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Pastor T, Zderic I, Berk T, Souleiman F, Vögelin E, Beeres FJP, Gueorguiev B, Pastor T. New generation of superior single plating vs. low-profile dual minifragment plating in diaphyseal clavicle fractures: a biomechanical comparative study. J Shoulder Elbow Surg 2024; 33:409-416. [PMID: 37748530 DOI: 10.1016/j.jse.2023.08.008] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/31/2023] [Accepted: 08/06/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND Recently, a new generation of superior clavicle plates was developed featuring the variable-angle locking technology for enhanced screw positioning and a less prominent and optimized plate-to-bone fit design. On the other hand, minifragment plates in dual plating mode have demonstrated promising clinical results. The aim of the current study was to compare the biomechanical competence of single superior plating using the new-generation plate vs. dual plating using low-profile minifragment plates. METHODS Sixteen paired human cadaveric clavicles were pairwise assigned to 2 groups for instrumentation with either a superior 2.7-mm variable-angle locking compression plate (group 1), or with one 2.5-mm anterior combined with one 2.0-mm superior matrix mandible plate (group 2). An unstable clavicle shaft fracture (AO/OTA 15.2C) was simulated by means of a 5-mm osteotomy gap. Specimens were cyclically tested to failure under craniocaudal cantilever bending, superimposed with bidirectional torsion around the shaft axis, and monitored via motion tracking. RESULTS Initial construct stiffness was significantly higher in group 2 (9.28 ± 4.40 N/mm) compared to group 1 (3.68 ± 1.08 N/mm), P = .003. The amplitudes of interfragmentary motions in terms of axial and shear displacement, fracture gap opening and torsion, over the course of 12,500 cycles were significantly higher in group 1 compared to group 2, P ≤ .038. Cycles to 2 mm shear displacement were significantly lower in group 1 (22,792 ± 4346) compared to group 2 (27,437 ± 1877), P = .047. CONCLUSION From a biomechanical perspective, low-profile 2.5/2.0-mm dual plates could be considered as a useful alternative for diaphyseal clavicle fracture fixation, especially in less common unstable fracture configurations.
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Affiliation(s)
- Tatjana Pastor
- AO Research Institute Davos, Davos, Switzerland; Department for Plastic and Hand Surgery, Inselspital University Hospital Bern, University of Bern, Bern, Switzerland
| | - Ivan Zderic
- AO Research Institute Davos, Davos, Switzerland
| | - Till Berk
- Department of Trauma, University Hospital Zurich, Zurich, Switzerland
| | - Firas Souleiman
- Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Esther Vögelin
- Department for Plastic and Hand Surgery, Inselspital University Hospital Bern, University of Bern, Bern, Switzerland
| | - Frank J P Beeres
- Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | | | - Torsten Pastor
- Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland.
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van den Heuvel S, Penning D, Sanders F, van Veen R, Sosef N, van Dijkman B, Schepers T. Functional outcome of routine versus on-demand removal of the syndesmotic screw. Bone Jt Open 2023; 4:957-963. [PMID: 38108322 PMCID: PMC10726379 DOI: 10.1302/2633-1462.412.bjo-2023-0061] [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: 12/19/2023] Open
Abstract
Aims The primary aim of this study was to present the mid-term follow-up of a multicentre randomized controlled trial (RCT) which compared the functional outcome following routine removal (RR) to the outcome following on-demand removal (ODR) of the syndesmotic screw (SS). Methods All patients included in the 'ROutine vs on DEmand removal Of the syndesmotic screw' (RODEO) trial received the Olerud-Molander Ankle Score (OMAS), American Orthopaedic Foot and Ankle Hindfoot Score (AOFAS), Foot and Ankle Outcome Score (FAOS), and EuroQol five-dimension questionnaire (EQ-5D). Out of the 152 patients, 109 (71.7%) completed the mid-term follow-up questionnaire and were included in this study (53 treated with RR and 56 with ODR). Median follow-up was 50 months (interquartile range 43.0 to 56.0) since the initial surgical treatment of the acute syndesmotic injury. The primary outcome of this study consisted of the OMAS scores of the two groups. Results The median OMAS score was 85.0 for patients treated with RR, and 90.0 for patients treated with ODR (p = 0.384), indicating no significant difference between ODR and RR. The secondary outcome measures included the AOFAS (88.0 in the RR group and 90.0 for ODR; p = 0.722), FAOS (87.5 in the RR group and 92.9 for ODR; p = 0.399), and EQ-5D (0.87 in the RR group and 0.96 for ODR; p = 0.092). Conclusion This study demonstrated no functional difference comparing ODR to RR in syndesmotic injuries at a four year follow-up period, which supports the results of the primary RODEO trial. ODR should be the standard practice after syndesmotic screw fixation.
