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Conybeare A, Bennett L, Osborne MS. Provision of bone conduction hearing implants in England in adults and children: a review of Hospital Episode Statistics data 2012-2021. J Laryngol Otol 2024:1-6. [PMID: 38456642 DOI: 10.1017/s0022215123002347] [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] [Indexed: 03/09/2024]
Abstract
OBJECTIVE Bone conduction hearing implants are a well-established method of hearing rehabilitation in children and adults. This study aimed to review any changes in provision in England. METHODS The total number of bone conduction hearing implantations performed was analysed from 2012 to 2021 utilising Hospital Episode Statistics data for England. RESULTS The total number of procedures has increased by 58 per cent. One-stage bone conduction hearing implantations in adults accounts for the largest proportion of this increase (93 per cent of the total). The number performed in children has remained stable and accounts for 73 per cent (n = 433) of all two-stage procedures. CONCLUSION The data show that bone conduction hearing implant surgery is becoming increasingly popular, particularly in adults. This has correlated with the increase in availability, national recommendations and choice of devices.
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Affiliation(s)
- Alison Conybeare
- Department of Otolaryngology, Birmingham Children's Hospital, Birmingham, UK
| | - Lauren Bennett
- Department of Otolaryngology, Russells Hall Hospital, Birmingham, UK
| | - Max S Osborne
- Department of Otolaryngology, Russells Hall Hospital, Birmingham, UK
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Cazzato RL, Garnon J, Jennings JW, Gangi A. Interventional management of malignant bone tumours. J Med Imaging Radiat Oncol 2023; 67:862-869. [PMID: 37742284 DOI: 10.1111/1754-9485.13587] [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: 05/10/2023] [Accepted: 09/03/2023] [Indexed: 09/26/2023]
Abstract
In the last few decades, interventional radiology (IR) has significantly increased its role in the management of bone tumours including bone metastases (BM) that represent the most common type of tumour involving the bone. The current IR management of BM is based on the 'palliative-curative' paradigm and relies on the use of consolidative (i.e. osteplasty, osteosynthesis) and/or ablation (i.e. cryoablation, radiofrequency ablation, electrochemotherapy) techniques. The present narrative review will overview the current role of IR for the management of BM.
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Affiliation(s)
- Roberto Luigi Cazzato
- Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France
| | - Julien Garnon
- Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France
| | - Jack William Jennings
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Missouri, USA
| | - Afshin Gangi
- Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
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Hao XD, Zhang YZ, Wang SB, Liu G. Unobstructed orthopaedic surgical robot assisted percutaneous iliosacral screw fixation of sacral brittle fractures. Front Med (Lausanne) 2023; 10:1218720. [PMID: 38034536 PMCID: PMC10687396 DOI: 10.3389/fmed.2023.1218720] [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: 05/08/2023] [Accepted: 11/02/2023] [Indexed: 12/02/2023] Open
Abstract
Pelvic fractures mostly result from high-energy injuries in life; the longitudinal fracture of the sacrum is the most common type of sacrum fracture. This study was designed to evaluate the accuracy, safety, and efficacy of percutaneous sacroiliac joint screw placement in the treatment of longitudinal sacrum fractures with the assistance of unobstructed orthopaedic surgery robots. According to different surgical methods, 32 patients were divided into robot group and free hand group, with 16 patients in each group. The operation time, intra-operative blood loss, intra-operative fluoroscopy times, screw placement angle deviation were collected. There were statistically significant differences in terms of angle deviation of screw placement (1.96 ± 0.75° vs. 2.87 ± 1.03°; p = 0.0145), deviation of the guide needle (1.92 ± 0.93 mm vs. 2.91 ± 1.22 mm; p = 0.0209), intra-operative fluoroscopy time (7.25 ± 1.72 s vs. 20.93 ± 5.64 s; p = 0.0000), insertion time of each sacroiliac joint screw (14.72 ± 2.66 min vs. 29.21 ± 5.18 min; p = 0.0000). There was no statistically significant difference in terms of blood loss (100.21 ± 7.37 mL vs. 102.52 ± 8.15 mL; p = 0.4136). These results suggest that orthopaedic surgery robot for the treatment of longitudinal sacrum fracture is safer and provides less irradiation than the traditional freehand methods.
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Affiliation(s)
- Xiao-dong Hao
- Department of Orthopaedics, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Yuan-zhi Zhang
- Department of Orthopaedics, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Shao-bai Wang
- School of Kinesiology, Shanghai University of Sport, Shanghai, China
| | - Gang Liu
- Department of Orthopaedics, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
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de Oliveira JP, Santos ALB, Helito CP, Codes RND, Ariel de Lima D, Lima DAD. Analysis of the Mechanical Behavior of Porcine Graft Fixation in a Polyurethane Block Using a 3D-printed PLA Interference Screw. Rev Bras Ortop 2023; 58:e604-e610. [PMID: 37663193 PMCID: PMC10468250 DOI: 10.1055/s-0043-1768620] [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: 07/24/2022] [Accepted: 10/18/2022] [Indexed: 09/05/2023] Open
Abstract
Objective The interest in using 3D printing in the healthcare field has grown over the years, given its advantages and potential in the rapid manufacturing of personalized devices and implants with complex geometries. Thus, the aim of the present study was to compare the mechanical fixation behavior of a 3D-printed interference screw, produced by fused deposition modeling of polylactic acid (PLA) filament, with that of a titanium interference screw. Methods Eight deep flexor porcine tendons, approximately 8 mm wide and 9 cm long, were used as graft and fixed to a 40 pounds-per-cubic-foot (PCF) polyurethane block at each of its extremities. One group was fixed only with titanium interference screws (group 1) and the other only with 3D-printed PLA screws (BR 20 2021 018283-6 U2) (group 2). The tests were conducted using an EMIC DL 10000 electromechanical universal testing machine in axial traction mode. Results Group 1 (titanium) obtained peak force of 200 ± 7 N, with mean graft deformation of 8 ± 2 mm, and group 2 (PLA) obtained peak force of 300 ± 30 N, and mean graft deformation of 7 ± 3 mm. Both the titanium and PLA screws provided good graft fixation in the polyurethane block, with no slippage or apparent deformation. In all the samples, the test culminated in graft rupture, with around 20 mm of deformation in relation to the initial length. Conclusion The 3D-printed PLA screw provided good fixation, similar to that of its titanium counterpart, producing satisfactory and promising results.
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Affiliation(s)
- Juliana Pereira de Oliveira
- Engenheiro, Departamento de Engenharia e Tecnologia, Universidade Federal Rural do Semiárido, Mossoró, RN, Brasil
| | - André Luigui Bezerra Santos
- Engenheiro, Departamento de Engenharia e Tecnologia, Universidade Federal Rural do Semiárido, Mossoró, RN, Brasil
| | - Camilo Partezani Helito
- Ortopedista e Traumatologista, Departamento de ortopedia e Traumatologia, Instituto de Ortopedia e Traumatologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Rodrigo Nogueira de Codes
- Engenheiro, Departamento de Engenharia e Tecnologia, Universidade Federal Rural do Semiárido, Mossoró, RN, Brasil
| | - Diego Ariel de Lima
- Médico, Departamento de Ciências da Saúde, Universidade Federal Rural do Semiárido, Mossoró, RN, Brasil
| | - Diego Ariel de Lima
- Médico, Departamento de Ciências da Saúde, Universidade Federal Rural do Semiárido, Mossoró, RN, Brasil
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Freitas A, Demeneghi NC, Barin FR, Battaglion LR, Pires RE, Giordano V. Pipkin Type-II Femoral Head Fracture - A Biomechanical Evaluation by the Finite-Element Method. Rev Bras Ortop 2023; 58:507-513. [PMID: 37396077 PMCID: PMC10310412 DOI: 10.1055/s-0042-1756326] [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: 01/16/2022] [Accepted: 07/26/2022] [Indexed: 07/04/2023] Open
Abstract
Objective To evaluate the biomechanical capacity of two forms of fixation for Pipkin type-II fractures, describing the vertical fracture deviation, the maximum and minimum principal stresses, and the Von Mises equivalent stress in the syntheses used. Materials and Methods Two internal fasteners were developed to treat Pipkin type-II fractures through finite elements: a 3.5-mm cortical screw and a Herbert screw. Under the same conditions, the vertical fracture deviation, the maximum and minimum principal stresses, and the Von Mises equivalent stress in the syntheses used were evaluated. Results The vertical displacements evaluated were of 1.5 mm and 0.5 mm. The maximum principal stress values obtained in the upper region of the femoral neck were of 9.7 KPa and 1.3 Kpa, and the minimum principal stress values obtained in the lower region of the femoral neck were of -8.7 KPa and -9.3 KPa. Finally, the peak values for Von Mises stress were of 7.2 GPa and 2.0 GPa for the fixation models with the use of the 3.5-mm cortical screw and the Herbert screw respectively. Conclusion The fixation system with the Herbert screw generated the best results in terms of reduction of vertical displacement, distribution of the maximum principal stress, and the peak Von Mises equivalent stress, demonstrating mechanical superiority compared to that of the 3.5-mm cortical screw in the treatment of Pipkin type-II fractures.
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Affiliation(s)
- Anderson Freitas
- Hospital Regional do Gama, Brasília, Distrito Federal, Brasil
- Departamento de Ortopedia, Instituto de Pesquisa e Ensino, Hospital Ortopédico e Medicina Especializada (IPE-HOME), Brasília, Distrito Federal, Brasil
| | | | - Fabrício Reichert Barin
- Departamento de Ortopedia, Instituto de Pesquisa e Ensino, Hospital Ortopédico e Medicina Especializada (IPE-HOME), Brasília, Distrito Federal, Brasil
| | - Leonardo Rigobello Battaglion
- Departamento de Ortopedia e Anestesiologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (FMRP-USP), Ribeirão Preto, São Paulo, Brasil
| | - Robinson Esteves Pires
- Departamento do Aparelho Locomotor, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil
| | - Vincenzo Giordano
- Serviço de Ortopedia e Traumatologia Nova Monteiro, Hospital Municipal Miguel Couto, Rio de Janeiro, Rio de Janeiro, Brasil
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Quinzi V, Salvati SE, Brutto V, Tasciotti G, Marzo G, Ferrazzano GF. Comparison of the Accuracy of Two Transfer Caps in Positional Transmission of Palatal Temporary Anchorage Devices: An In Vitro Study. Dent J (Basel) 2023; 11. [PMID: 36826196 DOI: 10.3390/dj11020051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 02/07/2023] [Accepted: 02/10/2023] [Indexed: 02/16/2023] Open
Abstract
The aim of this study was to compare the positional information transfer accuracy of palatal temporary anchorage devices (TADs) of two different brands of transfer caps: PSM and Leone. Thirty plaster casts of maxillary dental arches were chosen for master models. A couple of Leone TADs were inserted in each master model. For each master model, two analysis models were created: using two transfer caps, Leone and PSM, the impressions were taken, the analogues were connected on the transfer caps, and the casts were poured. Using digital methods and equipment, such as a 3D scanner, a 3D analysis and a comparison of the accuracy of the two transfer caps in transferring the positional information of the TADs was then made. The data obtained were analyzed using the Mann-Whitney U-test at a significance level of α = 0.05. PSM transfer caps showed higher error frequency in almost all measurements. Only two measurements had a larger error in the analysis models made with Leone transfer caps. The Mann-Whitney U-test found a significant difference between the error levels of TADs found in the analysis models created with PSM transfer caps. Leone transfer caps showed greater reliability in TADs positional information transmission.
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BATISTA ES, FRANCO A, SOARES MQS, NASCIMENTO MDCC, JUNQUEIRA JLC, OENNING AC. Assessment of cone beam computed tomography for determining position and prognosis of interradicular mini-implants. Dental Press J Orthod 2022; 27:e222190. [PMID: 36449961 PMCID: PMC9707856 DOI: 10.1590/2177-6709.27.5.e222190.oar] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 03/24/2021] [Accepted: 06/14/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To investigate the influence of dynamic visualization of cone beam computed tomography (CBCT) scans on orthodontist's assessment of positioning status and prognosis of interradicular mini-implants (MI). METHODS Three MI positions were virtually simulated in thirty CBCT volumes: (1) MI 1 mm from the lamina dura (LD), (2) MI touching the LD and (3) MI overlapping the LD. Each position was exposed to orthodontists (n = 35) as panoramic reconstruction, sagittal reconstruction and a sequence of axial slices. Each orthodontist evaluated the MI position (relationship with the LD) and scored the prognosis using a four-point scale (the higher the score, the better the prognosis). Kappa, Friedman and Nemenyi statistics were used. RESULTS Statistically significant associations were detected between the prognosis scores and the type of image visualized (p<0.05). The dynamic visualization of the CBCT volume (axial slices) was associated with higher scores for prognosis and more reliable evaluation of MI positioning. Inconsistent outcomes were more frequently associated with panoramic and sagittal reconstructions. CONCLUSION The dynamic visualization of axial slices allowed orthodontists to perform better assessment of MI position and considerably affected prognosis judgment.
