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Teimouri M, Akbari Aghdam H, Alipoor R, Lalehzar SS. Operative treatment results of posterior malleolar fractures in trimalleolar fractures with screw fixation and plate fixation: short-term results. Int J Burns Trauma 2024; 14:14-24. [PMID: 38505346 PMCID: PMC10944710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 01/04/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND Ankle fractures are among the most common lower limb fractures. There is no agreement about the best treatment for these fractures. This study compared the short-term results of screw and plate fixation methods. METHODS In this prospective study, 32 patients that underwent screw fixation for posterior malleolar fracture and 32 patients that underwent plate fixation for posterior malleolar fracture were assessed 1, 3, and 6 months after surgery. RESULTS The mean age in group 1 (screw fixation) and group 2 (plate fixation) was 32.56, and 37.82 ± 9.99, respectively. The frequency of gender in group 1 (screw fixation) and group 2 (plate fixation) for females and males was 20%, 80%, 4%, and 18%, respectively. The mean range of motion (ROM) in month 1 in group 1 was 89.4, in group 2 was 90.22, in month 3 in group 1 was 100.6, in group 2 was 100.36, in month 6 in group 1 was 115.4, and in group 2 was 110.68. The mean visual analog scale (VAS) in month 1 in group 1 was 6.88, in group 2 was 6.09, in month 3 in group 1 was 4.14, in group 2 was 3.63, in month 6 in group 1 was 2.56, and in group 2 was 2.54. In group 1, we had 1 case of nerve injury, 1 case of deep infection, and 3 cases of superficial infection, and in group 2, we had 2 cases of nerve injury, 2 cases of deep infection, and no case of superficial infection. The mean foot and ankle outcome score (FAOS) in group 1 was 75.44, and in group 2 was 74.36. CONCLUSION In our study, we were unable to indicate a superior treatment method. More comprehensive studies with larger populations are suggested.
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Affiliation(s)
- Mehdi Teimouri
- Department of Orthopedic Surgery, Kashani University Hospital, School of Medicine, Isfahan University of Medical SciencesIsfahan, Iran
| | - Hossein Akbari Aghdam
- Department of Orthopedic Surgery, Kashani University Hospital, School of Medicine, Isfahan University of Medical SciencesIsfahan, Iran
- Department of Orthopedic Surgery, School of Medicine, Isfahan University of Medical SciencesIsfahan, Iran
| | - Reza Alipoor
- Department of Orthopedic Surgery, Kashani University Hospital, School of Medicine, Isfahan University of Medical SciencesIsfahan, Iran
| | - Sahar Sadat Lalehzar
- Department of Orthopedic Surgery, Kashani University Hospital, School of Medicine, Isfahan University of Medical SciencesIsfahan, Iran
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Ding Y, Wang B, Liu Y, Dong S, Sun X, Cao Z, Wang L. A Rapid and Safe Minimally Invasive Procedure for Percutaneous Pedicle Screw Removal: A Case-Control Study and Technical Description. J Pain Res 2024; 17:219-226. [PMID: 38226072 PMCID: PMC10789567 DOI: 10.2147/jpr.s443879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 12/30/2023] [Indexed: 01/17/2024] Open
Abstract
Purpose Percutaneous pedicle screw fixation is a common minimally invasive treatment for traumatic thoracolumbar and lumbar fractures; however, research on hardware removal after successful healing is limited. We aimed to introduce a rapid, safe, minimally invasive, and cost-effective method for percutaneous pedicle screw removal. Patients and Methods We conducted a retrospective analysis of demographic (age, sex, body mass index, alcohol use, and current smoking), clinical (hypertension and diabetes mellitus), surgical (affected levels, number of screws, time of surgery, and blood loss), and treatment cost characteristics of 92 patients who had undergone percutaneous pedicle screw removal between May 2016 and February 2023. The first 57 patients underwent the conventional method, and the remaining 35 underwent the modified method. Independent-sample t-tests and chi-square tests were used to compare continuous and categorical variables, respectively, between the two groups. Results No significant differences were observed in the demographic parameters, complications, or affected levels between the groups. However, the average surgical time (P=0.000) was significantly shorter, and the average blood loss volume (P=0.002) and total cost (P=0.000) were significantly lower in the modified group than in the conventional group. Conclusion Compared with the conventional method, our modified method can shorten the surgical time, reduce blood loss, and reduce the total cost of treatment. It is a quick and safe minimally invasive method that does not require additional surgical instruments and is suitable for implementation in primary hospitals.
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Affiliation(s)
- Yan Ding
- Department of Orthopedics, Yantaishan Hospital, Yantai, People’s Republic of China
| | - Banqin Wang
- Department of Blood Transfusion, Shandong Provincial Qianfoshan Hospital Affiliated with Shandong First Medical University, Jinan, People’s Republic of China
| | - Yongjun Liu
- Department of Orthopedics, Yantaishan Hospital, Yantai, People’s Republic of China
| | - Shengjie Dong
- Department of Orthopedics, Yantaishan Hospital, Yantai, People’s Republic of China
| | - Xuri Sun
- Department of Orthopedics, Yantaishan Hospital, Yantai, People’s Republic of China
| | - Zhilin Cao
- Department of Orthopedics, Yantaishan Hospital, Yantai, People’s Republic of China
| | - Leisheng Wang
- Department of Orthopedics, Yantaishan Hospital, Yantai, People’s Republic of China
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Mahato NK. Topographic localization of the sacroiliac joint and superior gluteal artery branches on the posterolateral ilium. Clin Anat 2023; 36:971-976. [PMID: 36601727 DOI: 10.1002/ca.24005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 12/24/2022] [Accepted: 12/24/2022] [Indexed: 01/06/2023]
Abstract
Latrogenic vascular injuries at the posterior ilium during sacroiliac screw placements are not uncommon. Though intra-operative imaging reduces the risk of such injuries, anatomical localization of the sacral segments using discrete topographical landmarks is not currently available. This descriptive study proposes the use of an anatomical grid system to localize the sacroiliac articulation on the posterolateral ilium. It also investigates the positional variability of the branches of the superior gluteal artery (SGA) within areas defined by the grid. 48 dried adult hip bones were examined to determine the position of the sacral articular surface on the posterolateral surface of the ilium. A novel grid-system was defined and used to map the positions of the articulation of the first two sacral segments on the posterolateral ilium. Superficial and deep branches of the SGA were dissected in donor cadavers and their courses were virtually overlayed on the grid system. The grid system localized the sacral articular surfaces within a defined area on the posterior ilium. Arterial distributions indicated the presence of the superficial branch of SGA more frequently over the screw insertion area (at an intermuscular plane), while the deep branch ran closer to the ilium but antero-inferior to the screw placement areas. This study proposes a new topographical perspective of visualizing SGA branches with respect to the cranial sacral segments. Precise localization of vascular anatomy may help to reduce potential risk of injury during sacroiliac screw placements.
