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Grivas TB, Jevtic N, Ljubojevic D, Pjanic S, Golic F, Vasiliadis E. Segmental Rib Index and Spinal Deformity: Scoliogenic Implications. Healthcare (Basel) 2023; 11:3004. [PMID: 37998495 PMCID: PMC10671148 DOI: 10.3390/healthcare11223004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/20/2023] [Accepted: 11/16/2023] [Indexed: 11/25/2023] Open
Abstract
The aim of this report is to evaluate the segmental rib index (RI) from the T1 to T12 spinal levels in mild and moderate idiopathic scoliosis (IS) curves of thoracic, thoracolumbar and lumbar type by gender. The relationship of segmental RI to the frontal plane radiological deformity presented as the Cobb angle and to the posterior truncal surface deformity presented as the scoliometric readings of Angle of Trunk Rotation (ATR) in these patients is also assessed. Any statistically significant relationship between these parameters would be very important for biomechanical relations in rib cage (RC) deformity presented as rib hump deformity (RHD) and deformity in the spine, and would thus provide valuable information about scoliogeny. The segmental rib index (RI) is presented in 83 boys and girls with mild and moderate IS. The measurements include the scoliometric readings for truncal asymmetry (TA), the Cobb angle assessment and the segmental RI from T1-T12. The statistical package SPSS 23 was used for statistical analysis. The TA was documented and the Cobb angle is presented by gender and curve type. The segmental RI of thoracic, thoracolumbar and lumbar curves are presented for the first time. The correlations of the segmental RI to surface deformity presented as rib hump deformity (RHD) in all IS patients, and particularly in thoracic curves, to Cobb angle by gender and age and the comparison of the segmental RI index of asymmetric but not scoliotic children to the scoliotic peers by curve (in thoracic, thoracolumbar, lumbar curves) in boys and girls are presented. The findings emphasize the significant protagonistic role of thoracic asymmetry in relation to the spinal deformity, mainly in girls for the thoracic and in boys for the thoracolumbar curves. The cut-off point of age of the examined scoliotics was 14 years, which is when the RI shows a stronger correlation with spinal deformity, namely when thoracic deformity is decisively effective in the development of thoracic spinal deformity, in terms of Cobb angle. In summary, the results of this study may provide scoliogenic implications for IS, as far as the role of the thorax is concerned.
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Affiliation(s)
- Theodoros B. Grivas
- Department of Orthopedics & Traumatology, “Tzaneio” General Hospital of Piraeus, 185 36 Piraeus, Greece
| | | | | | - Samra Pjanic
- Department of Pediatric Rehabilitation, Institute for Physical and Rehabilitation Medicine “Dr Miroslav Zotovic“, 78000 Banja Luka, Bosnia and Herzegovina; (S.P.)
| | - Filip Golic
- Department of Pediatric Rehabilitation, Institute for Physical and Rehabilitation Medicine “Dr Miroslav Zotovic“, 78000 Banja Luka, Bosnia and Herzegovina; (S.P.)
| | - Elias Vasiliadis
- 3rd Department of Orthopaedics, School of Medicine, KAT Hospital, National and Kapodistrian University of Athens, 165 41 Athens, Greece;
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Sleiman A, Bejcek C, Nestler A, Revelt N, Thuppal S, Mills A, Gardner M. The history of orthopaedic use of nitinol compression staples. Injury 2023; 54:111036. [PMID: 37769424 DOI: 10.1016/j.injury.2023.111036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 08/28/2023] [Accepted: 09/08/2023] [Indexed: 09/30/2023]
Abstract
INTRODUCTION The use of nitinol continuous compression staples has shown clinical utility in the management of various orthopaedic injuries. While literature is most robust in the realm of foot/ankle and spine surgery, the use of nitinol staples has been documented in fixation of wrist, olecranon, patella, and pelvis fractures. METHODOLOGY A narrative review was conducted by searching three online databases - PubMed, Web of Science, and Cochrane using the terms "Nitinol" and "Staple" published between 2003 and 2023. A total of 42 articles met inclusion/exclusion criteria and were included in this review. REVIEW Literature outside of foot/ankle and spine surgery is largely limited to biomechanical studies, case reports, and finite element analyses. The literature is summarized within this review by anatomic location including foot/ankle, lower extremity, hand, upper extremity, spine, and pelvis. CONCLUSION Existing literature demonstrates a diverse array of applications for nitinol continuous compression staples in both axial and appendicular orthopaedic care. Advantages of these implants include ease of application, ability to capture small bony fragments, continuous compression across a fracture or arthrodesis, and full coaptation which maximizes the surface area for healing and/or fusion.