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Affiliation(s)
- Eroncy Souto BATISTA
- Faculdade São Leopoldo Mandic, Instituto de Pesquisas São Leopoldo Mandic (Campinas/SP, Brazil)
| | - Ademir FRANCO
- Faculdade São Leopoldo Mandic, Instituto de Pesquisas São Leopoldo Mandic (Campinas/SP, Brazil)
| | | | | | | | - Anne Caroline OENNING
- Faculdade São Leopoldo Mandic, Instituto de Pesquisas São Leopoldo Mandic (Campinas/SP, Brazil)
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Miura T, Kijima H, Kimura R, Watanabe J, Okazaki Y, Miyakoshi N. Efficacy and Safety of Acetabular Cup without Screw Fixation in Total Hip Arthroplasty: A Systematic Review and Meta-Analysis. Medicina (Kaunas) 2022; 58:medicina58081058. [PMID: 36013524 PMCID: PMC9413682 DOI: 10.3390/medicina58081058] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/20/2022] [Accepted: 08/02/2022] [Indexed: 11/16/2022]
Abstract
Background and Objectives: Adequate initial fixation of the uncemented acetabular component in total hip arthroplasty is necessary to achieve long-term survival. Although screw fixation contributes to improved cup stability, there is currently no consensus on the use of this method. This study aimed to assess the existing randomized controlled trials (RCTs) on the efficacy and safety of cup fixation in total hip arthroplasty without screws. Materials and Methods: We searched the EMBASE, MEDLINE, Cochrane Central Register of Controlled Trials, World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov databases to identify RCTs published before February 2022. Primary outcomes were reoperation, cup migration, and Harris Hip Score. Secondary outcomes were the presence of a radiolucent line in the acetabular region, translation and rotation movement, and polyethylene wear. We conducted meta-analyses using the random-effects models. The revised Cochrane risk-of-bias tool was used to assess the risk of bias for outcomes of interest; the Grading of Recommendations, Assessment, Development, and Evaluation approach was used to summarize the body of evidence. Results: We included six reports from four studies. Total hip arthroplasty without screw fixation to the acetabular cup had little to no effect on reoperation (pooled relative risk, 0.98; 95% confidence interval, 0.14–6.68; I2 = 0%), cup migration (pooled relative risk, 1.72; 95% confidence interval, 0.29–10.33; I2 = 1%), Harris Hip Score (mean difference, 1.19; 95% confidence interval, −1.31–3.70; I2 = 0%), radiolucent line (pooled relative risk, 5.91; 95% confidence interval, 0.32–109.35), translation and rotation of all axes, and polyethylene wear (mean difference, 0.01; 95% confidence interval, −0.01–0.04; I2 = 0%), with very low certainty of evidence on all measures. Conclusions: The efficacy of acetabular cups without screw fixation in total hip arthroplasty remains uncertain, suggesting the need for prudent clinical application. Further large-scale, well-designed studies with low risk of bias are required.
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Affiliation(s)
- Takanori Miura
- Department of Orthopedic Surgery, Tazawako Hospital 17-1 Ukiyozaka Obonai, Tazawako, Senboku 014-1201, Akita, Japan
- Correspondence: ; Tel.: +81-187-43-1131
| | - Hiroaki Kijima
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8543, Akita, Japan
| | - Ryota Kimura
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8543, Akita, Japan
| | - Jun Watanabe
- Scientific Research Workshop Peer Support Group (SRWS-PSG), Osaka, Osaka, Japan
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke City 329-0498, Tochigi, Japan
- Center for Community Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke City 329-0498, Tochigi, Japan
| | - Yuji Okazaki
- Scientific Research Workshop Peer Support Group (SRWS-PSG), Osaka, Osaka, Japan
- Department of Emergency Medicine, Hiroshima City Hiroshima Citizens Hospital, 7-33, Motomachi, Naka-ku, Hiroshima City 730-8518, Hiroshima, Japan
| | - Naohisa Miyakoshi
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8543, Akita, Japan
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Zarifian A, Akbarinezhad Fough A, Eygendaal D, Rivlin M, Mousavi Shaegh SA, Kachooei AR. Length of Plates and Number of Screws for the Fixation of Distal Humerus Fractures: A Finite Element Biomechanical Study. J Hand Surg Am 2022; 47:690.e1-690.e11. [PMID: 34474947 DOI: 10.1016/j.jhsa.2021.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 04/29/2021] [Accepted: 07/09/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE We performed a biomechanical analysis using the finite element method to assess the effects of plate length and the number of screws on construct stiffness, stress distribution, and fracture displacement in the fixation of type A2 distal humerus fractures. METHODS A 3-dimensional humerus model was constructed using computed tomography of a healthy man. After creating a 2-mm extra-articular fracture gap, orthogonal double-plate fixation was performed with an incremental increase in plate length and the number of screws, creating 17 fixation models. Four screws were placed in each plate's distal segment, and the number of screws was increased incrementally in the segment proximal to the fracture, starting from 2 in the medial (M) and 2 in the lateral (L) plate (M2∗L2). RESULTS The fifth screw proximal to the fracture in the lateral plate (L5) played an essential role in increasing stiffness under bending, axial, and torsional forces surpassing the intact bone, which may have been due to the bypassing of the stress riser area. Minimum construct stiffness was created when 5 (M3∗L2) screws were inserted into the proximal segment. For bending forces, the M4∗L2 construct was stronger than M3∗L3 (total 6 proximal screws), and M5∗L3 was stronger than M4∗L4 (total 8 proximal screws), showing higher stiffness when the plates ended at different levels. The M4∗L2 construct (6 screws) had stiffness comparable with M4∗L3, M4∗L4, and M5∗L4 during bending, showing comparable stiffness with the least instrumentation density. CONCLUSION Our findings suggested M3∗L5 as the optimum and M3∗L2 as the minimum construct to resist all bending, axial and torsional forces. CLINICAL RELEVANCE Applying the results may improve surgical techniques, decrease the rate of complications, including fixation failure and nerve injury, and optimize the time of surgery. Moreover, hardware removal is less cumbersome with fewer screws.
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Pereira CDS, Maçães AO, Lemos CL, Rodrigues-Pinto R. Sacro-pelvic Anthropometry in the Portuguese Population and Its Implication for Screw Placement in Spinal Surgery: A Single Centre Retrospective Analysis. Rev Bras Ortop 2022; 57:930-940. [PMID: 36540731 PMCID: PMC9757976 DOI: 10.1055/s-0042-1744293] [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: 06/14/2021] [Accepted: 01/20/2022] [Indexed: 10/18/2022] Open
Abstract
Objective The aim of this study was to assess the sacropelvic anthropometry in the Portuguese population, through the study of pelvic computed tomography (CT) scans. Methods Pelvic CT scans of 40 individuals were analyzed, and the length and angle measurements were performed according to predefined screw trajectories of S1 anterior (S1A), anterolateral (S1AL) and anteromedial (S1AM), S2 anterolateral (S2AL) and anteromedial (S2AM), S2 alar iliac (S2AI), iliac, and sacroiliac (SI) screws. Comparisons between genders were also performed. Results The S1A screw trajectory mean length was 30.80 mm. The S1AL mean length and lateral angle were 36.48 mm and 33.13°, respectively, and the S1AM's were 46.23 mm and 33.21°. The S2AL mean length was 28.66 mm and lateral angle was 26.52°, and the S2AM length and angle were 29.99 mm and 33.61°, respectively. The S2 alar-iliac screw trajectory mean length, lateral, and caudal angles were 125.84 mm, 36.78°, and 28.66°, respectively. The iliac screw trajectory mean length, lateral, and caudal angles were 136.73 mm, 23,86° and 24.01°, respectively. The sacroiliac screw trajectory length was 75.50 mm. The length of the screws was longer in men than in women, except for the S1A and SI screws, for which no difference was found between genders. Conclusion This study describes sacropelvic anatomical specifications. These defined morphometric details should be taken into consideration during surgical procedures.
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Affiliation(s)
| | - André Oliveira Maçães
- Departamento de Ortopedia, Centro Hospitalar do Porto, Porto, Portugal,Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Porto, Portugal
| | - Carolina Luisa Lemos
- Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Porto, Portugal,Instituto de Investigação e Inovação em Saúde (I3S), Universidade do Porto, Porto, Portugal
| | - Ricardo Rodrigues-Pinto
- Departamento de Ortopedia, Centro Hospitalar do Porto, Porto, Portugal,Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Porto, Portugal,Endereço para correspondência Ricardo Rodrigues-Pinto, MD, PhD Diretor da Unidade Vertebro-Medular (UVM), Departamento de Ortopedia, Centro Hospitalar do PortoLargo do Prof. Abel Salazar, 4099-001 PortoPortugal
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11
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Fujii T, Tateura M, Ogawa M, Ozeki S. Ultimate Load Measuring System for Fixation of Soft Tissue to Bone. Foot Ankle Int 2022; 43:253-259. [PMID: 34590871 DOI: 10.1177/10711007211040504] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The initial ultimate load for graft fixation is one of the essential factors in the reconstruction of lateral ankle ligaments. Several anchoring devices have been developed to fix the substitute ligament into the bone. A fair comparison of these fixation methods warrant a reproducible examination system. The purpose of this study was to make an experimental animal model and to compare the initial ultimate loads of 3 graft fixation methods, including the use of EndoButton (EB), interference screw (IFS), and a novel socket anchoring (SA) technique. METHODS Porcine calcaneus bones and 5-mm-wide split bovine Achilles tendons were used as fixation bases and graft materials, respectively. Both ends were firmly sutured side-by-side, using the circumferential ligation technique as a double-strand substitute that was 45 mm in length. Porcine calcanei with similar characteristics to adult human calcanei were mounted on a tensile testing machine, and substitutes were fixed into bones using the 3 fixation methods. A polyester tape was passed through the tendon loop and connected to a crosshead jig of the testing machine. The initial ultimate loads were measured in 15 specimens for each fixation method to simulate a lateral ankle ligament (LAL) injury. RESULTS The ultimate loads (ULs) were 223.6 ± 52.7 N for EB, 229.7 ± 39.7 N for SA, and 208.8 ± 65.3 N for IFS. No statistically significant difference was observed among the 3 groups (P = .571). All failures occurred at the bone-ligament substitute interface. CONCLUSION The initial ULs in all 3 fixation methods were sufficient for clinical usage. These values were larger than the UL of the anterior talofibular ligament; however, these were smaller than the UL of the calcaneofibular ligament. CLINICAL RELEVANCE In an experimental animal model, ULs for SA, EB, and IFS techniques showed no significant difference. All failures were observed in the fixation site of the calcaneus and were overwhelmingly related to suture fixation failure.
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Affiliation(s)
- Tatsuya Fujii
- First Department of Orthopaedic Surgery, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama, Japan
| | - Makoto Tateura
- First Department of Orthopaedic Surgery, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama, Japan
| | - Masato Ogawa
- First Department of Orthopaedic Surgery, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama, Japan
| | - Satoru Ozeki
- First Department of Orthopaedic Surgery, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama, Japan
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Morita K, Ohashi H, Kawamura D, Tani S, Karagiozov K, Murayama Y. Cervical lateral mass screw length analysis in men versus women. Clin Anat 2021; 35:454-460. [PMID: 34837269 DOI: 10.1002/ca.23812] [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: 09/24/2021] [Revised: 11/17/2021] [Accepted: 11/22/2021] [Indexed: 11/08/2022]
Abstract
Posterior fixations with lateral mass screws have become popular. The Roy-Camille and the Magerl techniques have been established and screw length was identified as a particularly important element. Sex and ethnicity are significant factors in cervical spine morphology, but few studies have been performed for screw length. We performed measurements using computed tomography (CT) images of adult patients hospitalized for surgery of the cervical spine, with targeted 3D data analysis. The final number of patients was 47 (33 men, 14 women) and 235 vertebrae. With the Roy-Camille technique, the screw length was longest at C3 (men: 13.0 mm ± 1.9 mm, women: 13.0 mm ± 1.9 mm) and smallest at C7 (men: 10.8 mm ± 1.8 mm, women: 9.4 mm ± 1.2 mm). With the Magerl technique, the screw length was smallest at C3 (men: 14.8 mm ± 1.6 mm, women: 14.3 mm ± 1.6 mm) and longest at C7 for men (16.8 mm ± 2.8 mm), and at C6 for women (15.4 mm ± 3.0 mm). To differ from spinal canal or pedicle, cervical lateral mass showed no obvious morphological differences from that of subjects of other ethnicity. The placement of a standard lateral mass screw would not cause complications in Japanese patients, even with the use of devices designed in North America or Europe. However, the anatomical background is essential because it is important to optimize the selection for each patient to avoid complications considering sex and individual differences.
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Affiliation(s)
- Kohei Morita
- The Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Hiroki Ohashi
- The Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Daichi Kawamura
- The Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Satoshi Tani
- The Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Kostadin Karagiozov
- The Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Yuichi Murayama
- The Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan
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13
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Cheruvu VPR, Gaba S, John JR, Rawat S. Management of extra-articular shaft fractures of the non-thumb metacarpals: plate-screw fixation versus K-wire fixation. Int J Burns Trauma 2021; 11:365-376. [PMID: 34858716 PMCID: PMC8610815] [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: 05/25/2021] [Accepted: 08/27/2021] [Indexed: 06/13/2023]
Abstract
Metacarpal fractures are common injuries and comprise nearly 36% to 42% of all fractures in the hand. The majority of these can be managed non-surgically. Operative fixation when needed, can be done by a variety of techniques. In this study, we have compared the outcomes of two techniques, plate-screw fixation and K-wire fixation. We have conducted a prospective, non-randomized, comparative study of patients who presented with extra-articular metacarpal shaft fractures of non-thumb metacarpals over a period of 18 months. 30 patients were enrolled according to the inclusion criteria and were alternately allotted to the plate-screw group and the K-wire group. At admission, patient demographics, clinical features, number of fractures, and fracture patterns were recorded, and radiographs were taken. In the plate-screw group, low-profile plates and screws were used, and in the K-wire group, 1 or 2 K-wires were used for fixation after fracture reduction. Hand mobilization exercises were started within one week in the plate-screw group, while in the K-wire group full mobilization was allowed at 4 weeks post-surgery. The Disabilities of Arm, Shoulder and Hand (DASH) score was calculated and compared between the two groups at 6 months and 12 months after surgery. The mean 6-month DASH score in the plate-screw group was 6.3287±2.2453, while it was 17.1627±6.2103 in the K-wire group (p value <0.001). At the end of 1-year follow-up, the mean DASH score in the plate-screw group was 5.1080±1.6637, and in the K-wire group, it was 5.1073±1.9392 (p value =0.848). In conclusion, extra-articular metacarpal shaft fractures of the non-thumb metacarpals treated by plate-screw fixation had significantly better DASH scores and hence better functional outcomes at the end of 6 months. However, at the end of 1 year, the DASH scores in both the groups were almost similar, suggesting similar functional outcomes in the long term.