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Affiliation(s)
- Niladri Kumar Mahato
- Department of Biomedical Sciences, Heritage College of Osteopathic Medicine, Ohio University, Athens, Ohio, USA
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Khalaf K, Azhang A, Cheng CH, Nikkhoo M. Biomechanical Investigation of Bone Screw Head Design for Extracting Stripped Screw Heads: Integration of Mechanical Tests and Finite Element Analyses. Materials (Basel) 2023; 16:5470. [PMID: 37570173 PMCID: PMC10419446 DOI: 10.3390/ma16155470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 07/20/2023] [Accepted: 07/24/2023] [Indexed: 08/13/2023]
Abstract
Enhancing the design of bone screw head sockets to prevent stripping and improve the torque required for smooth unscrewing is a significant challenge in orthopedic applications. This research aims to establish a quantitative methodology by integrating mechanical testing with finite element (FE) simulations to determine a safe limitation depth for the screwdriver when engaging with the hexagonal socket, thus avoiding stripped screw heads. A FE model was developed to investigate the biomechanical responses of the screw head design. Five custom-made hexagonal sockets were manufactured, and single load torsional tests were conducted to assess the mechanical performance of the screws and drivers. The results from the mechanical tests were compared with the FE simulations, demonstrating a close agreement and confirming the model's validity. Furthermore, additional FE models were created to study the impact of manufacturing tolerances on the socket width and screwdriver width. The findings revealed that the maximum torque to failure for the four designs was lower than the margins specified in ISO 6475. Additionally, increasing the depth of the screwdriver led to higher maximum torque values. This research suggests that the technique of screw insertion, specifically the depth of the driver tool within the screw socket, holds greater importance in preventing stripped screw heads than the design and manufacturing width of the bone screw's hexagonal socket and screwdriver. This confirms the importance of screwdriver engagement inside the bone screw socket to prevent stripped screw heads and sheds light on the added value of maximum torque prediction for future design modifications.
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Affiliation(s)
- Kinda Khalaf
- Department of Biomedical Engineering, Health Engineering Innovation Center, Khalifa University of Science and Technology, Abu Dhabi P.O. Box 127788, United Arab Emirates
| | - Arash Azhang
- Department of Biomedical Engineering, Science and Research Branch, Islamic Azad University, Tehran 1477893855, Iran
| | - Chih-Hsiu Cheng
- School of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou 33305, Taiwan
| | - Mohammad Nikkhoo
- Department of Biomedical Engineering, Science and Research Branch, Islamic Azad University, Tehran 1477893855, Iran
- School of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou 33305, Taiwan
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Wang CC, Hung JY, Uan JY, Fang CY, Kuo YL, Chang WJ, Ohiro Y, Sun YS. Facile bioactive transformation of magnesium alloy surfaces for surgical implant applications. Front Bioeng Biotechnol 2023; 11:1156525. [PMID: 37593325 PMCID: PMC10427868 DOI: 10.3389/fbioe.2023.1156525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 05/02/2023] [Indexed: 08/19/2023] Open
Abstract
The market for orthopedic implant alloys has seen significant growth in recent years, and efforts to reduce the carbon footprint of medical treatment (i.e., green medicine) have prompted extensive research on biodegradable magnesium-based alloys. Magnesium alloys provide the mechanical strength and biocompatibility required of medical implants; however, they are highly prone to corrosion. In this study, Mg-9Li alloy was immersed in cell culture medium to simulate degradation in the human body, while monitoring the corresponding effects of the reaction products on cells. Variations in pH revealed the generation of hydroxyl groups, which led to cell death. At day-5 of the reaction, a coating of MgCO3 (H2O)3, HA, and α -TCP appeared on sample surfaces. The coating presented three-dimensional surface structures (at nanometer to submicron scales), anti-corrosion effects, and an altered surface micro-environment conducive to the adhesion of osteoblasts. This analysis based on bio-simulation immersion has important implications for the clinical use of Mg alloys to secure regenerated periodontal tissue.
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Affiliation(s)
- Cheng-Chieh Wang
- Division of Endodontics, Department of Dentistry, Taipei Medical University Hospital, Taipei, Taiwan
| | - Jing-Ya Hung
- School of Dental Technology, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - Jun-Yen Uan
- Department of Materials Science and Engineering, National Chung Hsing University, Taichung, Taiwan
| | - Chih-Yuan Fang
- Division of Oral and Maxillofacial Surgery, Department of Dentistry, Wan Fang Hospital, Taipei, Taiwan
| | - Yu-Lin Kuo
- Department of Mechanical Engineering, National Taiwan University of Science and Technology, Taipei, Taiwan
| | - Wei-Jen Chang
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
- Dental Department, Shuang-Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Yoichi Ohiro
- Oral and Maxillofacial Surgery, Division of Oral Pathobiological Science, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Ying-Sui Sun
- School of Dental Technology, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
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Gibas-Stanek M, Żabicki S, Urzędowski M, Pihut M. Evaluation of Palatal Bone Thickness at the Implantation Areas of Two Popular Bone-Anchored Distalizers-A Cone Beam Computed Tomography Retrospective Study. Diagnostics (Basel) 2023; 13:2421. [PMID: 37510166 PMCID: PMC10378256 DOI: 10.3390/diagnostics13142421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023] Open
Abstract
Since class II malocclusion and lack of space within the dental arch due to early loss of deciduous molars is a common orthodontic problem in the Polish population, bone-anchored distalizers are becoming more and more popular. The aim of the present study was to evaluate palatal soft and hard tissue thickness using cone beam computed tomography (CBCT) at the area of micro-implant placement of two appliances for maxillary first molar distalization: Beneslider and TopJet distalizer. The study data were 100 consecutively selected CBCT images (53 of men and 47 of women). Measurements of bone and mucosa thickness were performed at six locations in the palate and tested according to their correlation with sex and age. The biggest bone and mucosa thickness were recorded in the insertion site of the TopJet miniscrew. Bone thickness in all points of paramedian insertion was significantly greater in males and the mean difference was approximately 1-1.8 mm. Age correlates significantly (p < 0.05) and positively (r > 0) with the thickness of the mucosa at all points: the older the patient, the thicker the mucosa at each measurement point. Anatomical diversity of the hard palate in the population involves the need to perform bone and mucosa thickness measurements before palatal micro-implant placement.
