Orthopaedic medicine is in the process of undergoing a remarkable transformation in the realm of fracture fixation techniques, signaling a pivotal turning point in the care and treatment of individuals grappling with a myriad of bone fractures. These innovations are reshaping the landscape of orthopaedic trauma care, enhancing the prospects of recovery and overall patient well-being. From addressing the intricate challenges of hip fractures to advancing surgical implants to novel osteosynthesis methods, these developments are not only expanding the repertoire of orthopaedic surgeons but also presenting patients with new hope for regaining mobility and health.
Hip Fracture Care: Lifesaving Innovations
Dr. Liporace, an orthopaedic surgeon who has dedicated his career to improving care for hip fractures, and his team have introduced a surgical system that helps strengthen hip fractures, allowing patients to bear weight on their repaired hips immediately after surgery. Not only does this system make the surgical procedure technically easier for surgeons, but it also ensures a better match between the patient’s anatomy and biomechanics. Dr. Liporace’s accelerated care hip fracture program has led to a dramatic reduction in morbidity and mortality, fewer blood clots, and a decrease in the use of narcotics after surgery. Additionally, it enables more patients to return home directly from the hospital, rather than going to a rehabilitation facility.
Innovative Surgical Implants for Complex Fractures
Dr. Liporace’s commitment to advancing orthopaedic care extends beyond hip fractures. He and his team have developed a range of surgical implants that address various challenging fractures:
Nail System: Designed for treating proximal humerus fractures, tibia fractures, femur features, and ankle arthritis, this nail system provides a comprehensive solution for a wide range of complex fractures.
Plating System: Targeting proximal humerus fractures, this system offers a versatile solution to improve patient outcomes.
Revision Knee Replacement System: For patients with the most complex failed knee replacements and situations involving catastrophic bone loss, this system offers innovative solutions.
Distal Femur Fracture System: Dr. Liporace contributed to the development of an enhanced surgical technique that combines surgical nails and plates to fix these types of fractures. This technique enables patients to ambulate faster and recover more quickly after surgery.
Total Hip Replacement System: Collaborating with a team, Dr. Liporace has designed a system of plates and screws to enhance surgical results for patients with broken bones around the implants of total hip replacements.
Revolutionizing Osteosynthesis
Traditionally, orthopaedic surgeons have relied on metal-based osteosynthesis materials for fracture fixation. However, in complex comminuted osteoporotic fractures, these materials may not provide the best solution due to their rigid and non-customizable nature. Metal plates, in particular, have been known to induce joint stiffness and soft tissue adhesions.
A novel osteosynthesis method using a light-curable polymer composite called AdhFix has been introduced. This method allows for customization by surgeons in situ and has shown promise in reducing soft tissue adhesions, which are common with traditional metal plates in complex fractures. Studies comparing AdhFix to conventional metal plates have demonstrated its superior stiffness and mechanical performance.
Pelvic Fractures
Pelvic fractures with sacroiliac extension present significant challenges in orthopaedic care. Managing these injuries and achieving favorable outcomes can be complex, especially when patients have comorbidities and non-compliance issues. In one case, a patient with a history of deep vein thrombosis (DVT) and COVID-19 infection experienced a pulled-out sacroiliac screw (SIS) due to pelvic fracture. To address this challenging situation, a spinopelvic in-situ fixation from L4 to S2 was performed and augmented with a left SIS. The patient’s quick recovery, early mobilization, and ability to bear full weight after the surgery demonstrated the viability of this approach.
Forskolin Scaffold: A Game-Changer in Bone Regeneration
Conventional bone grafts are often used for complex fractures, but they may not always work effectively and can be costly. Orthopaedic surgeons have started using specific human proteins, such as recombinant human bone morphogenetic proteins (rhBMPs), to encourage bone growth, both along and in conjunction with grafts or scaffolds. However, rhBMPs have limitations, including cost, immune system reactions, and unwanted bone growth in unintended locations.
Researchers at the UConn School of Medicine introduced a different approach to encourage bone growth. They developed a scaffold made of a biodegradable polymer impregnated with forskolin, a small molecule that encourages bone growth. This scaffold releases forskolin primarily within a 24-hour period, minimizing the undesirable effects seen with long-term use of traditional recombinant human bone morphogenetic proteins (rhBMPs). This study has shown that the forskolin scaffold performed as effectively as rhBMP-impregnated scaffolds in encouraging new bone growth while being more cost-effective, stable, and less likely to induce an immune system reaction.
Orthopaedic advances in fracture fixation techniques have significantly improved patient care and outcomes. Pioneering surgeons and innovative methods, such as AdhFix and forskolin-impregnated scaffolds, are changing the field and providing patients with better options for regaining mobility and health after bone fractures. As technology and research continue to progress, orthopaedic trauma surgeons are paving the way for even more innovative solutions to benefit their patients in the future.