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Affiliation(s)
- Ved Prakash Rao Cheruvu
- Department of Plastic Surgery, Post Graduate Institute of Medical Education and Research Chandigarh 160012, India
| | - Sunil Gaba
- Department of Plastic Surgery, Post Graduate Institute of Medical Education and Research Chandigarh 160012, India
| | - Jerry R John
- Department of Plastic Surgery, Post Graduate Institute of Medical Education and Research Chandigarh 160012, India
| | - Sourabh Rawat
- Department of Plastic Surgery, Post Graduate Institute of Medical Education and Research Chandigarh 160012, India
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14
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Yagi M, Ogiri M, Holy CE, Bourcet A. Comparison of clinical effectiveness of fenestrated and conventional pedicle screws in patients undergoing spinal surgery: a systematic review and meta-analysis. Expert Rev Med Devices 2021; 18:995-1022. [PMID: 34503387 DOI: 10.1080/17434440.2021.1977123] [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] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Pedicle screws are commonly used for spinal procedures for fusion stability, which is particularly important in osteoporotic patients, who are at an increased risk of requiring revision procedures. AREAS COVERED A systematic review and meta-analysis were conducted to compare clinical effectiveness of conventional pedicle screws (CPS) vs fenestrated pedicle screws (FPS) in patients undergoing spinal surgery. Primary outcomes included screw loosening, revision surgeries (involving an implant) and reoperations (not involving intervention on an implant) in patients treated with CPS vs FPS, sub-stratified by with and without osteoporosis. Secondary outcomes included changes in pain scores. Forty-eight studies with 8,302 patients were included, with 1,565 (19.18%) treated with FPS and 6,710 (80.82%) treated with CPS. FPS was associated with a lower risk of screw loosening (p = 0.001) vs CPS. In the general population, there was a non-significant trend of lower revision rate, but no difference in reoperation rate, between patients treated with FPS vs CPS. In osteoporotic patients, revision rates were significantly lower for FPS vs CPS (p = 0.009). EXPERT OPINION This review suggests that FPS are effective for surgical fixation and reduce rates of screw loosening, and in osteoporotic patients, revision surgeries, compared to CPS.
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Affiliation(s)
- Mitsuru Yagi
- Department of Orthopedic Surgery, Keio University School of Medicine, Japan
| | - Mami Ogiri
- Division of the Chief Medical Officer, Johnson & Johnson K.K. Medical Company, Chiyoda, Tokyo, Japan
| | - Chantal E Holy
- Medical Devices, Johnson and Johnson Limited, New Brunswick, NJ, USA
| | - Anh Bourcet
- Health Economics & Market Access, Johnson & Johnson Medical Asia Pacific, Singapore, Singapore
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15
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Torabi M, Khorramymehr S, Nikkhoo M, Rostami M. The effect of orthopedic screw profiles on the healing time of femoral neck fracture. Comput Methods Biomech Biomed Engin 2021; 25:97-110. [PMID: 34459294 DOI: 10.1080/10255842.2021.1932840] [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] [Indexed: 10/20/2022]
Abstract
One possible treatment for femoral neck fractures, especially in young people, is the use of bone screws or Lug screws. The design of these implants requires taking into account the biocompatibility of materials, mechanical properties plus surface properties, and thread's geometric, as well as chemical properties, etc. Various profiles are designed for fracture fixation. The most famous of these profiles, which are introduced by the ISO standard, are HB, HC, and HD type profiles. This article investigates the performance of these profiles in reducing or increasing the healing time. This study is based on the rule of bone remodeling and using a set of three-dimensional computational (finite element) models. The study revealed that the HB profile outperformed the other two profiles. Meanwhile, HD profile was also better than HC profile.
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Affiliation(s)
- Masoud Torabi
- Department of Biomedical Engineering, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Siamak Khorramymehr
- Department of Biomedical Engineering, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Mohammad Nikkhoo
- Department of Biomedical Engineering, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Mostafa Rostami
- Department of Biomedical Engineering, Amirkabir University of Technology, Tehran, Iran
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16
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Ghargozloo D, Tomarchio A, Ballerini M, Chitoni G. Traumatic bilateral scaphoid fractures. Med Glas (Zenica) 2021; 18:222-5. [PMID: 33480228 DOI: 10.17392/1332-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 12/10/2020] [Accepted: 12/17/2020] [Indexed: 11/18/2022]
Abstract
Aim To illustrate the surgical treatment of bilateral post-traumatic scaphoid fracture. Methods We came across a young student, who sustained bilateral, undisplaced scaphoid waist fractures following a fall during a football match. Despite careful clinical and radiographic evaluation by four views at the Accident and Emergency (A&E) Department, we initially performed only the diagnosis of the left scaphoid fracture treating it with a percutaneous Acutrack headless screw. Eight months later this patient returned to the A&E department due to a new trauma to his right wrist with the onset of painful symptoms: cystic scaphoid non-union. No pain had been reported on the wrist in those months. Results We performed osteosynthesis with Herbert headless screw through an extended volar approach placing a non-vascularized cortico-spongious bone grafts taken from radius. Periodic follow up by clinical examination, X-ray and CT scan with evidence of bone healing was performed. Conclusion Bilateral scaphoid fractures are rarely encountered, mostly as stress fractures in athletes and manual workers. If left untreated, arthritis, deformity, and instability can lead to significant disability. Comprehensive imaging should be done in case of suspected scaphoid fractures, especially after a trauma, even in the presence of modest symptoms, as failure to do so may lead to missed fracture. Considering what was exposed, the radiographic check on the right wrist repeated about two weeks after the trauma would have avoided a missed diagnosis, even in the absence of reported clinical symptoms. We therefore recommend to repeat the radiographic examination in all situations like these.
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17
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Chang CH, Lin LY, Roberts WE. Orthodontic bone screws: A quick update and its promising future. Orthod Craniofac Res 2020; 24 Suppl 1:75-82. [PMID: 33225592 DOI: 10.1111/ocr.12429] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 07/27/2020] [Revised: 09/11/2020] [Accepted: 09/16/2020] [Indexed: 11/26/2022]
Abstract
Orthodontic bone screws (OBSs) provide intraoral anchorage by penetrating oral mucosa and seating firmly in basilar bone (BB). Retromolar (prosthetic-type) implants introduced the extra-alveolar (E-A) concept for BB anchorage to move teeth throughout the alveolar process, but the clinical procedures were complex and expensive. Titanium alloy (Ti) miniscrews placed in inter-radicular (I-R) alveolar bone are more convenient and provide some tooth movement potential, but multiple screws are usually required and the devices often interfere with the path of tooth movement. The advantages of BB anchorage and the convenience of miniscrew are combined into the E-A OBS system. These miniscrews are relatively large in diameter (2 mm), and strong (stainless steel), which are placed intraorally in the BB of the infra-zygomatic crest (IZC) and mandibular buccal shelf (MBS). E-A OBSs provide osseous anchorage to retract the dentition and/or rotate either arch. Recovery of impactions is effectively managed with lever arm springs anchored with IZC or MBS bone screws. An emerging frontier is BB anchorage for correcting severe malocclusions with clear aligners. Since the osseous-anchored mechanics are complementary, fixed appliances and clear aligners can be used individually or in tandem to resolve a broad variety of malocclusions. This report summarizes current concepts for conservatively managing complex malocclusions such as severe crowding, skeletal discrepancies, asymmetries and impactions with the OBS system.
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Affiliation(s)
| | - Lexie Y Lin
- Beethoven Orthodontic Center, HsinChu, Taiwan
| | - Wilbur Eugene Roberts
- Department of Orthodontics, School of Dentistry, Indiana University, Indianapolis, IN, USA.,Department of Mechanical Engineering, IUPUI, Indianapolis, IN, USA.,Department of Orthodontics, School of Dentistry, Loma Linda University, Loma Linda, CA, USA
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18
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Fleury RBC, Shimano AC, Matos TD, Teixeira KDO, Romero V, Defino HLA. The Role of Pedicle Screw Surface on Insertion Torque and Pullout Strength. Rev Bras Ortop 2020; 55:695-701. [PMID: 33364646 PMCID: PMC7748926 DOI: 10.1055/s-0040-1710072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 08/31/2019] [Accepted: 02/20/2020] [Indexed: 10/31/2022] Open
Abstract
Objective Compare by mechanical tests the pullout resistance and the insertion torque of rough and smooth pedicle screws. Methods Pedicle screws with rough surface and smooth surface, with diameters of 4.8; 5.5 and 6.5 mm, were inserted in polyurethane blocks with density of 10 PCF (0.16 g/cm3). Insertion torque and pullout strength were assessed. Results The pullout strength of the rough surface and smooth surface screws did not differ, except in the group of 4.8 mm diameter screws. In this group, the rough surface screws showed greater resistance to pullout. Conclusion Pedicle screws with a rough surface did not show increased pullout resistance in the acute phase of their insertion in polyurethane blocks compared to smooth surface screws. The rough surface screws had a higher insertion torque than the smooth surface screws, depending on the diameter of the screw and the preparation of the pilot hole.
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Affiliation(s)
- Rodrigo Barra Caiado Fleury
- Curso de Pós-Graduação, Departamento de Biomecânica, Medicina e Reabilitação do Aparelho Locomotor, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - Antônio Carlos Shimano
- Departamento de Biomecânica, Medicina e Reabilitação do Aparelho Locomotor, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - Thiago Dantas Matos
- Curso de Pós-Graduação, Departamento de Biomecânica, Medicina e Reabilitação do Aparelho Locomotor, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - Kelsen de Oliveira Teixeira
- Curso de Pós-Graduação, Departamento de Biomecânica, Medicina e Reabilitação do Aparelho Locomotor, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - Valéria Romero
- Departamento de Clínica Médica, Faculdade de Ciências Médicas da Universidade Estadual de Campinas, Campinas, SP, Brasil
| | - Helton Luiz Aparecido Defino
- Departamento de Biomecânica, Medicina e Reabilitação do Aparelho Locomotor da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, São Paulo, SP, Brasil
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19
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Fletcher JWA, Wenzel L, Neumann V, Richards RG, Gueorguiev B, Gill HS, Preatoni E, Whitehouse MR. Surgical performance when inserting non-locking screws: a systematic review. EFORT Open Rev 2020; 5:26-36. [PMID: 32071771 PMCID: PMC7017595 DOI: 10.1302/2058-5241.5.180066] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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: 01/05/2023] Open
Abstract
Billions of screws are inserted by surgeons each year, making them the most commonly inserted implant. When using non-locking screws, insertion technique is decided by the surgeon, including how much to tighten each screw. The aims of this study were to assess, through a systematic review, the screw tightness and rate of material stripping produced by surgeons and the effect of different variables related to screw insertion. Twelve studies were included, with 260 surgeons inserting a total of 2793 screws; an average of 11 screws each, although only 1510 screws have been inserted by 145 surgeons where tightness was measured – average tightness was 78±10% for cortical (n = 1079) and 80±6% for cancellous screw insertions (n = 431). An average of 26% of all inserted screws irreparably damaged and stripped screw holes, reducing the construct pullout strength. Furthermore, awareness of bone stripping is very poor, meaning that screws must be considerably overtightened before a surgeon will typically detect it. Variation between individual surgeons’ ability to optimally insert screws was seen, with some surgeons stripping more than 90% of samples and others hardly any. Contradictory findings were seen for the relationship between the tightness achieved and bone density. The optimum tightness for screws remains unknown, thus subjectively chosen screw tightness, which varies greatly, remains without an established target to generate the best possible construct for any given situation. Work is needed to establish these targets, and to develop methods to accurately and repeatably achieve them.
Cite this article: EFORT Open Rev 2020;5:26-36. DOI: 10.1302/2058-5241.5.180066
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Affiliation(s)
- James W A Fletcher
- Department for Health, University of Bath, UK.,AO Research Institute Davos, Switzerland
| | - Lisa Wenzel
- AO Research Institute Davos, Switzerland.,Department of Trauma Surgery, Trauma Center Murnau, Germany
| | | | | | | | | | | | - Michael R Whitehouse
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, Southmead Hospital, Bristol, UK.,National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, UK
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20
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Devkota P, Ahmad S, Pande KC. Intertrochanteric Fracture of the Femur in an Ankylosed Hip: A Case Report. Rev Bras Ortop 2019; 54:736-738. [PMID: 31875075 PMCID: PMC6923655 DOI: 10.1016/j.rboe.2017.11.016] [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: 10/01/2017] [Accepted: 11/23/2017] [Indexed: 11/30/2022] Open
Abstract
Intertrochanteric fractures of the femur in ankylosed hips are extremely rare. The aims of the operative management for elderly patients with intertrochanteric fractures are to prevent general complications, to maintain mobility, and to relieve pain. The optimal management to achieve these goals is not clear. The authors present a case of a 74-year-old man with an intertrochanteric fracture of the femur in an ankylosed hip. The fracture was managed surgically with dynamic hip screws and cannulated screws. Two years after the surgery, good union was observed at the fracture, and the patient was ambulating independently.
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Affiliation(s)
- Pramod Devkota
- Departmento de Ortopedia e Cirurgia de Traumatismos, Suri Seri Begawan Hospital, Kuala Belait, Brunei
| | - Shiraz Ahmad
- Departmento de Ortopedia e Cirurgia de Traumatismos, Suri Seri Begawan Hospital, Kuala Belait, Brunei
| | - Ketan C Pande
- Departmento de Ortopedia e Cirurgia de Traumatismos, RIPAS Hospital, Bandar Seri Begawan, Brunei
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21
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Zhang GA, Zhang WP, Chen YC, Hou Y, Qu W, Ding LX. Efficacy of Vertebroplasty in Short-Segment Pedicle Screw Fixation of Thoracolumbar Fractures: A Meta-Analysis. Med Sci Monit 2019; 25:9483-9489. [PMID: 31829312 PMCID: PMC6927238 DOI: 10.12659/msm.917253] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 08/08/2019] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Short-segment pedicle screw instrumentation provides superior outcomes in treating thoracolumbar fractures. Nevertheless, the effect of intermediate screws on the outcome of short-segment instrumentation at the fracture level has not been specifically analyzed. We performed an update meta-analysis of the effect of additional vertebroplasty on the outcome of short-segment instrumentation to determine the role of screws for patients with fractured vertebra. MATERIAL AND METHODS A systematic literature search was conducted, updated to January 2019, in terms of the efficacy of additional vertebroplasty on the outcome of short-segment instrumentation at the fracture level. After rigorous quality review, we extracted the data from qualified clinical studies. We further analyzed odds ratios (ORs) of the endpoints of interest based on the included trials. RESULTS Compared with the control group, short-segmental fixation combined with intermediate screws restored Cobb angle (P<0.001) and reduced anterior vertebral height compression (P=0.001). However, our results did not reveal statistically significant differences in operative time (P=0.28) or estimated blood loss (P=0.23). A statistically significant difference was observed in mean hospital stay (P=0.02). CONCLUSIONS Reinforcement with fracture-level screw combination can help stabilize the fractures and restore the anatomy. Nevertheless, additional trials and studies with longer follow-ups and on larger populations are warranted to confirm the current findings.