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Affiliation(s)
- Marta Gibas-Stanek
- Department of Prosthodontics and Orthodontics, Dental Institute, Faculty of Medicine, Jagiellonian University Medical College, Montelupich St. 4/108, 31-155 Krakow, Poland
| | - Szczepan Żabicki
- Department of Prosthodontics and Orthodontics, Dental Institute, Faculty of Medicine, Jagiellonian University Medical College, Montelupich St. 4/108, 31-155 Krakow, Poland
| | - Michał Urzędowski
- Department of Prosthodontics and Orthodontics, Dental Institute, Faculty of Medicine, Jagiellonian University Medical College, Montelupich St. 4/108, 31-155 Krakow, Poland
| | - Małgorzata Pihut
- Department of Prosthodontics and Orthodontics, Dental Institute, Faculty of Medicine, Jagiellonian University Medical College, Montelupich St. 4/108, 31-155 Krakow, Poland
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Widmer J, Aubin CE, van Lenthe GH, Matsukawa K. Editorial: Innovations to improve screw fixation in traumatology and orthopedic surgery. Front Bioeng Biotechnol 2022; 10:1094813. [PMID: 36507265 PMCID: PMC9733944 DOI: 10.3389/fbioe.2022.1094813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 11/16/2022] [Indexed: 11/27/2022] Open
Affiliation(s)
- Jonas Widmer
- Department of Orthopedics, Balgrist University Hospital, Zürich, Switzerland,*Correspondence: Jonas Widmer,
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Yao T. [Research on Self-tapping Performance Test of Self-tapping Bone Screws]. Zhongguo Yi Liao Qi Xie Za Zhi 2022; 46:449-453. [PMID: 35929164 DOI: 10.3969/j.issn.1671-7104.2022.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To study the self-tapping performance test method of self-tapping bone screws based on the YY/T 1505 standard. METHODS With reference to the method of YY/T 1505, various factors affecting the self-tapping force test was optimised, and the self-tapping force judgment method was improved. RESULTS The experimental results showed that the self-tapping force obtained by the improved self-tapping force judgment method has good repeatability and high stability of the experimental data. At the same time, the test results of other influencing factors indicated that the manufacturer should fully consider the test material and the size of the pre-drilled hole. CONCLUSIONS An improved method for judging the self-tapping force is helpful for the repeatability and stability of the test data. This study has certain significance referring to the self-tapping performance test of self-tapping bone screws.
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Affiliation(s)
- Tianping Yao
- Shanghai Institute of Medical Device Testing, Shanghai, 201318
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Bregoli C, Biffi CA, Morellato K, Gruppioni E, Primavera M, Rampoldi M, Lando M, Adani R, Tuissi A. Osseointegrated Metallic Implants for Finger Amputees: A Review of the Literature. Orthop Surg 2022; 14:1019-1033. [PMID: 35524645 PMCID: PMC9163974 DOI: 10.1111/os.13296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/06/2022] [Accepted: 04/08/2022] [Indexed: 12/01/2022] Open
Abstract
Digital trauma amputations and digital agenesis strongly affect the functionality and aesthetic appearance of the hand. Autologous reconstruction is the gold standard of treatment. Unfortunately, microsurgical options and transplantation procedures are not possible for patients who present contraindications or refuse to undergo transplantation from the toe (e.g. toe‐to‐thumb transplantation). To address these issues, osseointegrated finger prostheses are a promising alternative. The functional assessments registered during follow‐up confirmed the promising outcomes of osseointegrated prostheses in the treatment of hand finger amputees. This review outlines (a) a detailed analysis of osseointegrated finger metallic components of the implants, (b) the surgical procedures suggested in the literature, and (c) the functional assessments and promising outcomes that demonstrate the potential of these medical osseointegrated devices in the treatment of finger amputees.