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Affiliation(s)
- Anthony Sleiman
- Division of Orthopedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, 801 N. Rutledge St, Springfield, IL 62702, United States
| | - Christopher Bejcek
- Division of Orthopedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, 801 N. Rutledge St, Springfield, IL 62702, United States
| | - Anthony Nestler
- Division of Orthopedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, 801 N. Rutledge St, Springfield, IL 62702, United States
| | - Nicolas Revelt
- Division of Orthopedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, 801 N. Rutledge St, Springfield, IL 62702, United States
| | - Sowmyanarayanan Thuppal
- Division of Orthopedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, 801 N. Rutledge St, Springfield, IL 62702, United States
| | - Andrew Mills
- Division of Orthopedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, 801 N. Rutledge St, Springfield, IL 62702, United States; Springfield Clinic Orthopedic Surgery, 800 N 1st St, Springfield, IL 62702, United States
| | - Matthew Gardner
- Division of Orthopedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, 801 N. Rutledge St, Springfield, IL 62702, United States; Springfield Clinic Orthopedic Surgery, 800 N 1st St, Springfield, IL 62702, United States.
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Grivas TB, Vasiliadis E, Vynichakis G, Chandrinos M, Athanasopoulos K, Christodoulides P. Why Is There Always a Remnant Rib Hump Deformity after Spinal Operations in Idiopathic Scoliosis: Aetiological Implications and Recognition of the Proper Rib Level for Costoplasty. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1697. [PMID: 37892360 PMCID: PMC10605549 DOI: 10.3390/children10101697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 09/28/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023]
Abstract
The aim of this report is to review the literature dealing with the postoperative correction of rib hump (RH) after spinal operations for adolescent idiopathic scoliosis (AIS) and its aetiological implications of hump postoperative fate for IS. Recommendations related to RH deformity for the follow-up of younger asymmetric but not scoliotic children are provided, and the concept that clinical monitoring of the chest deformity is more important than merely an initially negative radiographic examination (curve less than 10°) is underlined. Additionally, guidelines are provided based on the segments T1-T12 rib index (RI) in the existing lateral preoperative radiographs for the optimal selection of the rib level for a successfully costoplasty. This review is based on the collected articles that used either the RI method, derived from the double rib contour sign (DRCS) at the lateral spinal radiographs, or alternative methods for the assessment of the RH deformity and presented the results of the operative treatment of the scoliotic spine on RH. A total of 19 relevant articles published from 1976 to 2022 were found in PubMed. Findings: All the above articles show that not only is the hump incompletely corrected, but it recurs and worsens during the follow-up and even more intensively in skeletally immature operated scoliosis children. Conclusions and Future Directions: Surgery straightens the spine, yet the RH is corrected approximately only as much as the spinal derotation. The only way to correct the RH more is with costoplasty, which, however, is not performed in most cases for many reasons. The key reason for this phenomenon is the fact that the RH deformity (RHD) is mainly due to the asymmetric development of the ribs and much less so due to the rotation of the vertebrae in the thoracic spine. Surgery on the spine cannot limit the asymmetry of the ribs or stop the mechanism that causes their asymmetrical growth. The results presented in all the reviewed articles support the important protagonistic role of RHD on scoliogenesis, which precedes the subsequent formed spinal deformity.
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Affiliation(s)
- Theodoros B. Grivas
- Department of Orthopedics & Traumatology, “Tzaneio” General Hospital of Piraeus, 18536 Piraeus, Greece
| | - Elias Vasiliadis
- 3rd Department of Orthopaedics, School of Medicine, National and Kapodistrian University of Athens, KAT Hospital, 16541 Athens, Greece;
| | - George Vynichakis
- Orthopedic Department, Gen. Hospital of Argolida—N.M. Argos, 21231 Argos, Greece; (G.V.); (M.C.)
| | - Michail Chandrinos
- Orthopedic Department, Gen. Hospital of Argolida—N.M. Argos, 21231 Argos, Greece; (G.V.); (M.C.)