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Affiliation(s)
- Gen-Ai Zhang
- Department of Spine Surgery, Beijing Shi Ji Tan Hospital, Capital Medical University, Beijing, P.R. China
| | - Wen-Ping Zhang
- School of Public Health, Shanxi Medical University, Taiyuan, Shanxi, P.R. China
| | - Ying-Chun Chen
- Department of Spine Surgery, Beijing Shi Ji Tan Hospital, Capital Medical University, Beijing, P.R. China
| | - Yu Hou
- Department of Spine Surgery, Beijing Shi Ji Tan Hospital, Capital Medical University, Beijing, P.R. China
| | - Wei Qu
- Department of Spine Surgery, Beijing Shi Ji Tan Hospital, Capital Medical University, Beijing, P.R. China
| | - Li-Xiang Ding
- Department of Spine Surgery, Beijing Shi Ji Tan Hospital, Capital Medical University, Beijing, P.R. China
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22
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Sadr Haghighi AH, Pouyafar V, Navid A, Eskandarinezhad M, Abdollahzadeh Baghaei T. Investigation of the optimal design of orthodontic mini-implants based on the primary stability: A finite element analysis. J Dent Res Dent Clin Dent Prospects 2019; 13:85-89. [PMID: 31592304 PMCID: PMC6773917 DOI: 10.15171/joddd.2019.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 08/31/2018] [Accepted: 07/02/2019] [Indexed: 12/01/2022] Open
Abstract
Background. The design of an orthodontic mini-implant is a significant factor in determining its primary stability and its clinical success. The aim of this study was to measure the relative effect of mini-implant design factors on primary stability of orthodontic mini-implants.
Methods. Thirty-two 3-dimensional assemblies of mini-implant models with their surrounding bone were generated using finite element analysis software. The maximum displacement of each mini-implant model was measured as they were loaded with a 2-N horizontal force. Employing Taguchi’s design of experiments as a statistical method, the contribution of each design factor to primary stability was calculated. As a result of the great effect of the upper diameter and length, to better detect the impact of the remaining design factors, another set of 25 models with a fixed amount of length and diameter was generated and evaluated.
Results. The diameter and length showed a great impact on the primary stability in the first set of experiments (P<0.05). According to the second set of experiments, increased taper angle in the threaded and non-threaded area decreased the primary stability. There was also an optimum amount of 2.5 mm for threaded taper length beyond which the primary stability decreased.
Conclusion. It is advisable to increase the diameter and length if primary stability is at risk. In the second place, a minimum amount of taper angle, both in the threaded and non-threaded area with an approximate proportion of 20% of threaded taper length to MI length, would be desirable for MIs with a moderate size.
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Affiliation(s)
- Amir Hooman Sadr Haghighi
- Department of Orthodontics, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Vahid Pouyafar
- Department of Mechanical Engineering, Tabriz University, Tabriz, Iran
| | - Ali Navid
- Department of Mechanical Engineering, Tabriz University, Tabriz, Iran
| | - Mahsa Eskandarinezhad
- Department of Endodontics, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran
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23
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Labronici PJ, Santos Filho FCD, Diamantino YLO, Loureiro E, Ezequiel MCDG, Alves SD. Proximal Femur Fracture and Vascular Injury in Adults-Case Report. Rev Bras Ortop 2019; 54:343-346. [PMID: 31363292 DOI: 10.1016/j.rbo.2017.09.003] [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: 08/16/2017] [Accepted: 09/19/2017] [Indexed: 10/18/2022] Open
Abstract
Vascular complications in the surgical treatment of hip fractures are rare. Depending on the arterial injury, severe intraoperative bleeding or a subacute hematoma formation with arterial pseudoaneurysm development can occur. In the literature, the more frequently described complications are large local hematomas after osteosynthesis with sliding hip screws. This report shows a case of delayed arterial injury after proximal femur osteosynthesis.
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Affiliation(s)
- Pedro José Labronici
- Serviço de Ortopedia e Traumatologia, Hospital Santa Teresa, Petrópolis, RJ, Brasil.,Universidade Federal Fluminense, Niterói, RJ, Brasil
| | | | | | - Eduardo Loureiro
- Cirurgia Vascular, Hospital Santa Teresa, Petrópolis, RJ, Brasil.,Cirurgia Vascular, Hospital Federal da Lagoa, Rio de Janeiro, RJ, Brasil
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24
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Giordano V, Giordano M, Aquino R, Grossi JO, Senna H, Koch HA. How do Orthopedic Surgeons Manage Displaced Femoral Neck Fracture in the Middle-Aged Patient? Brazilian Survey of 78 Orthopaedic Surgeons. Rev Bras Ortop 2019; 54:288-294. [PMID: 31363283 PMCID: PMC6597433 DOI: 10.1055/s-0039-1691761] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 07/02/2018] [Indexed: 10/31/2022] Open
Abstract
Objective The aim of the present study was to evaluate the practices and preferences of Brazilian orthopedic surgeons for the treatment of femoral neck fractures in middle-aged patients. Methods A survey containing 10 images of femoral neck fractures was sent to a group of 100 orthopedic surgeons, all of them members of the Brazilian Society of Orthopedics and Traumatology. The questionnaire asked the treatment option for cases of nondisplaced and displaced fractures of the femoral neck in middle-aged patients, that is, those between 50 and 69 years old. Descriptive and inferential statistical analyzes were performed using the chi-squared (χ2) and the Fisher exact tests. The level of significance was 5%. Results The survey was answered by 78% of the orthopedic surgeons invited to participate in the study. There was no significant difference in the treatment method distribution between generalists and specialists ( p = 0.16) in the sample of nondisplaced femoral neck fractures. There was a highly significant difference in the treatment method distribution between generalists and specialists ( p < 0.0001) in the sample of displaced fractures of the femoral neck. Conclusion Preservation of the femoral head through multiple cannulated screws fixation is the treatment of choice for nondisplaced femoral neck fractures for both generalists and specialists. Low chronological and/or physiological age are the main factors for this decision-making. In displaced femoral neck fractures, femoral head replacement is preferred for both groups of orthopedists (generalists and specialists). In this situation, specialists prefer total hip arthroplasty (THA), whereas generalists favor partial hip arthroplasty (PHA).
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Affiliation(s)
- Vincenzo Giordano
- Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rio de Janeiro, Brasil.,Clínica São Vicente, Rio de Janeiro, Brasil
| | - Marcos Giordano
- Serviço de Traumato-Ortopedia, Hospital de Força Aérea do Galeão, Rio de Janeiro, Brasil
| | - Rodrigo Aquino
- Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rio de Janeiro, Brasil
| | - João Otávio Grossi
- Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rio de Janeiro, Brasil
| | - Hudson Senna
- Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rio de Janeiro, Brasil
| | - Hilton Augusto Koch
- Departamento de Radiologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
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张 祎, 饶 烽, 皮 伟, 张 培, 姜 保. [Proximal femoral nails antirotation and dynamic hip screws for fixation of unstable intertrochanteric fractures of femur: A meta-analysis]. Beijing Da Xue Xue Bao Yi Xue Ban 2019; 51:493-500. [PMID: 31209421 PMCID: PMC7439035 DOI: 10.19723/j.issn.1671-167x.2019.03.017] [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] [Received: 03/07/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of proximal femoral nail antirotation (PFNA) and dynamic hip screw (DHS) for unstable intertrochanteric fractures using meta-analysis. METHODS The PubMed, Embase, Cocharane Central Register of Controlled Trials, Google Scholar, China Science and Technology Papers and Citation Database (CSTPCD) and China Journal Full-text Database (CNKI) were searched for published randomized controlled trials before January 1, 2019. Two researchers independently screened the literature in the light of the inclusion and exclusion criteria, evaluated the quality of the studies and extracted the data which were consisted of clinical efficacy indexes, such as incision length, operation time,intraoperative blood loss, weight-bearing time,fracture-healing time, Harris hip score and safety indicators like complications. Meta-analysis was performed with the Revman 5.3 software provided by Cochrane Community in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) standard. RESULTS Nine randomized controlled trials met the requirement with a total of 779 patients, of whom 383 were fixed with PFNA and 396 with DHS. Meta-analysis demonstrated that PFNA was associated with smaller surgical incision length [MD=-7.43, 95%CI (-9.31, -5.55), P<0.05], shorter operation time [MD=-22.76, 95%CI (-29.57, -11.95), P<0.05], less intraoperative blood loss [MD=-216.34, 95%CI (-275.18, - 157.49), P<0.05], earlier weight bearing after surgery [MD=-12.34, 95%CI (-17.71, -6.97), P<0.05], shorter fracture healing time [MD=-5.00, 95%CI (-7.73, -2.26), P<0.05], higher postoperative Harris hip score [MD=12.22, 95%CI (3.88, 20.55), P<0.05], higher rate of excellent Harris hip score [OR=3.56, 95%CI (1.44, 8.81), P<0.05] and lower incidence rate of postoperative complications [OR=0.48, 95%CI (0.33, 0.70), P<0.05], such as hip varus, wound infection, urinary tract infection, pulmonary infection, pressure sore, deep vein thrombosis, pulmonary embolism, heart failure and cerebral infraction when compared with DHS. No statistical difference was shown between the groups when it came to subgroup analysis by age. However, there was no significant difference (P>0.05) in the duration of hospitalization and the complications resulting in the occurrences of internal fixation loosening, such as femoral shaft fracture (during or post operation), internal fixation fracture, cut-out, displacement or retraction. CONCLUSION Current published evidence supports the superiority of PFNA to DHS for unstable intertrochanteric fractures in terms of clinical efficacy. The conclusion was limited because of the relatively low quality of evidence with low strength of confidence. Large scale and high-quality randomized controlled trials are required to validate the safety of PFNA and DHS for unstable intertrochanteric fractures.
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Affiliation(s)
- 祎然 张
- />北京大学人民医院创伤骨科, 北京 100044Department of Trauma and Orthopedics, Peking University People’s Hospital, Beijing 100044, China
| | - 烽 饶
- />北京大学人民医院创伤骨科, 北京 100044Department of Trauma and Orthopedics, Peking University People’s Hospital, Beijing 100044, China
| | - 伟 皮
- />北京大学人民医院创伤骨科, 北京 100044Department of Trauma and Orthopedics, Peking University People’s Hospital, Beijing 100044, China
| | - 培训 张
- />北京大学人民医院创伤骨科, 北京 100044Department of Trauma and Orthopedics, Peking University People’s Hospital, Beijing 100044, China
| | - 保国 姜
- />北京大学人民医院创伤骨科, 北京 100044Department of Trauma and Orthopedics, Peking University People’s Hospital, Beijing 100044, China
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Abstract
This study aims to evaluate the clinical and radiographic treatment outcomes of comminuted Mason type II radial head fractures, which underwent open reduction and internal fixation (ORIF) using a new implant (mother-child screw, MCS).This study included 16 patients (7 male and 9 female patients; mean age: 40.9 years, age range: 19-68 years), who were treated with ORIF, followed by MCS fixation for comminuted type II radial head fractures. The clinical results were evaluated using the Mayo Elbow Performance Score (MEPS). Radiographs, which included the quality of fracture reduction, stability, osteoarthritis, and heterotopic ossification of the elbow, were investigated. The mean follow-up period was 23.4 months.Anatomical reduction and bone union were achieved in all patients treated with MCS, and mean union time was 6.2 weeks. The average flexion-extension arc of elbow motion was 135.6° (range: 125°-150°), and the average arc of forearm rotation was 155.3° (range: 145°-170°). Furthermore, MEPS was 94.1 (range: 85-100), and the rate of excellent and good was 100%. All patients returned to preinjury work within a mean period of 11.7 weeks. No heterotopic ossification and joint stiffness of the elbow were encountered. Two patients had mild arthritic changes (grade I), but none of these patients complained of pain.The use of MCS fixation for comminuted type II radial head fractures resulted in good clinical and radiographic outcomes.
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Affiliation(s)
- Yan Shi
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou
| | - Gao-Feng Wang
- Department of Orthopaedic Surgery, The Affiliated Wujin Hospital of Jiangsu University, Changzhou, China
| | - Kai Mei
- Department of Orthopaedic Surgery, The Affiliated Wujin Hospital of Jiangsu University, Changzhou, China
| | - Jie Zhang
- Department of Orthopaedic Surgery, The Affiliated Wujin Hospital of Jiangsu University, Changzhou, China
| | - Chang-Jun Yun
- Department of Orthopaedic Surgery, The Affiliated Wujin Hospital of Jiangsu University, Changzhou, China
| | - Chen Qian
- Department of Orthopaedic Surgery, The Affiliated Wujin Hospital of Jiangsu University, Changzhou, China
| | - Jun-Ying Sun
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou
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Chen W, Fang XM, Qian PY, Sanjeev Kumar PS, Chen HW, Xiao-Yun HU. Evaluation of Multi-Slice Spiral Computed Tomography in In vivo Simulation of Individualized Cervical Pedicle Screw Placement at C3-C7 in Chinese Healthy Population. Indian J Orthop 2018; 52:651-656. [PMID: 30532307 PMCID: PMC6241050 DOI: 10.4103/ortho.ijortho_3_17] [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 Cervical pedicle screw fixation through posterior approach has shown greater cervical stability advantage. The cervical pedicle screw fixation technique through posterior approach is demanding. The key to the technique is the choice of point and angle of screw entrance. The angle of screw placement is variable. Morphometric measurements of the cervical pedicle are a prerequisite for individualized screw. CT imaging has become the most reliable and important means to obtain cervical pedicle's measurement data and morphology in vivo. This study explores the feasibility and application of precise in vivo measurements by multi-slice computed tomography (MSCT) for individualized cervical transpedicular screw placement at C3-C7 in Chinese healthy population. MATERIALS AND METHODS 80 adults who underwent cervical examination by enhanced and nonenhanced computed tomography angiography, respectively, were selected and submitted to bone algorithm reconstruction for slice thickness and interval of 0.75 mm to acquire clear images and detailed bone structures. Simulation of individualized screw placement was performed with a 4.0 mm diameter screw with the help of postprocessing workstation. Pedicle transverse angle (PTA) and sagittal angle (PSA) were measured using the single- and double-line methods (analog nailing, 4.0 mm in diameter) in 160 pairs of C3-C7 pedicles, setting positive and negative values for cranial direction and foot side PSAs, respectively. Comparison of the measured change scope in PTA and PSA between the two methods was carried out; the range was defined as the error range. RESULTS Significantly, different results (P < 0.05) were obtained between the single- and double-line methods in the error ranges of PTA and PSA in C3-C7 pedicles. Interestingly, the double-line method was better in simulating the actual needs of individualized nailing. The mean values of PTA and PSA were 42.9°, 45.5°, 42.4°, 37.1°, 29.0° and 8.4°, 5.0°, -4.0°, and -7.8°, -8.1°, respectively, with the double-line method. CONCLUSION MSCT reconstruction techniques can determine the direction and required parameters for individualized screw placement. In addition, accurate in vivo measurements of PTA and PSA, particularly PSA, provide the orthopedic surgeon with theoretical guidance and reliable basis in screw placement.