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Affiliation(s)
- Chiara Bregoli
- Unit of Lecco, CNR ICMATE, National Research Council, Lecco, Italy
| | | | | | | | - Matteo Primavera
- Hand and Reconstructive Surgery Unit, Centro Traumatologico Ortopedico A. Alesini, Rome, Italy
| | - Michele Rampoldi
- Hand and Reconstructive Surgery Unit, Centro Traumatologico Ortopedico A. Alesini, Rome, Italy
| | - Mario Lando
- Department of Hand surgery and Microsurgery, University Hospital of Modena, Modena, Italy
| | - Roberto Adani
- Department of Hand surgery and Microsurgery, University Hospital of Modena, Modena, Italy
| | - Ausonio Tuissi
- Unit of Lecco, CNR ICMATE, National Research Council, Lecco, Italy
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Clarke T, Whitworth N, Platt S. Defining a Safe Zone for Percutaneous Screw Fixation of Posterior Malleolar Fractures. J Foot Ankle Surg 2021; 60:929-934. [PMID: 33879359 DOI: 10.1053/j.jfas.2020.10.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 09/09/2020] [Accepted: 10/05/2020] [Indexed: 02/03/2023]
Abstract
Posterior malleolar fractures require fixation to confer stability to the ankle. Although some have suggested that fractures involving less than 25% of the articular surface require no intervention, estimation of malleolar size on plain imaging is inaccurate. Some posterior malleolar fractures may be particularly suitable for posterior-to-anterior percutaneous screw fixation of the posterior malleolus via a posterolateral approach. We hypothesized that there may be a safe zone in the posterolateral ankle, identifiable with reliable anatomic landmarks, that might allow safe percutaneous screw placement for fracture fixation. The study protocol involved Step 1, in which multiple Kirschner wires were used in a single cadaveric specimen to attempt to identify a safe zone entry point in the posterior ankle, and Step 2, in which a single wire was used in each of six additional cadaveric specimens to test the ability to safely replicate the use of that entry point. In Step 1, a safe zone entry point was identified, located immediately lateral to the Achilles tendon and 1 cm above the level of the tip of the medial malleolus, when visualizing the posterior ankle. In Step 2, using these landmarks and an image intensifier, single wires were then successfully placed in the other six specimens without injury to any significant structure. If confirmed in clinical studies, the safe zone entry point that we have identified could potentially be used to facilitate posterior-to-anterior percutaneous fixation in patients with posterior malleolar fractures for whom open reduction may not be required or may be contraindicated.
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Affiliation(s)
- Thomas Clarke
- Principal House Officer, Department of Musculoskeletal Services - Surgical, Anaesthetics and Procedural Services (SaPS), Gold Coast University Hospital, Gold Coast Health, Southport, Queensland, Australia.
| | - Nicholas Whitworth
- Registrar, Department of Orthopaedics, Cairns Hospital, Cairns and Hinterland Hospital and Health Service, Cairns, Queensland, Australia
| | - Simon Platt
- Senior Staff Specialist, Department of Musculoskeletal Services - Surgical, Anaesthetics and Procedural Services (SaPS), Gold Coast University Hospital, Gold Coast Health, Southport, Queensland, Australia
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Yu T, Ying J, Liu J, Huang D, Yan H, Xiao B, Zhuang Y. Percutaneous posteroanterior screw fixation for Haraguchi type 1 posterior malleolar fracture in tri-malleolar fracture: Operative technique and randomized clinical results. J Orthop Surg (Hong Kong) 2021; 29:2309499021997996. [PMID: 33641534 DOI: 10.1177/2309499021997996] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE The study described a novel surgical treatment of Haraguchi type 1 posterior malleolar fracture in tri-malleolar fracture and patient outcomes at intermediate period follow-up. METHODS All patients from January 2015 to December 2017 with tri-malleolar fracture of which posterior malleolar fractures were Haraguchi type 1, were surgically treated in this prospective study. Lateral and medial malleolar fractures were managed by open reduction and internal fixation through dual incision approaches. 36 cases of Haraguchi type 1 posterior malleolar fractures were randomly performed by percutaneous posteroanterior screw fixation with the aid of medial exposure (group 1). And 40 cases were performed by percutaneous anteroposterior screw fixation (group 2). Clinical outcomes, radiographic outcomes and patient-reported outcomes were recorded. RESULTS Seventy-six patients with mean follow-up of 30 months were included. There were no significant differences in the mean operation time (81.0 ± 11.3 vs. 77.2 ± 12.4), ankle function at different periods of follow-up, range of motions and visual analog scale (VAS) at 24 months between the two groups (p > 0.05). However, the rate of severe post-traumatic arthritis (Grade 2 and 3) and the rate of step-off rather than gap in radiological evaluation were lower in group 1 than that in group 2 (p < 0.05). CONCLUSION Using our surgical technique, more patients had good outcome with a lower rate of severe post-traumatic arthritis, compared with the group of percutaneous anteroposterior screw fixation. Percutaneous posteroanterior screw fixation can be a convenient and reliable alternative in treating Haraguchi type 1 posterior malleolar fracture.
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Affiliation(s)
- Tianming Yu
- Department of Traumatic Orthopedics, 105854Ningbo No. 6 Hospital, Ningbo, Zhejiang, P.R. China
| | - Jichong Ying
- Department of Traumatic Orthopedics, 105854Ningbo No. 6 Hospital, Ningbo, Zhejiang, P.R. China
| | - Jianlei Liu
- Department of Traumatic Orthopedics, 105854Ningbo No. 6 Hospital, Ningbo, Zhejiang, P.R. China
| | - Dichao Huang
- Department of Traumatic Orthopedics, 105854Ningbo No. 6 Hospital, Ningbo, Zhejiang, P.R. China
| | - Hailin Yan
- Department of Traumatic Orthopedics, 105854Ningbo No. 6 Hospital, Ningbo, Zhejiang, P.R. China
| | - Baiping Xiao
- Department of Traumatic Orthopedics, 105854Ningbo No. 6 Hospital, Ningbo, Zhejiang, P.R. China
| | - Yunqiang Zhuang
- Department of Traumatic Orthopedics, 105854Ningbo No. 6 Hospital, Ningbo, Zhejiang, P.R. China
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Tavares A, Montanha-Andrade K, Cury PR, Crusoé-Rebello I, Neves FS. Tomographic assessment of infrazygomatic crest bone depth for extra-alveolar miniscrew insertion in subjects with different vertical and sagittal skeletal patterns. Orthod Craniofac Res 2021; 25:49-54. [PMID: 33908170 DOI: 10.1111/ocr.12485] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 04/06/2021] [Accepted: 04/13/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To evaluate bone availability at the infrazygomatic crest for extra-alveolar bone miniscrew insertion in subjects with different vertical and sagittal skeletal patterns. SETTING AND SAMPLE POPULATION Measurements of the infrazygomatic crest were performed on multislice computed tomography scans from 58 adults with different skeletal patterns. MATERIALS AND METHODS Infrazygomatic crest bone depth was measured at 4, 5 and 6 mm from the cementoenamel junction (CEJ) of the maxillary first molar at three different angles (60°, 70° and 80°) in the first molar occlusal plane. The sagittal and vertical skeletal patterns were determined. Analysis of variance followed by Tukey's post hoc test was used (P ≤ .05). RESULTS Bone depth was greater near the CEJ (8.7 ± 3.1 mm) and lower in the apical area (5.8 ± 2.7 mm). In Class II subjects, considering 6 mm from the CEJ, there was a significantly lower depth at the 80° angle (5.4 ± 2.5 mm) than at 60° (8.6 ± 3.5 mm; P = .007). In mesofacial subjects, considering 5 and 6 mm from the CEJ, bone depth was lower at 80° (5.7 ± 3.2 mm and 5.3 ± 2.5 mm) than at 60° considering 4 mm from the CEJ (P ≤ .019). CONCLUSION Bone availability was lower at the apical level, especially in Class II and mesofacial subjects. Therefore, when the planned insertion site is located in the apical direction, it is recommended to choose shorter miniscrews (2.0 x 12mm) and a smaller insertion angle (60°) and/or to plan a miniscrew bone insertion deep enough to allow bicortical fixation.
