The fixation strength of hydroxyapatite-coated Schanz screws and standard stainless steel Schanz screws in lower extremity lengthening : a comparison based on a new torque value index: the fixation index

INTRODUCTION

Lengthening procedures are often complicated by loosening of pins. It has been reported that coating with hydroxyapatite improves fixation and reduces the rate of pin-track infection.

MATERIALS AND METHODS

We compared 47 hydroxyapatite-coated Schanz screws (HA screws) in 12 monolateral fixators mounted at the University Hospital Hamburg-Eppendorf with 45 standard stainless steel screws in 9 monolateral fixators mounted at the St Josefs-Hospital Wiesbaden by measuring the insertion and extraction torque values. The average implantation period was 7 months for the hydroxyapatite-coated screws and 5.4 months for the uncoated screws. We established the quotient of the maximum extraction torque over insertion torque which shows the change in the fixation strength with respect to time, the fixation index. It eliminates the influence of the varying pin-bone contact.

RESULTS

There was no significant difference in the rate of infection. In the Schanz screws without signs of infection the index was 1.92 for the HA screws and 0.76 for the stainless steel screws (P = 0.0002) giving evidence of the improvement of the fixation by the coating.

CONCLUSION

HA coating resulted in improved fixation of Schanz screws in bone and may be useful in prolonged external fixation of the lower leg. The fixation index proved to be a simple tool for the evaluation of the fixation strength of Schanz screws.

Immunfluorescence study of neuropeptides in identified neurons of the rat auditory superior olivary complex

The present study was conducted to investigate the distribution and immunohistochemical characteristics of ascending and descending projection neurons of the rat superior olivary complex (SOC), a group of interrelated brainstem nuclei. Ascending neurons were identified by injection of cholera toxin B subunit (CTB) into the central nucleus of the inferior colliculus (IC), descending neurons were labeled by application of Fluoro-Gold (FG) into the scala tympani of the cochlea, ipsilaterally to the IC injection. In accordance with the literature, we observed neurons innervating the IC located in the lateral superior olivary nucleus (LSO) and dorsal periolivary groups (DPO) on both sides, in the superior paraolivary nucleus (SPO) predominantly ipsilateral, as well as in the ipsilateral medial superior olivary nucleus (MSO) and the medial nucleus of the trapezoid body (MNTB). Cochlear projection neurons were found predominantly in the ipsilateral LSO as well as in the bilateral SPO, DPO, MSO and MNTB. In addition, a considerable population of neurons in the ipsilateral LSO and SPO were identified as being both ascending and descending. To further characterize these double-projecting neurons, brainstem sections were incubated in antisera directed against different neuroactive substances. The majority of ascending/descending cells in the LSO contained calcitonin gene-related peptide, but not substance P (SP), met-enkephalin (ENK) or tyrosine hydroxylase (TH). Some of these neurons apparently were contacted by ENK- or SP-immunoreactive fibers and terminals. In addition, we found TH-immunoreactive neurons in the lateral MNTB region. These neurons, which were labeled upon tracer injection into the cochlea (but not upon IC injection), probably belong to the C1 catecholaminergic cell group and may represent a division of the uncrossed olivocochlear bundle. The present results reveal the existence of a previously unknown subpopulation of SOC neurons that project to both the cochlea and the inferior colliculus. Their CGRP immunoreactivity and their uncrossed projection pattern provide evidence that they may belong to the cholinergic, putatively excitatory cell group.