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Affiliation(s)
- Wei Chen
- Department of Intervention Radiology, Huai’an First People's Hospital, Nanjing Medical University, Jiangsu Province, China
| | - Xiang-Ming Fang
- Imaging Center, Wuxi People's Hospital Affiliated to Nanjing Medical University, Jiangsu Province, China
| | - Ping-Yan Qian
- Imaging Center, Wuxi People's Hospital Affiliated to Nanjing Medical University, Jiangsu Province, China
| | - PS Sanjeev Kumar
- Department of Medical Imaging, Parexel International Pvt Ltd, Hyderabad, Telangana, India
| | - Hong-wei Chen
- Imaging Center, Wuxi People's Hospital Affiliated to Nanjing Medical University, Jiangsu Province, China
| | - HU Xiao-Yun
- Imaging Center, Wuxi People's Hospital Affiliated to Nanjing Medical University, Jiangsu Province, China,Address for correspondence: Dr. Xiao-Yun HU, Imaging Center, Wuxi People's Hospital Affiliated to Nanjing Medical University, No. 299, Qingyang Road, Wuxi 214023, Jiangsu Province, China. E-mail:
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Liu N, Tian L, Jiang RX, Xu C, Shi L, Lei W, Zhang Y. An in vitro biomechanical evaluation of an expansive double-threaded bi-directional compression screw for fixation of type II odontoid process fractures: A SQUIRE-compliant article. Medicine (Baltimore) 2017; 96:e6720. [PMID: 28422889 PMCID: PMC5406106 DOI: 10.1097/md.0000000000006720] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 11/26/2022] Open
Abstract
Odontoid process fracture accounts for 5% to 15% of all cervical spine injuries, and the rate is higher among elderly people. The anterior cannulated screw fixation has been widely used in odontoid process fracture, but the fixation strength may still be limited under some circumstances. This study aims to investigate the biomechanical fixation strength of expansive double-threaded bi-directional compression screw (EDBCS) compared with cannulated lag screw (CLS) and improved Herbert screw (IHS) for fixation of type II odontoid process fracture.Thirty fresh cadaveric C2 vertebrae specimens were harvested and randomly divided into groups A, B, and C. A type II fracture model was simulated by osteotomy. Then the specimens of the 3 groups were stabilized with a single CLS, IHS, or EDBCS, respectively. Each specimen was tested in torsion from 0° to 1.25° for 75 s in each of 5 cycles clockwise and 5 cycles anticlockwise. Shear and tensile forces were applied at the anterior-to-posterior and proximal-to-distal directions, respectively, both to a maximum load of 45 N and at a speed of 1 mm/min.The mean torsional stiffness was 0.309 N m/deg for IHS and 0.389 N m/deg for EDBCS, which were significantly greater compared with CLS, respectively (0.169 N m/deg) (P < .05 and P < .05). The mean shear stiffness for the EDBCS was 238 N/mm, which was significantly greater than CLS (150 N/mm) and IHS (132 N/mm) (P < .05 and P < .05). All 3 screws only partly restored tensile stiffness, but not significantly.Fixation with the EDBCS can improve the biomechanical strength for odontoid process fracture compared with CLS and IHS, especially in terms of torsional and shear stiffness.
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Affiliation(s)
- Ning Liu
- Department of Orthopedics, Xijing Hospital, The Fourth Military Medical University
| | - Li Tian
- Department of Anesthesiology, Xijing Hospital, The Fourth Military Medical University, Xi’an
| | - Rong-Xian Jiang
- Department of Orthopedics, 62th Hospital of PLA, Puer, China
| | - Chao Xu
- Department of Orthopedics, Xijing Hospital, The Fourth Military Medical University
| | - Lei Shi
- Department of Orthopedics, Xijing Hospital, The Fourth Military Medical University
| | - Wei Lei
- Department of Orthopedics, Xijing Hospital, The Fourth Military Medical University
| | - Yang Zhang
- Department of Orthopedics, Xijing Hospital, The Fourth Military Medical University
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Abstract
OBJECTIVE To determine whether supplementary tibial graft fixation with a staple is routinely necessary for anterior cruciate ligament (ACL) reconstructions. METHODS We retrospectively reviewed a series of consecutive patients who underwent ACL reconstruction at our institution from April 2012 to July 2013. Patients who fulfilled the inclusion and exclusion criteria were divided into two groups, of which one with tibial fixation of the graft with a biointerference screw alone (biointerference screw group) and the other with tibial fixation of the graft with a biointerference screw and supplementary extra tunnel staple fixation (biointerference screw and staple group). All the surgeries were performed by a single fellowship-trained sports surgeon, using a standardized transportal technique and rehabilitation protocol. Both well-matched groups were evaluated at 1-year follow-up objectively for ligament laxity using instrumented testing with KT-2000 arthrometer and clinical tests as well as subjectively with the validated International Knee Documentation Committee 2000 (IKDC) and Lysholm knee score. All complications were reported. RESULTS A total of 64 patients (31 in the only biointerference screw group and 33 in the biointerference screw and staple group) were included in the study. At 1 year, there was no significant difference in the objective and subjective outcome assessments between the two groups. However, four patients from the group with supplementary staple experienced symptomatic hardware on kneeling of which two necessitated removal of hardware. CONCLUSION Our study showed that supplementary tibial graft fixation with a staple is not routinely necessary for ACL reconstructions. It confers no additional benefits when compared with the use of biointerference screw alone for tibial graft fixation but may increase the risks of symptomatic hardware.
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30
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Abstract
BACKGROUND Calcaneum is the most commonly fractured tarsal bone. The optimal treatment for displaced calcaneus fractures involving the posterior facet is surgical. The extensile lateral approach is commonly preferred because it provides sufficient exposure of the subtalar facet. However, this technique has the risk of complications such as wound necrosis and sural nerve injury. Various minimally invasive approaches, such as sinus tarsi approach, limited posterior approach, and percutaneous approach, have been introduced to reduce possible complications. This study was prospectively performed to evaluate the results of the sinus tarsi approach for Sanders Type 2 calcaneal fractures using postoperative computed tomography (CT). MATERIALS AND METHODS Between October 2012 and December 2013, 20 Sanders Type 2 calcaneal fractures were consecutively treated using a sinus tarsi approach and checked using CT preoperatively, immediately postoperatively, and at 12 months after surgery. Clinical evaluations were performed using the visual analog scale (VAS) and the ankle-hindfoot score developed by the American Orthopaedic Foot and Ankle Society (AOFAS). Radiographic evaluations were performed using calcaneus lateral and axial radiographs, hindfoot alignment radiograph, and CT. Changes in Böhler's angles and calcaneal widths were evaluated both preoperatively and at last followup. Reduction of the posterior facet was graded according to articular step, defect, and angulation of the posterior facet in CT. RESULTS VAS and AOFAS scores were significantly improved at 1 year after surgery but did not improve further. Böhler's angles and calcaneal widths were significantly improved after surgery. Böhler's angle was significantly smaller at the last followup than immediately after surgery, whereas calcaneal width was maintained. Reduction of the posterior facet was graded excellent in five feet (25%), good in ten (50%), and fair in five (25%) on immediately postoperative CT. Two feet (10%) had transient sural nerve injury which resolved within 3 months. Five feet (20%) had subfibular pain due to a prominent screw heads. CONCLUSION Surgical management using a sinus tarsi approach produced good clinical and radiographic results and low wound complications for Sanders type 2 calcaneal fractures. It is important to have stable fixation and to achieve sufficient reduction of calcaneal width for the prevention of loss of reduction and lateral subfibular impingement.
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Affiliation(s)
- Chul Hyun Park
- Department of Orthopaedic Surgery, Yeungnam University Hospital, Daegu, South Korea,Address for correspondence: Prof. Chul Hyun Park, Department of Orthopaedic Surgery, Yeungnam University Hospital, 317-1, Daemyong-dong, Nam-gu, Daegu 42415, Korea. E-mail:
| | - Dong Yeol Lee
- Department of Orthopaedic Surgery, Yeungnam University Hospital, Daegu, South Korea
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Abstract
BACKGROUND Vascular injury during minimally invasive total hip arthroplasty (THA) is uncommon, yet a well-recognized and serious issue. It emerges because of non-visibility of vascular structures proximal to the pelvic bone during reaming, drilling holes, and fixing of screws. Numerous studies have found that screw fixation during cementless THA is beneficial for the initial stability of cup; yet, no anatomical guidelines support angular eccentric screw fixation. MATERIALS AND METHODS In this study, we obtained the pelvic arterial-phase computed tomographic data of thirty eight humans and reconstructed the three-dimensional models of osseous and vessel structures. We performed the surgical simulation to fix these structures with cementless cups and screws with angular eccentricities. RESULTS The effect of screw eccentricities (angular eccentricities of ±17° and ±34°) on the vascular injury was determined. Measurement between screw and adjoining vessels was performed and analyzed statistically to ascertain a comparative risk study for blood vessels that are not visible during surgery. CONCLUSION Authors similarly discussed the significant absence of appreciation of quadrant systems proposed by Wasielewski et al. on eccentric screws. Adjustment of quadrant systems provided by Wasielewski et al. is required for acetabular implants with eccentric holes for fixation of acetabular screws.
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Affiliation(s)
- Nishant Kumar Singh
- School of Biomedical Engineering, Indian Institute of Technology (Banaras Hindu University), Varanasi, Uttar Pradesh, India
| | - Sanjay Kumar Rai
- School of Biomedical Engineering, Indian Institute of Technology (Banaras Hindu University), Varanasi, Uttar Pradesh, India,Address for correspondence: Dr. Sanjay Kumar Rai, School of Biomedical Engineering, Indian Institute of Technology, Banaras Hindu University, Varanasi, Uttar Pradesh, India. E-mail:
| | - Amit Rastogi
- Department of Orthopaedics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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Abstract
BACKGROUND The aim of the present prospective study is to evaluate whether the touted advantages of minimal invasive-transforaminal lumbar interbody fusion (MI-TLIF) translate into superior, equal, or inferior outcomes as compared to open-transforaminal lumbar interbody fusion (O-TLIF). This is the first study from the Indian subcontinent prospectively comparing the outcomes of MI-TLIF and O-TLIF. MATERIALS AND METHODS All consecutive cases of open and MI-TLIF were prospectively followed up. Single-level TLIF procedures for spondylolytic and degenerative conditions (degenerative spondylolisthesis, central disc herniations) operated between January 2011 and January 2013 were included. The pre and postoperative Oswestry Disability Index (ODI) and visual analog scale (VAS) for back pain and leg pain, length of hospital stay, operative time, radiation exposure, quantitative C-reactive protein (QCRP), and blood loss were compared between the two groups. The parameters were statistically analyzed (using IBM® SPSS® Statistics version 17). RESULTS 129 patients underwent TLIF procedure during the study period of which, 71 patients (46 MI-TLIF and 25 O-TLIF) fulfilled the inclusion criteria. Of these, a further 10 patients were excluded on account of insufficient data and/or no followup. The mean followup was 36.5 months (range 18-54 months). The duration of hospital stay (O-TLIF 5.84 days + 2.249, MI-TLIF 4.11 days + 1.8, P < 0.05) was shorter in MI-TLIF cases. There was less blood loss (open 358.8 ml, MI 111.81 ml, P < 0.05) in MI-TLIF cases. The operative time (O-TLIF 2.96 h + 0.57, MI-TLIF 3.40 h + 0.54, P < 0.05) was longer in MI group. On an average, 57.77 fluoroscopic exposures were required in MI-TLIF which was significantly higher than in O-TLIF (8.2). There was no statistically significant difference in the improvement in ODI and VAS scores in MI-TLIF and O-TLIF groups. The change in QCRP values preoperative and postoperative was significantly lower (P < 0.000) in MI-TLIF group than in O-TLIF group, indicating lesser tissue trauma. CONCLUSION The results in MI TLIF are comparable with O-TLIF in terms of outcomes. The advantages of MI-TLIF are lesser blood loss, shorter hospital stay, lesser tissue trauma, and early mobilization. The challenges of MI-TLIF lie in the steep learning curve and significant radiation exposure. The ultimate success of TLIF lies in the execution of the procedure, and in this respect the ability to achieve similar results using a minimally invasive technique makes MI-TLIF an attractive alternative.