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Affiliation(s)
- Alana Tavares
- Post-graduate Program in Dentistry and Health, School of Dentistry, Federal University of Bahia, Ufba, Salvador, Brazil
| | - Kátia Montanha-Andrade
- Post-graduate Program in Dentistry and Health, School of Dentistry, Federal University of Bahia, Ufba, Salvador, Brazil
| | - Patricia Ramos Cury
- Division of Periodontics, School of Dentistry, Federal University of Bahia, Ufba, Salvador, Brazil
| | - Ieda Crusoé-Rebello
- Division of Dentomaxillofacial Radiology, School of Dentistry, Federal University of Bahia, Ufba, Salvador, Brazil
| | - Frederico Sampaio Neves
- Division of Dentomaxillofacial Radiology, School of Dentistry, Federal University of Bahia, Ufba, Salvador, Brazil
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Mousavi SH, Masoumi O, Akbariaghdam H, Mohammadsharifi G. Investigation of Hamstring Tendon Graft Fixation for the Reconstruction of Anterior Cruciate Ligament using Interference Screw Merely or in Combination with Supplementary Staple: A Clinical Trial. Adv Biomed Res 2020; 9:52. [PMID: 33457335 PMCID: PMC7792865 DOI: 10.4103/abr.abr_257_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 01/21/2020] [Accepted: 05/18/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Hamstring graft tendon for anterior cruciate ligament (ACL) reconstruction is a common approach worldwide. Tibial side graft fixation to achieve appropriate stability is a serious concern, worldwide. The current study aims to compare the outcomes of mere use of interference screw for fixation of hamstring tendon graft versus the use of interference screw plus supplementary staple. MATERIALS AND METHODS This is a randomized clinical trial conducted on 53 patients who underwent ACL reconstruction from 2016 to 2018. The study population was randomly divided into two groups: graft fixation with interference screw only and interference screw plus supplementary staple. Postoperative recovery time, postoperative clinical examinations, and the scale of the International Knee Documentation Committee were assessed for participants and compared between two groups. RESULTS Comparison of two groups regarding demographic information, including age, gender distribution, postoperative recovery time, and body mass index, showed no statistical difference (P > 0.05). Postoperative Pivot test was insignificantly positive in 4 (16.7%) cases of screw interference with supplementary staple while it was positive in 3 (10.7%) cases with screw interference only approach (P = 0.98). IKCD index was not statistically different between two groups postoperatively (P = 0.72), while IKCD scores changed significantly following the surgical procedure, regardless of the type of the surgical procedure (P < 0.001). CONCLUSION Use of supplementary staple beside interference screw was as successful as mere use of interference screw for fixation of hamstring tendon autologous graft of the ACL reconstruction, regarding force withstanding. The comparison of the two approaches revealed no remarkable difference.
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Affiliation(s)
- Sayed Hamid Mousavi
- Department of Orthopedics, Kashani Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Omid Masoumi
- Department of Orthopedics, Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hossein Akbariaghdam
- Department of Orthopedics, Kashani Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ghasem Mohammadsharifi
- Department of Orthopedics, Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
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Vilá-Rico J, Bravo-Giménez B, Jimenez-Díaz V, Mellado-Romero MA, Ojeda-Thies C. Arthroscopic Subtalar Arthrodesis: Does the Type of Fixation Modify Outcomes? J Foot Ankle Surg 2018; 57:726-731. [PMID: 29709422 DOI: 10.1053/j.jfas.2017.12.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Indexed: 02/03/2023]
Abstract
The goal of the present study was to analyze a modified American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale score, time to union, and the incidence of fusion after isolated arthroscopic posterior subtalar arthrodesis using either 1 or 2 screws of different diameters. We reviewed a consecutive series of 65 patients, mean age 50.0 ± 15.6 years, including 38 males (58.5%) and 27 females (41.5%), who had undergone arthrodesis from May 2004 to February 2011. The mean follow-up duration was 57.5 (range 24 to 105) months. The patients were divided into 3 groups according to the fixation method used: group 1 (n = 12; 18.5%) underwent fixation with one 6.5-mm screw; group 2 (n = 40; 61.5%) with one 7.3-mm screw; and group 3 (n = 13; 20%) with two 7.3-mm screws. An overall statistically significant (p <.0001) improvement was seen in the modified AOFAS scale score for all 3 fixation groups; however, the difference was not statistically significant (p = .79) among the fixation groups. Fusion was achieved in 62 patients (95.4%) after a mean of 12.1 (range 9 to 16) weeks. The difference in the time to union was not statistically significant (p = .781) among the fixation groups. Nine patients (13.8%) experienced complications, and nonunion was significantly (p = .005) more prevalent in the single 6.5-mm screw group. In conclusion, all 3 screw configurations led to improved modified AOFAS scale scores, although nonunion was more common among patients fixed with a single 6.5-mm screw.
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Affiliation(s)
- Jesús Vilá-Rico
- Orthopedic Surgeon, Hospital Universitario Doce de Octubre, Madrid, Spain; Assistant Professor, Departamento de Cirugía, Universidad Complutense, Madrid, Spain.