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Haber L, Starring H, Newcomb N, Larson AN, Desai B, Roybal J, Fant W, Milbrandt T, Boeyer M, Marks M, Newton P, Samdani A, Miyanji F, Hoernschemeyer D. Drain options after vertebral body tethering. Spine Deform 2023; 11:367-372. [PMID: 36219390 DOI: 10.1007/s43390-022-00595-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 09/17/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE Since the introduction of vertebral body tethering (VBT) for adolescent idiopathic scoliosis (AIS), a variety of post-operative chest drainage systems have been utilized. Most surgeons use formal chest tubes with a Pleur-evac, while others use smaller bulb suction drains (e.g., Blake drain). In addition, some centers utilize pleural closure. This multicenter study evaluates whether drain type or pleural closure impact perioperative and 90 day complication rates. METHODS A retrospective review was conducted from three institutions with established VBT programs. All preoperative, perioperative and 90 day postoperative data were analyzed to determine differences in outcomes between three cohorts: standard chest tube (SCT), standard chest tube with pleural closure (SCTPC) and 10 French Bulb drain (BD). RESULTS 104 patients were identified for the study. 57 SCT, 25 SCTPC and 22 BD. All data are listed in order: SCT, SCTPC, BD. Length of stay (3.7, 4.3, 3.0 days) was less in the BD group (p = 0.009); post-operative drainage (460, 761, 485 cc) was less in the SCT and BD groups (p < 0.001); intra-operative estimated blood loss (EBL) 146, 382, 64 cc was less in the BD group (p < 0.001). No significant difference in number of days (3.2, 3.2, and 2.8 days) drainage was in place, groups (p = 0.311). Complication profile was similar with 2 chest tube reinsertions in the SCT and one hemothorax that resolved spontaneously in BD group. CONCLUSIONS In this series of 104 patients, SCT, SCTPC and BD all had a similar safety profile. All three methods were safe and effective in managing post-operative chest drainage after thoracic VBT. In the series, BD group had significantly shorter LOS than both groups that used chest tubes. LEVEL OF EVIDENCE Level III, Retrospective cohort study.
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Affiliation(s)
- Lawrence Haber
- Department of Orthopaedic Surgery, Ochsner Clinic Foundation, 1415 Jefferson Hwy, New Orleans, LA, 70121, USA
| | - Hunter Starring
- Department of Orthopaedic Surgery, Ochsner Clinic Foundation, 1415 Jefferson Hwy, New Orleans, LA, 70121, USA.
| | - Nicholas Newcomb
- University of Queensland-Ochsner Clinical School, New Orleans, LA, USA
| | - A Noelle Larson
- Department of Pediatric Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Bhumit Desai
- Department of Orthopaedic Surgery, Ochsner Clinic Foundation, 1415 Jefferson Hwy, New Orleans, LA, 70121, USA
| | - Jessica Roybal
- Department of Pediatric Surgery, Ochsner Clinic Foundation, New Orleans, LA, USA
| | - Whitney Fant
- Department of Orthopaedic Surgery, Ochsner Clinic Foundation, 1415 Jefferson Hwy, New Orleans, LA, 70121, USA
| | - Todd Milbrandt
- Department of Pediatric Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Melanie Boeyer
- Department of Orthopaedic Surgery, University of Missouri-Columbia, Columbia, MO, USA
| | | | - Peter Newton
- Division Orthopedics and Scoliosis, Rady Children's Hospital, San Diego, CA, USA
| | - Amer Samdani
- Department of Pediatric Orthopedic Surgery, Shriners Children's Philadelphia, Philadelphia, PA, USA
| | - Firoz Miyanji
- Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
| | - Dan Hoernschemeyer
- Department of Orthopaedic Surgery, University of Missouri-Columbia, Columbia, MO, USA
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The Use of Nitinol Compression Staple Fixation and Bone Graft for Scaphoid Waist Fractures and Nonunion: A Surgical Technique. Tech Hand Up Extrem Surg 2020; 25:35-40. [PMID: 32544108 DOI: 10.1097/bth.0000000000000303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In the management of scaphoid fractures, nonunion is an important complication that can lead to carpal instability and early-onset arthritis. Various techniques have been described to treat scaphoid nonunions, yet a clear consensus on the superiority of one method is not yet established. The use of compression staple fixation has been described in the literature and may be a viable alternative to other fixation techniques. Volar Nitinol staple fixation avoids damage to the trapezium during retrograde fixation with a screw. It also avoids damage to the proximal dorsal cartilage, which occurs during anterograde screw fixation. Because of its shape and position on the volar aspect of the scaphoid, staple fixation provides compression, prevents graft extrusion, and avoids taking up space in the medullary canal of the scaphoid. Moreover, it may be technically easier than screw fixation. Despite these advantages, this technique has not been widely adopted. We describe the technique for utilizing Nitinol compression staples and bone grafting in the treatment of scaphoid nonunion.
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