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Affiliation(s)
- Arvind G Kulkarni
- Mumbai Spine Scoliosis and Disc Replacement Centre, Bombay Hospital, Mumbai, Maharashtra, India,Address for correspondence: Dr. Arvind G Kulkarni, Mumbai Spine Scoliosis and Disc Replacement Centre, New Marine Lines, Bombay Hospital, Mumbai - 400 020, Maharashtra, India. E-mail:
| | - Hussain Bohra
- Mumbai Spine Scoliosis and Disc Replacement Centre, Bombay Hospital, Mumbai, Maharashtra, India
| | - Abhilash Dhruv
- Mumbai Spine Scoliosis and Disc Replacement Centre, Bombay Hospital, Mumbai, Maharashtra, India
| | - Abhishek Sarraf
- Mumbai Spine Scoliosis and Disc Replacement Centre, Bombay Hospital, Mumbai, Maharashtra, India
| | - Anupreet Bassi
- Mumbai Spine Scoliosis and Disc Replacement Centre, Bombay Hospital, Mumbai, Maharashtra, India
| | - Vishwanath M Patil
- Mumbai Spine Scoliosis and Disc Replacement Centre, Bombay Hospital, Mumbai, Maharashtra, India
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Zhao CQ, Ding W, Zhang K, Zhao J. Transforaminal lumbar interbody fusion using one diagonal fusion cage with unilateral pedicle screw fixation for treatment of massive lumbar disc herniation. Indian J Orthop 2016; 50:473-478. [PMID: 27746488 PMCID: PMC5017167 DOI: 10.4103/0019-5413.189595] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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 Large lumbar or lumbosacral (LS) disc herniations usually expand from the paramedian space to the neuroforamen and compress both the transversing (lower) and the exiting (upper) nerve roots, thus leading to bi-radicular symptoms. Bi-radicular involvement is a statistically significant risk factor for poor outcome in patients presenting with far lateral or foraminal disc herniation after facet preserving microdecompression. There is evidence showing that patients suffering from large lumbar disc herniations treated with interbody fusion have significant superior results in comparison with those who received a simple discectomy. We report our experiences on managing large LS disc herniation with bi-radicular symptoms by transforaminal lumbar interbody fusion (TLIF) using one diagonal fusion cage with unilateral pedicle screw/rod fixation. MATERIALS AND METHODS Twenty-three patients who suffered from single level lumbar or LS disc herniation with bi-radicular symptoms treated with unilateral decompression and TLIF using one diagonal fusion cage with ipsilateral pedicle screw/rod fixation operated between January 2005 and December 2009, were included in this study. Operation time and blood loss were recorded. The pain and disability status were pre- and postoperatively evaluated by the visual analog score (VAS) and Oswestry Disability Index (ODI). Interbody bony fusion was detected by routine radiographs and computed tomography scan. Adjacent segment degeneration was detected by routine radiographs and magnetic resonance imaging examination. Overall outcomes were categorized according to modified Macnab classification. RESULTS The patients were followed up for an average of 44.7 months. Pain relief in the VAS and improvement of the ODI were significant after surgery and at final followup. No severe complications occurred during hospital stay. Interbody bony fusion was achieved in every case. No cage retropulsion was observed, while 3 cases experienced cage subsidence. Adjacent segment degeneration occurred at 3 discs cephalic to the fusion segment at followup. No patients underwent revised surgery. Overall outcome was excellent in 5 patients (21.7%), good in 13 (56.5%), fine in 4 (17.5%), and poor in 1 (4.3%). CONCLUSIONS TLIF using one cage with ipsilateral pedicle screw/rod fixation is an effective treatment option for massive lumbar or LS disc herniation with bi-radicular involvement.
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Affiliation(s)
- Chang-Qing Zhao
- Department of Orthopaedics, Shanghai Key Laboratory of Orthopaedic Implants, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, P. R. China
| | - Wei Ding
- Department of Orthopaedics, Jiangyin People’ Hospital, Jiangyin 214400, P. R. China
| | - Kai Zhang
- Department of Orthopaedics, Shanghai Key Laboratory of Orthopaedic Implants, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, P. R. China
| | - Jie Zhao
- Department of Orthopaedics, Shanghai Key Laboratory of Orthopaedic Implants, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, P. R. China,Address for correspondence: Prof. Jie Zhao, Department of Orthopaedics, Shanghai Key Laboratory of Orthopaedic Implants, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai 200011, P. R. China. E-mail:
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Gupta M, Arya RK, Kumar S, Jain VK, Sinha S, Naik AK. Comparative study of multiple cancellous screws versus sliding hip screws in femoral neck fractures of young adults. Chin J Traumatol 2016; 19:209-12. [PMID: 27578376 PMCID: PMC4992136 DOI: 10.1016/j.cjtee.2015.11.021] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [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] Open
Abstract
PURPOSE Both cannulated cancellous screw (CCS) and sliding hip screw (SHS) are used in femoral neck fracture fixations, but which is superior is yet to be determined. This study was aimed to compare the clinicoradiological outcome of femoral neck fracture treated with SHS or CCS in young adults. METHODS Adults (16e60 years) with femoral neck fracture were divided into Group 1 fixed with SHS and Group 2 fixed with three CCS after closed reduction. Pain relief, functional recovery and postoperative radiographs at 6 weeks, 3 months, 6 months and then yearly for upto 4 years were analyzed. RESULTS Group 1 (n=40) achieved radiological union at mean of 7.6 months, with the union rate of 87.5% (n=35), avascular necrosis (AVN) rate of 7.5% (n=3) and mean Harris Hip Score (HHS) of 86.15 at the end of 4 years. In Group 2 (n=45) these parameters were union at 7.1 months, union rate of 82.22% (n=37), AVN rate of 6.67% (n=3) and HHS of 88.65. Comparative results were statistically insignificant. CONCLUSION There is no significant difference in clinicoradiological outcome between the two implants.
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Debieux P, Franciozi CES, Lenza M, Tamaoki MJ, Magnussen RA, Faloppa F, Belloti JC. Bioabsorbable versus metallic interference screws for graft fixation in anterior cruciate ligament reconstruction. Cochrane Database Syst Rev 2016; 7:CD009772. [PMID: 27450741 PMCID: PMC6458013 DOI: 10.1002/14651858.cd009772.pub2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) tears are frequently treated with surgical reconstruction with grafts, frequently patella tendon or hamstrings. Interference screws are often used to secure the graft in bone tunnels in the femur and tibia. This review examines whether bioabsorbable interference screws give better results than metal interference screws when used for graft fixation in ACL reconstruction. OBJECTIVES To assess the effects (benefits and harms) of bioabsorbable versus metallic interference screws for graft fixation in ACL reconstruction. SEARCH METHODS We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, CENTRAL (the Cochrane Library), MEDLINE, Embase, LILACS, trial registers and reference lists of articles. Date of search: January 2016. SELECTION CRITERIA We included randomised controlled trials and quasi-randomised trials comparing bioabsorbable with metallic interferences screws in ACL reconstruction. The main outcomes sought were subjective-rated knee function, failure of treatment, and activity level. DATA COLLECTION AND ANALYSIS At least two review authors selected eligible trials, independently assessed risk of bias, and cross-checked data. Data were pooled whenever relevant and possible. Requests for further information were sent to the original study authors. MAIN RESULTS We included 12 trials (11 randomised and one quasi-randomised) involving a total of 944 participants, and reporting follow-up results for 774. Participants in the 12 trials underwent ACL reconstruction with either hamstring tendon grafts (five trials) or patellar tendon grafts (seven trials). Trials participants were randomly allocated to bioabsorbable or metallic interference screws for graft fixation in both femur and tibia (seven trials); femur only (three trials); tibia only (one trial); location was not reported in the remaining trial. A variety of materials was used for the bioabsorbable screws, Poly-L-lactic acid (PLLA) being the most common. The metallic screws, where reported, were titanium.All trials were at high risk of bias, which invariably included performance bias. Seven trials were at high risk of attrition bias and eight at high risk of reporting bias. The quasi-randomised trial was assessed as being at high risk for selection bias. Based on these study limitations and insufficiency of the available data, we judged the quality of evidence for all outcomes was very low.The majority of the available data for patient-reported knee function was presented as Lysholm scores (0 to 100; higher scores = better function). There was very low quality but consistent evidence of no clinically important differences between the two groups in Lysholm scores at 12 months follow-up (mean difference (MD) -0.08, 95% confidence interval (CI) -1.48 to 1.32; three trials, 168 participants); 24 months (MD 0.35, 95% CI -1.27 to 1.98; three trials, 113 participants) or five or more years follow-up (MD 1.23, 95% CI -2.00 to 4.47; two trials, 71 participants). This lack of between-group differences was also reported for Lysholm scores in several trials that did not provide sufficient data for pooling as well as for other self-reported knee function scores reported in several trials.Treatment failure was represented by the summed data for implant breakage during surgery and major postoperative complications (implant failure, graft rupture, symptomatic foreign body reactions, effusion and treated arthrofibrosis and related conditions) that were usually described in the trial reports as requiring further substantive treatment. There is very low-quality evidence of greater treatment failure in the bioabsorbable screw group (60/451 versus 29/434; risk ratio (RR) 1.94 favouring metallic screw fixation, 95% CI 1.29 to 2.93; 885 participants, 11 studies). In a population with an assumed risk (based on the median control group risk) of 56 participants per 1000 having treatment failure after metallic screw fixation, this equates to 53 more (95% CI 17 to 108 more) per 1000 participants having treatment failure after bioabsorbable screw fixation. All 16 intraoperative complications in the bioabsorbable screw group were implant breakages upon screw insertion. Treatment failure defined as postoperative complications only still favoured the metallic screw group but the 95% CI also included the potential for a greater risk of treatment failure after metallic screw fixation: 44/451 versus 29/434; RR 1.44, 95% CI 0.93 to 2.23. Based on the assumed risk of 56 participants per 1000 having postoperative treatment failure after metallic screw fixation, this equates to 25 more (95% CI 4 fewer and 69 more) per 1000 participants having this outcome after bioabsorbable screw fixation.There was very low-quality evidence of very similar activity levels in the two groups at 12 and 24 months follow-up measured via the Tegner score (0 to 10; higher scores = greater activity): 12 months (MD 0.08, 95% CI -0.39 to 0.55; 122 participants, two studies); 24 months (MD 0.01, 95% CI -0.54 to 0.57; 72 participants, two studies). AUTHORS' CONCLUSIONS There is very low-quality evidence of no difference in self-reported knee function and levels of activity between bioabsorbable and metallic interference screws for graft fixation in ACL reconstruction. There is very low-quality evidence that bioabsorbable screws may be associated with more overall treatment failures, including implant breakage during surgery. Further research does not appear to be a priority, but if undertaken, should also examine costs.
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Affiliation(s)
| | - Carlos ES Franciozi
- Universidade Federal de São PauloDepartment of Orthopaedics and TraumatologyRua Borges Lagoa, 783 ‐ 5th FloorSão PauloBrazil04038‐032
| | - Mário Lenza
- Hospital Israelita Albert EinsteinOrthopaedic and Trauma DepartmentSão PauloBrazil
| | - Marcel Jun Tamaoki
- Universidade Federal de São PauloDepartment of Orthopaedics and TraumatologyRua Borges Lagoa, 783 ‐ 5th FloorSão PauloBrazil04038‐032
| | - Robert A Magnussen
- The Ohio State University Medical CenterOrthopaedic Surgery2050 Kenny RdColumbusUSA43221
| | - Flávio Faloppa
- Universidade Federal de São PauloDepartment of Orthopaedics and TraumatologyRua Borges Lagoa, 783 ‐ 5th FloorSão PauloBrazil04038‐032
| | - João Carlos Belloti
- Universidade Federal de São PauloDepartment of Orthopaedics and TraumatologyRua Borges Lagoa, 783 ‐ 5th FloorSão PauloBrazil04038‐032
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Abstract
PURPOSE To compare the outcome following headless compression screw fixation versus radial head arthroplasty versus plate fixation for 3-part Mason types III or IV radial head fracture. METHODS Records of 25 men and 16 women aged 21 to 80 (mean, 43.3) years who underwent fixation using 2 to 3 2-mm cannulated headless compression screws (n=16), radial head arthroplasty (n=13), or fixation with a 2-mm Synthes plate (n=12) for 3-part Mason types III or IV radial head and neck fracture were reviewed. Treatment option was decided by the surgeon based on the presence of associated injury, neurovascular deficit, and the Mason classification. Bone union, callus formation, and complications (such as heterotopic ossification, malunion, and nonunion) were assessed by an independent registrar or consultant using radiographs. The Mayo Elbow Performance Score and range of motion were assessed by an independent physiotherapist. RESULTS The median age of the 3 groups were comparable. Associated injuries were most common in patients with arthroplasty, followed by screw fixation and plate fixation (61.5% vs. 50% vs. 33%, p=0.54). The median time to bone union was shorter after screw fixation than plate fixation (55 vs. 86 days, p=0.05). No patient with screw fixation had nonunion, but 4 patients with plate fixation had nonunion. The 3 groups were comparable in terms of the mean Mayo Elbow Performance Score (p=0.56) and the mean range of motion (p=0.45). The complication rate was highest after plate fixation, followed by screw fixation and arthroplasty (50% vs. 18.8% vs. 15.4%, p=0.048). Excluding 20 patients with associated injuries (8 in screw fixation, 8 in arthroplasty, and 4 in plate fixation), the 3 groups were comparable in terms of the median time to bone union (p=0.109), mean Mayo Elbow Performance Score (p=0.260), mean range of motion (p=0.162), and complication rate (p=0.096). CONCLUSION Headless compression screw fixation is a viable option for 3-part radial head fracture. It achieves earlier bone union with fewer complications.