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Zhang P, Tang J, Dong Y, Lu L, Wang S, Song S, Wang G. A new navigational apparatus for fixation of acetabular posterior column fractures with percutaneous retrograde lagscrew: Design and application. Medicine (Baltimore) 2018; 97:e12134. [PMID: 30200104 PMCID: PMC6133477 DOI: 10.1097/md.0000000000012134] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The purpose of this study was to analyze the feasibility and accuracy of a newly developed guide apparatus for the percutaneous retrograde lag screw fixation of posterior column of acetabular fractures. 3D pelvic models were reconstructed from the helical computed tomographic data of 33 adult patients using the Mimics 10.01 software. The virtual cylindrical implants were placed along a line passing through the central point of the ischial tuberosity and the midpoint between the most prominent point of anterior superior iliac spine and that of posterior superior iliac spine. Some anatomical parameters were then measured, based on which a guide apparatus was developed, and its safety and accuracy were experimentally validated with pelvic and cadaveric specimens. The screws were successfully placed in all of the 66 hemipelves. There was a significant difference between the male and female groups in the AB distance (156.26 ± 7.28 mm and 151.38 ± 8.11 mm), OI distance (139.53 ± 7.56 mm and 125.15 ± 11.17 mm), and diameter (12.19 ± 1.97 mm and 10.19 ± 2.14 mm) of the virtual cylindrical implants. This guide apparatus was proved effective for percutaneous retrograde lag screw fixation of posterior column acetabular fractures by the experiments with the pelvic and cadaveric specimens. Screw fixation of posterior column fractures via OI is safe and feasible. We designed a new percutaneous retrograde screw fixation guide apparatus to assist internal fixation of posterior column acetabular fracture.
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Affiliation(s)
- Pijun Zhang
- Department of Orthopedics, The Second Affiliated Hospital of Hainan Medical University, Hainan Medical University, Haikou, Hainan
| | - Jie Tang
- Department of Orthopedics, The Second Affiliated Hospital of Hainan Medical University, Hainan Medical University, Haikou, Hainan
| | - Yonghui Dong
- Department of Orthopedics, Henan Provincial People's Hospital, Zhengzhou, Henan
| | - Lu Lu
- Department of Orthopedics, The Second Affiliated Hospital of Hainan Medical University, Hainan Medical University, Haikou, Hainan
| | - Shengjie Wang
- Department of Orthopedics, Henan Provincial People's Hospital, Zhengzhou, Henan
| | - Shifeng Song
- Department of Orthopedics, The Second Affiliated Hospital of Hainan Medical University, Hainan Medical University, Haikou, Hainan
| | - Gang Wang
- Department of Orthopedics and Traumatology, Nanfang Hospital, Nnanfang Medical University, Guangzhou, Guangdong, People's Republic of China
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Abstract
BACKGROUND Anatomy of the pedicles of the seventh cervical vertebra (C7) at the cervicothoracic junction is different from other cervical vertebrae. Fixation of C7 is required during cervical vertebra and upper thoracic injuries in clinical practice. However, the typical pedicle screw insertion methods may have problems in clinical practice based on the anatomical features of C7. This study is to explore a new pedicle screw insertion technique for C7 and to provide anatomical and radiographic basis for clinical application. MATERIALS AND METHODS C7 vertebral specimens from six human cadavers were observed for the relative position between the posterior bony landmark and the pedicle projection. Computed tomography (CT) was performed for 30 patients with cervical spondylosis (26-61 years old, mean age was 42.3 years old). The CT scan data were processed by Mimics 8.1 software for associated parameter measurement. Appropriate screw entry points (Eps) and insertion angles were selected. A total of 12 pedicle screws were inserted and then observed. The six specimens were observed after inserting the screw using this method. The junction site of the middle 1/3 and outer 1/3 segment of line G [The junction between point A (the intersection point of the superior margin of the lamina of C7 and the medial margin of the superior articular process) and point B (the intersection point of the lateral margin of the inferior articular process and the transverse process)] was taken as the Ep. The screw insertion direction parallel horizontally to the upper terminal lamina of C7 and the sagittal angle was between 35° and 45°. RESULTS Gross and imaging observations revealed that pedicle projection was on the line (line G) between point A (the intersection point of the superior margin of the lamina of C7 and the medial margin of the superior articular process) and point B (the intersection point of the lateral margin of the inferior articular process and the transverse process) and located at the middle 1/3 and outer 1/3 segments of the line (point L[also it is the screw entry points (Eps)]. No significant difference in the measurements on the left and right sides were observed (P > 0.05). No penetration of the 12 screws through pedicle was observed. CONCLUSION The junction site of the middle 1/3 and outer 1/3 segments of line G are the projection points of C7 pedicles on the lateral mass. The junction site anatomical position was simply and easy to be controlled during surgery, simultaneously avoided uncertainty of other methods. This study provides a new method for determining an Ep for C7 pedicle screw insertion.
