo,the range of motion in the knee had recovered.There was no varus-valgus instability.CONCLUSION Hoffa’s fracture is rarely seen in children aged 5 years,let alone in the medial condyle,and can easily be misdiagnosed due to limited physical and imaging examinations.Suspected Hoffa’s fracture in preschool children should be confirmed based on arthroscopic findings.Open reduction and internal fixation should be performed to protect the articular surface and prevent long-term complications.