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Affiliation(s)
- P H Wu
- Department of Orthopaedic Surgery, National University Hospital Systems, Singapore
| | - L Shen
- Department of Biostatistics, National University Singapore, Singapore
| | - Y H Chee
- Department of Orthopaedic Surgery, National University Hospital Systems, Singapore
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Agarwal A, Chauhan V, Singh D, Shailendra R, Maheshwari R, Juyal A. A comparative study of pedicle screw fixation in dorsolumbar spine by freehand versus image-assisted technique: A cadaveric study. Indian J Orthop 2016; 50:243-9. [PMID: 27293283 PMCID: PMC4885291 DOI: 10.4103/0019-5413.181779] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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 New and expensive technology such as three-dimensional computer assisted surgery is being used for pedicle screw fixation in dorsolumbar spine. Their availability, expenses and amount of radiation exposure are issues in a developing country. On the contrary, freehand technique of pedicle screw placement utilizes anatomic landmarks and tactile palpation without fluoroscopy or navigation to place pedicle screws. The purpose of this study was to analyze and compare the accuracy of freehand and image-assisted technique to place pedicle screws in the dorsolumbar spine of cadavers by an experienced surgeon and a resident. Evaluation was done using dissection of pedicle and computed tomography (CT) imaging. MATERIALS AND METHODS Ten cadaveric dorsolumbar spines were exposed by a posterior approach. Titanium pedicle screws were inserted from D5 to L5 vertebrae by freehand and image-assisted technique on either side by an experienced surgeon and a resident. CT was obtained. A blinded radiologist reviewed the imaging. The spines were then dissected to do a macroscopic examination. Screws, having evidence of cortical perforation of more than 2 mm on CT, were considered to be a significant breach. RESULTS A total of 260 pedicle screws were placed. The surgeon and the resident placed 130 screws each. Out of 130 screws, both of them placed 65 screws each by freehand and image- assisted technique each. The resident had a rate of 7.69% significant medial and 10.76% significant lateral breach with freehand technique while with image-assisted had a rate of 3.07% significant medial and 9.23% significant lateral breach. The expert surgeon had a rate of 6.15% significant medial and 1.53% significant lateral breach with freehand technique while with image-assisted had a rate of 3.07% significant medial and 6.15% significant lateral breach on CT evaluation. CONCLUSION Freehand technique is as good as the image-assisted technique. Under appropriate supervision, residents can safely learn to place freehand pedicle screws with an acceptable violation rate.
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Affiliation(s)
- Archit Agarwal
- Department of Orthopaedics, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
| | - Vijendra Chauhan
- Department of Orthopaedics, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India,Address for correspondence: Dr. Vijendra Chauhan, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun - 248 140, Uttarakhand, India. E-mail:
| | - Deepa Singh
- Department of Anatomy, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
| | - Raghuvanshi Shailendra
- Department of Radio-diagnosis and Imaging, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
| | - Rajesh Maheshwari
- Department of Orthopaedics, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
| | - Anil Juyal
- Department of Orthopaedics, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
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Patkowski M, Królikowska A, Reichert P. Comparison of Bioabsorbable Interference Screws Composed of Poly-l-lactic Acid and Hydroxyapatite (PLLA-HA) to WasherLoc Tibial Fixation in Patients After Anterior Cruciate Ligament Reconstruction of the Knee Joint. Polim Med 2016; 46:53-58. [PMID: 28397419 DOI: 10.17219/pim/65054] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 08/23/2016] [Accepted: 09/05/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The reconstruction of the anterior cruciate ligament (ACL) of the knee joint is a standard in ACL complete rupture treatment in athletes. One of the weakest points of this procedure is tibial fixation of grafts. OBJECTIVES The aim was, firstly, to evaluate patients 3-4 years after primary ACL reconstruction with the use of autologous ipsilateral STGR grafts and with tibial fixation using a bioabsorbable interference screw composed of PLLA-HA or WasherLoc, comparing the postoperative result to the preoperative condition and, secondly, to compare the results between the two groups of patients with different tibial fixation. MATERIAL AND METHODS Group I consisted of 20 patients with a bioabsorbable interference screw composed of PLLA-HA tibial fixation. In Group II, there were 22 patients after ACL reconstruction with the use of WasherLoc tibial fixation. The Lachman test, pivot-shift test, Lysholm Knee Scoring Scale and 2000 International Knee Documentation Committee (2000 IKDC) Subjective Knee Evaluation Form were used to evaluate the results. RESULTS The intra-group comparison of the results of the 2000 IKDC Subjective Knee Evaluation Form and Lysholm Knee Scoring Scale obtained in the groups studied showed statistically significant differences between the evaluation performed preoperatively and postoperatively. The inter-group comparison of the results of the 2000 IKDC Subjective Knee Evaluation Form and Lysholm Knee Scoring Scale obtained postoperatively showed no statistically significant differences between the two groups. CONCLUSIONS An evaluation 3-4 years after ACL reconstruction with the use of autologous ipsilateral STGR grafts demonstrated significant progress from the preoperative condition to the postoperative result in patients with tibial fixation using a bioabsorbable interference screw composed of PLLA-HA as well as in patients with WasherLoc tibial fixation. There were no differences found between the two groups of patients after ACL reconstruction in terms of manual stability testing or a subjective assessment of knee joint outcomes.
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Affiliation(s)
- Mateusz Patkowski
- Department of Orthopedics and Traumatology Surgery, T. Marciniak Lower Silesian Specialist Hospital - Emergency Medicine Center, Wrocław, Poland
| | | | - Paweł Reichert
- Department of Traumatology, Clinic of Traumatology and Hand Surgery, Wroclaw Medical University, Wrocław, Poland
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Ferreira NO, Andrucioli MCD, Nelson-Filho P, Zanella EP, Consolaro A, Romano FL, Matsumoto MAN. Bacterial biofilm on successful and failed orthodontic mini-implants--a scanning electron microscopy study. Microsc Res Tech 2015; 78:1112-6. [PMID: 26515408 DOI: 10.1002/jemt.22592] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 05/25/2015] [Accepted: 10/04/2015] [Indexed: 11/08/2022]
Abstract
Mini-implants have been extensively used in Orthodontics as temporary bone anchorage devices. However, early failure of mini-implants due to mobility might occur and the colonization of their surfaces by pathogenic bacteria has been referred to as one of the contributing factors. In this study, scanning electron microscopy (SEM) was used to assess the presence of microorganisms adhered to the surface of mini-implants that failed due to loss of stability. Twelve self-drilling titanium mini-implants (1.6 mm diameter × 9.0 mm long) were collected from 12 patients undergoing orthodontic treatment-7 successful and 5 failed mini-implants. The mean time of permanence in the mouth was 15.8 and 2.4 months for successful and failed mini-implants, respectively. The devices were placed in the maxilla and/or mandible and removed by the same surgeon and were processed for SEM analysis of the presence of microorganisms on their surfaces (head, transmucosal profile, and body). Extensive bacterial colonization on mini-implant head and transmucosal profile was observed in all successful and failed mini-implants. None of the failed mini-implants exhibited bacteria on its body and only one mini-implant belonging to the successful (stable) group exhibited bacteria on its body. The results did not suggest a relationship between failure and presence of bacterial colonies on mini-implant surfaces.
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Affiliation(s)
- Nayra Oliveira Ferreira
- Department of Pediatric Clinic, School of Dentistry of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | | | - Paulo Nelson-Filho
- Department of Pediatric Clinic, School of Dentistry of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Eduardo Pereira Zanella
- Department of Pediatric Clinic, School of Dentistry of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Alberto Consolaro
- Department of Stomatology, School of Dentistry of Bauru, University of São Paulo, São Paulo, Brazil
| | - Fábio Lourenço Romano
- Department of Pediatric Clinic, School of Dentistry of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Mírian Aiko Nakane Matsumoto
- Department of Pediatric Clinic, School of Dentistry of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
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Abstract
We present a case of tibial nerve impingement by an anteroposterior screw inserted for stabilization of a posterior malleolar fracture. This specific complication has not previously been described in published studies, although numerous reports have described various forms of peripheral nerve entrapment. We discuss the merits of fixation of these fractures using a posterolateral approach.
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Affiliation(s)
- Ankit Patel
- Trauma and Orthopaedic Department, Tunbridge Wells Hospital, Kent, United Kingdom.
| | - Loren Charles
- Trauma and Orthopaedic Department, Tunbridge Wells Hospital, Kent, United Kingdom
| | - James Ritchie
- Trauma and Orthopaedic Department, Tunbridge Wells Hospital, Kent, United Kingdom
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Abstract
We present a case of tibial nerve impingement by an anteroposterior screw inserted for stabilization of a posterior malleolar fracture. This specific complication has not previously been described in published studies, although numerous reports have described various forms of peripheral nerve entrapment. We discuss the merits of fixation of these fractures using a posterolateral approach.
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Affiliation(s)
- Ankit Patel
- Trauma and Orthopaedic Department, Tunbridge Wells Hospital, Kent, United Kingdom.
| | - Loren Charles
- Trauma and Orthopaedic Department, Tunbridge Wells Hospital, Kent, United Kingdom
| | - James Ritchie
- Trauma and Orthopaedic Department, Tunbridge Wells Hospital, Kent, United Kingdom
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Gardner AW, Toh MZ, Yew KSA, Lie DTT, Chou SM. Cannulated versus non-cannulated cancellous screw fixation for femoral neck fractures: a synthetic bone biomechanical study. J Orthop Surg (Hong Kong) 2015; 23:41-6. [PMID: 25920642 DOI: 10.1177/230949901502300110] [Citation(s) in RCA: 6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To compare the compressive strength of cannulated versus non-cannulated cancellous screws for undisplaced femoral neck fractures in synthetic bones. METHODS 18 synthetic proximal femurs simulating an AO B1 valgus impacted femoral neck fracture in osteoporotic bone were used. The fracture angles were between 55º and 63º (Pauwels grade 2). Fixation was made using 6.5-mm non-cannulated screws (n=6), 6.5-mm cannulated screws (n=6), or 7.3-mm cannulated screws (n=6). A custom-built jig was designed to guide the insertion of the screws in an identical triangular configuration. Screws were tightened by a single operator using a torque-measuring screwdriver. The femoral head was subjected to progressive axial loading at 5 mm/min. The load to failure and displacement were recorded. RESULTS The 3 groups did not differ significantly except that the load to failure was higher in the construct with 6.5-mm non-cannulated screws than that with 6.5-mm cannulated screws (1222 N vs 1008 N, p=0.003). CONCLUSION The compressive strength of a synthetic bone hip fracture model fixed with non-cannulated screws was higher than that of cannulated screws of the same diameter.
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Affiliation(s)
- A W Gardner
- Department of Orthopaedic Surgery, Jurong Health Services, Alexandra Hospital, Singapore
| | - M Z Toh
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore
| | - K S A Yew
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - D T T Lie
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - S M Chou
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore
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Abstract
BACKGROUND There is much more radiation exposure to the surgeons during minimally invasive pedicle screws placement. In order to ease the surgeon's hand-eye coordination and to reduce the iatrogenic radiation injury to the surgeons, a robot assisted percutaneous pedicle screw placement is useful. This study assesses the feasibility and clinical value of robot assisted navigated drilling for pedicle screw placement and the results thus achieved formed the basis for the development of a new robot for pedicle screw fixation surgery. MATERIALS AND METHODS Preoperative computed tomography (CT) of eight bovine lumbar spines (L1-L5) in axial plane were captured for each vertebra, the entry points and trajectories of the screws were preoperatively planned. On the basis of preoperative CT scans and intraoperative fluoroscopy, we aligned the robot drill to the desired entry point and trajectory, as dictated by the surgeon's preoperative plan. Eight bovine lumbar spines were inserted 80 K-wires using the spine robot system. The time for system registration and pedicle drilling, fluoroscopy times were measured and recorded. Postoperative CT scans were used to assess the position of the K-wires. RESULTS Assisted by spine robot system, the average time for system registration was (343.4 ± 18.4) s, the average time for procedure of drilling one pedicle screw trajectory was (89.5 ± 6.1) s, times of fluoroscopy for drilling one pedicle screw were (2.9 ± 0.8) times. Overall, 12 (15.0%) of the 80 K-wires violated the pedicle wall. Four screws (5.0%) were medial to the pedicle and 8 (10.5%) were lateral. The number of K-wires wholly within the pedicle were 68 (85%). CONCLUSIONS The preliminary study supports the view that computer assisted pedicle screw fixation using spinal robot is feasible and the robot can decrease the intraoperative fluoroscopy time during the minimally invasive pedicle screw fixation surgery. As spine robotic surgery is still in its infancy, further research in this field is worthwhile especially the accuracy of spine robot system should be improved.
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Affiliation(s)
- Hongwei Wang
- Department of Orthopedics, General Hospital of Shenyang Military Area Command of Chinese PLA, Liaoning, China
| | - Yue Zhou
- Department of Orthopedics, Xinqiao Hospital, The Third Military Medical University, Chongqing 400037, China
| | - Jun Liu
- Department of Orthopedics, General Hospital of Shenyang Military Area Command of Chinese PLA, Liaoning, China
| | - Jianda Han
- Department of Electronics, State Key Laboratory of Robotics, Shenyang Institute of Automation, Chinese Academy of Science, Shenyang, Liaoning 110016, China
| | - Liangbi Xiang
- Department of Orthopedics, General Hospital of Shenyang Military Area Command of Chinese PLA, Liaoning, China,Address for correspondence: Prof. Liangbi Xiang, Department of Orthopedics, General Hospital of Shenyang Military Area Command of Chinese PLA, Shenyang, Liaoning 110016, China. E-mail:
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Abstract
BACKGROUND Little is known about the bioabsorbable, anchor related postoperative changes in rotator cuff surgery, which has become more popular recently. The purpose of the present study was to use magnetic resonance imaging (MRI) to analyze the degradation of bioabsorbable anchors and to determine the incidences and characteristics of early postoperative reactions around the anchors and their mechanical failures. MATERIALS AND METHODS Postoperative MRIs of 200 patients who underwent arthroscopic rotator cuff repair were retrospectively analyzed. The tissue reactions around the bioanchors included fluid accumulations around the anchor, granulation tissue formation and changes in the condition of the surrounding osseous structure. The condition of the bioanchor itself was also examined, including whether the bioanchor failed mechanically. In the case of mechanical failure, the location of the failure was noted. Serial MRIs of 18 patients were available for analysis. RESULTS The total number of medial row bioanchors was 124, while that of the lateral row was 338. A low signal intensity rim suggestive of sclerosis surrounded all lateral row bioanchors. Ninety three lateral row bioanchors (27%) showed a rim with signal intensity similar to or less than that of surrounding bone, which was granulation tissue or foreign body reaction (FBR). Similar signal intensity was seen around nine medial row bioanchors (7%). Fluid accumulation was seen around 4 lateral row bioanchors (1%) and around 14 medial row bioanchors (11%). Five lateral row bioanchors showed the breakage, while there was none in the medial row bioanchors. There were nine cases with a cuff re-tear (4.5%). There was no evidence of affection of glenohumeral articular surfaces or of osteolysis around any bioanchor. In serial MRI, there was no change in appearance of the bioanchors, but the granulation tissue or FBR around four bioanchors and the fluid around one bioanchor showed a decrease in successive MRI. CONCLUSION This study highlights the normal and adverse reactions to Bioabsorbable anchors that surgeons can expect to see on MRI after rotator cuff repairs.