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Affiliation(s)
- Wensheng Liao
- Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China,Address for correspondence: Prof. Wensheng Liao, Department of Orthopedics, The First Affiliated Hospital of Hospital of Zhengzhou University, No. 1, Jianshe East Road, Zhengzhou 450052, China. E-mail:
| | - Liangbing Guo
- Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Heng Bao
- Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Limin Wang
- Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
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17
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Abstract
BACKGROUND Cervical pedicle screw fixation is an effective method for treating traumatic and non traumatic injuries. But many studies have reported higher incidence of cervical pedicle penetration, so many research efforts have aimed at improving the accuracy of cervical screw fixation. Most of the anatomical studies on cervical pedicle screw placement previously published focused on the measurements of anatomical parameters, the entry point of pedicle screw is vague. We preliminarily designed a C3, C4 and C5 pedicle screw fixation method that had clear entry point and clinical cases confirmed that this method is feasible and safe. So we did this study of cervical pedicle screw fixation for C6 and C7 vertebrae. MATERIALS AND METHODS Fifteen cervical vertebrae specimens were prepared and bilateral pedicle screws were manually inserted into C6 and C7. The intersection of the horizontal line through the midpoint of the transverse process root and the vertical line through the intersection of the posterolateral and posterior planes of the isthmus was the entry point. The screws were inserted along the axis of the pedicle, with the screw axis coinciding with the pedicle. The pedicle was truncated axially and sagittally along the trajectory and the narrowest pedicular height (PH), pedicular width (PW), overall length of the screw channel (LSC), transverse angle (E) and vertical angle (F) were measured. RESULTS In C6, the PW and PH were 6.12 ± 0.78 and 7.48 ± 0.81 mm, respectively. In C7, the PW and PH were 6.85 ± 0.73 and 8.03 ± 0.38 mm, respectively. The LSC was 30.83 ± 0.91 mm. Two E angles were identified, namely E1 and E2 and their values were 89.61 ± 1.24 and 59.71 ± 1.10°, respectively. Meanwhile, F averaged 75.86 ± 1.12°. CONCLUSION The intersection of the horizontal line through the midpoint of the transverse process root and vertical line through the intersection of the posterolateral and posterior planes of the isthmus can be used as an entry point for C6 and C7 pedicle screw fixation. The screws should be inserted at 60 or 90° with the posterolateral isthmus in the horizontal plane and at 75° with the posterior isthmus in the sagittal plane. The LSC should not exceed 30 mm.
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Affiliation(s)
- Ye Li
- Department of Orthopaedic Surgery, China-Japan Union Hospital of Jilin University, Changchun 130031, China
| | - Jingchen Liu
- Department of Orthopaedic Surgery, China-Japan Union Hospital of Jilin University, Changchun 130031, China,Address for correspondence: Prof. Jingchen Liu, Department of Orthopaedic Surgery, China-Japan Union Hospital of Jilin University, No. 126 Xiantai Street, Changchun 130031, China. E-mail:
| | - Yulong Liu
- Department of Orthopaedic Surgery, China-Japan Union Hospital of Jilin University, Changchun 130031, China
| | - Yuntao Wu
- Department of Orthopaedic Surgery, China-Japan Union Hospital of Jilin University, Changchun 130031, China
| | - Qingsan Zhu
- Department of Orthopaedic Surgery, China-Japan Union Hospital of Jilin University, Changchun 130031, China
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Shetty A, Kini AR, Chacko A, Sunil U, Vinod K, Geover L. Mini posterior lumbar interbody fusion with presacral screw stabilization in early lumbosacral instability. Indian J Orthop 2015; 49:278-83. [PMID: 26015626 PMCID: PMC4443408 DOI: 10.4103/0019-5413.156187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Surgical options for the management of early lumbosacral spondylolisthesis and degenerative disc disease with instability vary from open lumbar interbody fusion with transpedicular fixation to a variety of minimal access fusion and fixation procedures. We have used a combination of micro discectomy and axial lumbosacral interbody fusion with presacral screw fixation to treat symptomatic patients with lumbosacral spondylolisthesis or lumbosacral degenerative disc disease, which needed surgical stabilization. This study describes the above technique along with analysis of results. MATERIALS AND METHODS Twelve patients with symptomatic lumbosacral (L5-S1) instability and degenerative lumbosacral disc disease were treated by micro discectomy and interbody fusion using presacral screw stabilization. Patients with history of bowel, bladder dysfunction and local anorectal diseases were excluded from this study. Postoperatively all patients were evaluated neurologically and radiologically for screw position, fusion and stability. Oswestry disability index was used to evaluate results. RESULTS We had nine females and three males with a mean age of 47.33 years (range 26-68 years). Postoperative assessment revealed three patients to have screw placed in anterior 1/4(th) of the 1(st) sacral body, in rest nine the screws were placed in the posterior 3/4(th) of sacral body. At 2 years followup, eight patients (67%) showed evidence of bridging trabeculae at bone graft site and none of the patients showed evidence of instability or implant failure. CONCLUSION Presacral screw fixation along with micro discectomy is an effective procedure to manage early symptomatic lumbosacral spondylolisthesis and degenerative disc disease with instability.
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Affiliation(s)
- Arjun Shetty
- Department of Neurosurgery, Kasturba Medical College, Manipal, Karnataka, India,Departments of Neurosurgery and Orthopaedics and Traumatology, Tejasvini Hospital and SSIOT, Kadri, Mangalore, Karnataka, India
| | - Abhishek R Kini
- Departments of Neurosurgery and Orthopaedics and Traumatology, Tejasvini Hospital and SSIOT, Kadri, Mangalore, Karnataka, India,Address for correspondence: Dr. Abhishek R Kini, Departments of Orthopaedics and Traumatology, Tejasvini Hospital and SSIOT, Kadri, Mangalore - 575 002, Karnataka, India. E-mail:
| | - A Chacko
- Department of Neurosurgery, Kasturba Medical College, Manipal, Karnataka, India
| | - Upadhyaya Sunil
- Department of Neurosurgery, Kasturba Medical College, Manipal, Karnataka, India
| | - K Vinod
- Department of Neurosurgery, Kasturba Medical College, Manipal, Karnataka, India
| | - Lobo Geover
- Department of Neurosurgery, Kasturba Medical College, Manipal, Karnataka, India
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Liu F, Jiang C, Cao Y, Jiang X, Feng Z. Transforaminal lumbar interbody fusion using unilateral pedicle screw fixation plus contralateral translaminar facet screw fixation in lumbar degenerative diseases. Indian J Orthop 2014; 48:374-9. [PMID: 25143640 PMCID: PMC4137514 DOI: 10.4103/0019-5413.136240] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Transforaminal lumbar interbody fusion (TLIF) has been used in lumbar degenerative diseases. Some researchers have applied unilateral fixation in TLIF to reduce operational trauma without compromising the clinical outcome, but it is always suspected biomechanically unstable. The supplementary contralateral translaminar facet screw (cTLFS) seemed to be able to overcome the inherent drawbacks of unilateral pedicle screw (uPS) fixation theoretically. This study evaluates the safety, feasibility and efficacy of TLIF using uPS with cTLFS fixation in the treatment of lumbar degenerative diseases (LDD). MATERIALS AND METHODS 50 patients (29 male) underwent the aforementioned surgical technique for their LDD between December 2009 and April 2012. The results were evaluated based on visual analogue scale (VAS) of the leg and back, Japanese Orthopedic Association (JOA) score and Oswestry Disability Index (ODI) were recorded. The radiographic examinations in form of X-ray, computed tomography (CT) or magnetic resonance imaging was done preoperatively and 1 week, 3 months, 6 months, 12 months and 24 months postoperatively. The student t-test was used for comparison between the preoperative values and postoperative counterparts. P < 0.05 was considered to be statistically significant. RESULTS Among 50 patients, 22 received one level fusion and 28 two level's, with corresponding operation time and estimated blood loss being approximately 90 min, 150 ml and 120 min, 200 ml, respectively. No severe complications happened perioperatively. The mean VAS (back, leg) scores dropped from (7.6, 7.5) preoperatively to (2.1, 0.6) at 12 months' followup, ODI from 49.1 preoperatively to 5.6 and JOA score raised from 10.6 preoperatively to 28.5, all P < 0.001, suggesting of good clinical outcome. From the three-dimensional reconstructed CT, 62 out of 70 segments displayed solid fusion with fusion rate of 88.6% at 12 months postoperatively. CONCLUSIONS TLIF using uPS fixation plus cTLFS fixation is a safe, feasible and effective technique in the treatment of one or two level lumbar degenerative diseases short termly.
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Affiliation(s)
- Fubing Liu
- Department of Orthopedics, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Chun Jiang
- Department of Orthopedics, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yuanwu Cao
- Department of Orthopedics, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiaoxing Jiang
- Department of Orthopedics, Zhongshan Hospital, Fudan University, Shanghai, China,Address for correspondence: Prof. Xiaoxing Jiang, 180 Fenglin Road, Shanghai 200032, China. E-mail:
| | - Zhenzhou Feng
- Department of Orthopedics, Zhongshan Hospital, Fudan University, Shanghai, China
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Watson A, Zhang Y, Beattie S, Page RS. Prospective randomized controlled trial comparing dynamic hip screw and screw fixation for undisplaced subcapital hip fractures. ANZ J Surg 2012; 83:679-83. [PMID: 22998439 DOI: 10.1111/j.1445-2197.2012.06256.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2012] [Indexed: 12/13/2022]
Abstract
BACKGROUND Neck of femur fractures (NOFFs) are a common cause of morbidity and mortality in our community. Minimally displaced intracapsular fractures are treated with internal fixation by a two-hole dynamic hip screw (DHS) or three partially threaded cancellous screws. Data to support the superiority of one are limited. This prospective randomized controlled trial compares outcomes with these two fixation methods. METHODS We prospectively recruited patients over 50 years, with an acute fracture subcapital NOFF, who walked and lived independently, and were cognitively intact. They were randomized into DHS or cancellous screw groups and followed up for 2 years (overall 75.9%). Outcomes of mortality, revision, loss of fixation, avascular necrosis, surgical complications, WOMAC, Harris hip score and SF-12 were measured. RESULTS We recruited 62 patients (31 DHS, 29 cancellous screws, 2 failed consent). Six deaths (19.3%) were seen in each group. A total of 3.2% of DHS (1 out of 31) and 10.3% (3 out of 29) of cancellous screw patients required re-operation (P = 0.272). There was no statistical significant difference in patient satisfaction, quality of life (QoL), radiological union or osteonecrosis. There are trends towards better functional scores and QoL in cancellous screws, particularly at 1 year (P = 0.0061), but with a higher re-operation rate. There was a combined mortality and transition to institutional care of 40.0% (24 out of 60) at 2 years. CONCLUSIONS This study found no difference in outcomes between DHS and cancellous screws in the treatment of subcapital NOFFs in a fit, independent population, but we found a high level of physical decline in previously fit, independently ambulating patients. A large, multicentre trial will be required to differentiate between these two fixation methods.
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Affiliation(s)
- Adam Watson
- Barwon Orthopaedic Research Unit, The Geelong Hospital, Barwon Health, Geelong, Victoria, Australia.
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Abstract
BACKGROUND Fractures of the capitellum are rare injuries of the elbow usually seen in the adolescents. This fracture is often missed in the emergency room if a proper radiograph is not available. Recent reports have described many modalities of treatment favoring headless screw for fixation. The facility for headless screw fixation, however, is not available in most centers. This paper presents the diagnosis and management of type 4 capituller fractures (Mckee) with gadgets available in a district hospital. MATERIALS AND METHODS Between 2004 and 2007 three patients with right sided type IV capetullar fracture were treated in a district hospital. There were two boys aged 15 and 17 and one 33 years old lady. In one case, the fracture was missed in the emergency room. A double arc sign in the lateral views of the X-rays of the elbow was seen in all the cases. In each case a preoperative CT scan was done and a diagnosis of Mckee type IV fracture of the capitellum was made. Under tourniquet, using extended lateral approach, open reduction and internal fixation was done using 4mm partially threaded AO cancellous screws (n=2) and 2.7 mm AO screws (n=1), under vision from posterior to anterior direction from the posterior aspect of lateral condyle of humerus avoiding articular penetration. RESULTS All the fractures united uneventfully. At the end of one year follow-up, two cases had excellent elbow function; implants were removed and there were no signs of AVN or arthritis. The third case had good elbow ROM at 11 months without AVN. CONCLUSION Double arc sign on lateral X-rays of the elbow along with pre-operative CT scan evaluation is important to avoid a missed diagnosis and analysis of type IV capitellur fracture. Fixation with non-cannulated ordinary AO screws using extended Kocher's lateral approach has given good results.
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Affiliation(s)
- SS Suresh
- Department of Orthopaedics, Ibri Regional Referral Hospital, PO Box 46, Ibri 516, Sultanate of Oman,Address for correspondence: Dr. S S Suresh, PO Box 396, Ibri 516, Sultanate of Oman. E-mail:
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