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Affiliation(s)
- Aditya C Pawaskar
- Department of Orthopaedic Surgery, Asan Medical Center, School of Medicine, University of Ulsan, Korea
| | - Aashay Kekatpure
- Department of Orthopaedic Surgery, Asan Medical Center, School of Medicine, University of Ulsan, Korea
| | - Nam-Su Cho
- Department of Orthopaedic Surgery, Shoulder and Elbow Clinic, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Yong-Girl Rhee
- Department of Orthopaedic Surgery, Shoulder and Elbow Clinic, College of Medicine, Kyung Hee University, Seoul, Korea
| | - In-Ho Jeon
- Department of Orthopaedic Surgery, Asan Medical Center, School of Medicine, University of Ulsan, Korea,Address for correspondence: Dr. In-Ho Jeon, Department of Orthopedic Surgery, Asan Medical Center, Medical School of Ulsan University, 86 Asanbyeongwon gil, Songpa-gu 138-736, Seoul, Korea. E-mail:
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Lin D, Zuo S, Li L, Wang L, Lian K. Treatment of neglected femoral neck fractures using the modified dynamic hip screw with autogenous bone and bone morphogenetic protein-2 composite materials grafting. Indian J Orthop 2015; 49:342-6. [PMID: 26015636 PMCID: PMC4443418 DOI: 10.4103/0019-5413.156211] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The neglected femoral neck fracture is one where there has been a delay of more than 30 days to seek medical help from the time of the original injury. Salvage procedures, such as osteotomy and other treatment options such as vascularized and nonvascularized bone grafts have high failure rates and arthroplasty procedures are not ideal, given the patient's young age and higher levels of activity. We designed a hollow bone graft dynamic hip screw (Hb-DHS) (modified DHS, Hb-DHS) for use in neglected femoral neck fractures. This study evaluates the efficacy and safety of the modified dynamic hip screw (DHS) with autogenous bone and bone morphogenetic protein 2 (BMP-2) composite materials grafting for the treatment of the neglected femoral neck fractures. MATERIALS AND METHODS A prospective study was carried out in twenty patients of neglected femoral neck fractures treated with the modified DHS with autogenous bone and BMP-2 composite materials grafting between July 2007 and February 2010. There were 14 men and 6 women with a mean age of 29.6 years (range 19-42 years). The mean time from injury to surgery was 9.7 weeks (range 6-16 weeks). The operation time, intraoperative blood loss, fracture healing time, Harris scoring for hip function and complications were recorded to evaluate treatment effects. RESULTS The mean operation time was 75.8 min (range 55-100 min) with mean intraoperative blood loss volume of 105 mL (range 70-220 mL). The mean time to union was 17 weeks (range 12-24 weeks). One patient did not achieve union, and two patients had avascular necrosis of the femoral head. This patient with nonunion underwent intertrochanteric osteotomy. In patients with avascular necrosis one required total hip arthroplasty, the other did not require intervention at the last followup. A total of 14 patients (70%) had excellent results, 2 (10%) had good, 1 (5%) had moderate and 3 (15%) had poor results. CONCLUSION The modified DHS with autogenous bone and BMP-2 composite materials grafting for the treatment of neglected femoral neck fractures waseffective and had less complications.
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Affiliation(s)
- Dasheng Lin
- Department of Orthopaedic Surgery, The Affiliated Southeast Hospital of Xiamen University, Orthopaedic Center of People's Liberation Army, Zhangzhou 363000, China
| | - Shenjia Zuo
- Department of Orthopaedic Surgery, The Affiliated Southeast Hospital of Xiamen University, Orthopaedic Center of People's Liberation Army, Zhangzhou 363000, China
| | - Lin Li
- Department of Orthopaedic Surgery, The Affiliated Southeast Hospital of Xiamen University, Orthopaedic Center of People's Liberation Army, Zhangzhou 363000, China
| | - Lei Wang
- Department of Orthopaedic Surgery, The Affiliated Southeast Hospital of Xiamen University, Orthopaedic Center of People's Liberation Army, Zhangzhou 363000, China
| | - Kejian Lian
- Department of Orthopaedic Surgery, The Affiliated Southeast Hospital of Xiamen University, Orthopaedic Center of People's Liberation Army, Zhangzhou 363000, China,Address for correspondence: Dr. Kejian Lian, Department of Orthopaedic Surgery, The Affiliated Southeast Hospital of Xiamen University, Orthopaedic Center of People's Liberation Army, Zhangzhou 363000, China. E-mail:
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Abstract
BACKGROUND Femoral neck fractures are treated either by internal fixation or arthroplasty. Usually, cannulated cancellous screws are used for osteosynthesis of fracture neck of femur. The bone impregnated hip screw (BIHS) is an alternative implant, where osteosyntehsis is required in femoral neck fracture. MATERIALS AND METHODS The BIHS is a hollow screw with thread diameter 8.3 mm, shank diameter 6.5 mm and wall thickness 2.2 mm and holes in the shaft of the screw with diameter 2 mm, placed in a staggered fashion. Biomechanical and animal experimental studies were done. Clinical study was done in two phases: Phase 1 in a group of volunteers, only with BIHS was used in a pilot study and phase 2 comparative study was done in a group with AO cannulated screws and the other group treated with BIHS. RESULTS In the phase 1 study, out of 15 patients, only one patient had delayed union. In phase 2, there were 78 patients, 44 patients in BIHS showed early union, compared to the rest 34 cases of AO cannulated screws Out of 44 patients with BIHS, 41 patients had an excellent outcome, 2 had nonunions and one implant breakage was noted. CONCLUSIONS Bone impregnated hip screw has shown to provide early solid union since it incorporates the biomechanical principles and also increases the osteogenic potential and hence, found superior to conventional cannulated cancellous screw.
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Affiliation(s)
- PK Sundar Raj
- Department of Orthopedics, Government Medical College, Thiruvananthapuram, Kerala, India,Department of Orthopedics, Azeezia Medical College, Kollam, Kerala, India
| | - Jiju A Nuuman
- Department of Orthopedics, Government Taluk Headquarter's Hospital, Chirayinkeezhu, Thiruvananthapuram, Kerala, India
| | - Amish Sunder Pattathil
- Department of Orthopedics, Azeezia Medical College, Kollam, Kerala, India,Address for correspondence: Dr. Amish Sunder Pattathil, Department of Orthopedics, Azeezia Medical College, Kollam, Kerala, India. E-mail:
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Abstract
BACKGROUND Computed tomographic (CT) based navigation is a technique to improve the accuracy of pedicle screw placement. It is believed to enhance accuracy of pedicle screw placement, potentially avoiding complications arising due to pedicle wall breach. This study aims to assess the results of dorsolumbar fractures operated by this technique. MATERIALS AND METHODS Thirty consecutive skeletally mature patients of fractures of dorsolumbar spine (T9-L5) were subjected to an optoelectronic navigation system. All patients were thoroughly examined for neurological deficit. The criterion for instability were either a tricolumnar injury or presence of neurological deficit or both. Patients with multilevel fractures and distorted spine were excluded from study. Time taken for insertion of each pedicle screw was recorded and placement assessed with a postoperative CT scan using Laine's grading system. RESULTS Only one screw out of a total of 118 screws was misplaced with a Laine's Grade 5 placement, showing a misplacement rate of 0.847%. Average time for matching was 7.8 min (range 5-12 min). Average time taken for insertion of a single screw was 4.19 min (range 2-8 min) and total time for all screws after exposure was 34.23 min (range 24-45 min) for a four screw construct. No neurovascular complications were seen in any of the patients postoperatively and in subsequent followup of 1-year duration. CONCLUSION CT-based navigation is effective in improving accuracy of pedicle screw placement in traumatic injuries of dorsolumbar spine (T9-L5), however additional cost of procuring CT scan to the patient and cost of equipment is of significant concern in developing countries. Reduced radiation exposure and lowered ergonomic constraints around the operation table are its additional benefits.
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Affiliation(s)
- Saurabh Kapoor
- Department of Orthopaedic Surgery, Government Medical College and Hospital, Chandigarh, India
| | - Rajbahadur Sharma
- Department of Orthopaedics, Postgraduate Institute, Chandigarh, India
| | - Sudhir Garg
- Department of Orthopaedics, Maulana Azad Medical College and LNJP Hospital, New Delhi, India
| | - Rohit Jindal
- Department of Orthopaedics, Maulana Azad Medical College and LNJP Hospital, New Delhi, India
| | - Ravi Gupta
- Department of Orthopaedics, Maulana Azad Medical College and LNJP Hospital, New Delhi, India
| | - Anshul Goe
- Department of Orthopaedics, Maulana Azad Medical College and LNJP Hospital, New Delhi, India
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Abstract
PURPOSE. To evaluate the insertion torque and pullout strength of pedicle screws with or without repositioning. METHODS. 20 fresh porcine lumbar vertebrae of similar size were used. The entry point was at the site just lateral and distal to the superior facet joint of the vertebra, and to a depth of 35 mm. A 6.2-mm-diameter, 35-mm-long pedicle screw was inserted parallel to the superior end plate on one side as control. On the other side, an identical screw was first inserted 10º caudal to the superior end plate, and then repositioned parallel to the superior end plate. The insertional torque and pullout strength were measured. RESULTS. Three of the specimens were excluded owing to pedicle fractures during the pullout test. Repositioned pedicle screws were significantly weaker than controls in terms of the maximum insertional torque (3.20 ± 0.28 vs. 2.04 ± 0.28 Nm, 36% difference, p<0.01) and pullout strength (1664 ± 378 vs.1391 ± 295 N, p<0.01). CONCLUSION. Repositioning pedicle screws should be avoided, especially when the pedicle wall is breached. If repositioning is deemed necessary, augmentation with polymethyl methacrylate or a screw with a larger diameter should be considered.
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Affiliation(s)
- Chun Ee Tan
- Department of Orthopaedics and Traumatology, Penang Hospital, Penang, Malaysia
| | | | - Keith Dip Kei Luk
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong
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Burke NG, Kennedy J, Cousins G, Fitzpatrick D, Mullett H. Locking plate fixation with and without inferomedial screws for proximal humeral fractures: a biomechanical study. J Orthop Surg (Hong Kong) 2014; 22:190-4. [PMID: 25163953 DOI: 10.1177/230949901402200215] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [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. To compare the efficacy of locking plate fixation with and without inferomedial screws in maintaining the reduction of a proximal humeral fracture. METHODS. 22 synthetic humerus models were used. A standardised 3-part proximal humeral fracture with a 4-mm wedge segment was created and fixed with a locking plate and screws with (n=11) and without (n=11) inferomedial screws. The intrafragmentary motion of the construct at 250, 500, 750, and 1000 cycles of 532 N loading, and the load to failure of the 2 groups were compared. RESULTS. Locking plate fixation with inferomedial screws reduced the mean intrafragmentary motion in all cycles (p<0.01) and increased the load to failure (1452 N vs. 1159 N, p<0.001), compared to fixation without inferomedial screws. CONCLUSION. Additional inferomedial screws provide medial column support for fracture healing. This may reduce intrafragmentary motion and thus implant complications resulting from varus malalignment such as screw perforation or loss of reduction.
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Affiliation(s)
- Neil G Burke
- Department of Orthopaedic Research, Royal College of Surgeons, Dublin, Ireland
| | - Jim Kennedy
- Department of Orthopaedic Research, Royal College of Surgeons, Dublin, Ireland
| | - Grainne Cousins
- HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland
| | - David Fitzpatrick
- School of Electrical and Mechanical Engineering, University College Dublin, Ireland
| | - Hannan Mullett
- Department of Orthopaedic Research, Royal College of Surgeons, Dublin, Ireland
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Pal CP, Kumar B, Dinkar KS, Singh P, Kumar H, Goyal RK. Fixation with cancellous screws and fibular strut grafts for neglected femoral neck fractures. J Orthop Surg (Hong Kong) 2014; 22:181-5. [PMID: 25163951 DOI: 10.1177/230949901402200213] [Citation(s) in RCA: 7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To review the outcomes of fixation with cancellous screws and fibular strut grafts for neglected femoral neck fractures. METHODS 44 men and 28 women aged 17 to 50 years with neglected femoral neck fractures of the subcapital (n=12), transcervical (n=57), or basal (n=3) types underwent closed (n=39) or open (n=33) reduction and fixation with a single cancellous screw with double fibular strut grafts (n=24) or fixation with double cancellous screws with a single fibular strut graft (n=48). The mean time from injury to surgery was 10 weeks; the delay was 22 to 35 days in 43 patients and >35 days in 29 patients. Double fibular strut grafts were used for 18 patients with longer delay and resorption of the femoral neck, and 18 patients with posterior comminution of the femoral neck. The outcome was assessed using the Harris hip score. RESULTS Patients were followed up for a mean of 3 years. The time to bone union was 3 to 4 months in 48 patients, 4 to 5 months in 15, and 5 to 6 months in 5; nonunion was noted in 4 patients. In 18 patients with resorption of the femoral neck, bone union took a longer time. The Harris hip score was excellent (90-100) in 30 patients, good (80-89) in 20, fair (70-79) in 15, and poor (<70) in 7. Of the latter, 4 had nonunion and 3 developed avascular necrosis of the femoral head; they had persistent pain and restriction of hip joint movement. CONCLUSION Fixation with cancellous screws and fibular strut grafts for neglected femoral neck fractures is cost-effective and technically less demanding, and associated with good outcomes.
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Affiliation(s)
| | | | | | - Pulkesh Singh
- Department of Orthopaedics, UPRIMS & R, Saifai, India
| | - Harish Kumar
- Department of Orthopaedics, Safdarjung Hospital, New Delhi, India
| | - R K Goyal
- Department of Orthopaedics, UPRIMS & R, Saifai, India
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