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Affiliation(s)
- Stein van den Heuvel
- Trauma Unit, Department of Surgery. Amsterdam Movement Sciences, Amsterdam UMC, Amsterdam, the Netherlands
| | - Diederick Penning
- Trauma Unit, Department of Surgery. Amsterdam Movement Sciences, Amsterdam UMC, Amsterdam, the Netherlands
| | - Fay Sanders
- Trauma Unit, Department of Surgery. Amsterdam Movement Sciences, Amsterdam UMC, Amsterdam, the Netherlands
| | - Ruben van Veen
- Department of Trauma Surgery, OLVG, Amsterdam, the Netherlands
| | - Nico Sosef
- Department of Trauma Surgery, Spaarne Gasthuis, Hoofddorp, the Netherlands
| | - Bart van Dijkman
- Department of Trauma Surgery, Flevoziekenhuis, Almere, the Netherlands
| | - Tim Schepers
- Trauma Unit, Department of Surgery. Amsterdam Movement Sciences, Amsterdam UMC, Amsterdam, the Netherlands
| | - On behalf of the RODEO Collaborator group
- Trauma Unit, Department of Surgery. Amsterdam Movement Sciences, Amsterdam UMC, Amsterdam, the Netherlands
- Department of Trauma Surgery, OLVG, Amsterdam, the Netherlands
- Department of Trauma Surgery, Spaarne Gasthuis, Hoofddorp, the Netherlands
- Department of Trauma Surgery, Flevoziekenhuis, Almere, the Netherlands
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Ebrahimi A, Sohn S, Lucaciu A, Ashkani-Esfahani S, Waryasz G. Short-term Follow-up of Patients Receiving Bio-integrative Screws for Lisfranc Injuries: A Case Series. J Orthop Case Rep 2023; 13:34-39. [PMID: 38162344 PMCID: PMC10753658 DOI: 10.13107/jocr.2023.v13.i12.4068] [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: 09/26/2023] [Revised: 10/19/2023] [Indexed: 01/03/2024] Open
Abstract
Introduction Various methods are used for open reduction and internal fixation of Lisfranc injuries, and each shows different post-treatment outcomes. Other than the common post-surgery problems in these patients, including possible non-anatomical reduction, implant loosening, breakage, and arthritis, most of these patients will undergo a second surgery for implant removal which itself might cause further complications. To reduce the need for re-operation, bio-degradable or bio-integrative implants can be promising; however, the short- and long-term outcomes have been scarcely investigated to date. Case Report We followed up 10 adult patients who received bio-integrative screws for Lisfranc injuries. The patients were asked to fill out the patient-reported outcome measures (PROMs) surveys during one of the follow-up visits. We gathered variables including the type of injury, pain score, and PROMs including physical function (PF), pain interference, pain intensity, and depression. We evaluated the patients for wound dehiscence, non-union, and hardware failure. The median (interquartile range [IQR]) follow-up time of the patients in this study was 9 (4-11.5) months. Nine out of 10 patients with Lisfranc injuries who received bio-integrative screws showed improvements in their pain scores and started progressive weight-bearing. Among 3 patients who had sport-related Lisfranc injuries, 2 returned to play in <6 months, and one started side-to-side agility work in <3 months. The median (IQR) scores of PROMs representing PF, depression, physical health, mental health, pain interference, and pain intensity were 49.5 (30.1-61.9), 41 (41-49), 50.8 (39.2-57.7), 59 (48.9-63.7), 51.7 (41.6-72.6), and 43.5 (37.8-55.2), respectively. Conclusion Our results demonstrated promising short-term outcomes of using bio-integrative screws in patients with Lisfranc injuries based on PROMs and the rate of complications. Future studies on larger populations and more comprehensive variables with longer follow-up duration should be the next step in evaluating the pros and cons of these new implants.
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Affiliation(s)
- Alireza Ebrahimi
- Foot and Ankle Research and Innovation Lab, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sora Sohn
- Foot and Ankle Research and Innovation Lab, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Andreea Lucaciu
- Foot and Ankle Research and Innovation Lab, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Soheil Ashkani-Esfahani
- Foot and Ankle Research and Innovation Lab, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
- Foot and Ankle Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Gregory Waryasz
- Foot and Ankle Research and Innovation Lab, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
- Foot and Ankle Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Toga A, Fukuda K, Ozaki M, Fujii T, Yonezawa Y. Reinstrumentation for progressive hyper-kyphotic deformity after implant removal despite obtaining physiological alignment by posterior corrective surgery for adolescent idiopathic scoliosis with flat back: a case report. J Surg Case Rep 2023; 2023:rjad547. [PMID: 37867922 PMCID: PMC10587005 DOI: 10.1093/jscr/rjad547] [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: 07/09/2023] [Accepted: 09/26/2023] [Indexed: 10/24/2023] Open
Abstract
This case report describes a 13-year-old female patient with adolescent idiopathic scoliosis (AIS) and flat back who experienced progressive kyphotic deformity after implant removal despite obtaining physiological alignment postoperatively. The patient underwent multiple surgeries, and a late-developing infection complicated her treatment course. Despite hard bracing to prevent kyphotic change, the kyphosis progressed to 74° within a year after implant removal, leading to a decrease in patient height and back pain. Revision surgery was eventually necessary. Possible factors for the kyphotic progression include injury to paraspinal back muscles due to multiple surgeries or insufficient bony fusion from late-developing infection. This case highlights the importance of thorough evaluation and follow-up for optimal patient outcomes after implant removal in AIS patients, particularly those with flat back.
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Affiliation(s)
- Akira Toga
- Department of Orthopaedic Surgery, Saiseikai Yokohamashi Tobu Hospital, 3-6-1 Shimosueyoshi, Tsurumi-ku, Yokohama, Kanagawa 230-8765, Japan
| | - Kentaro Fukuda
- Department of Orthopaedic Surgery, Saiseikai Yokohamashi Tobu Hospital, 3-6-1 Shimosueyoshi, Tsurumi-ku, Yokohama, Kanagawa 230-8765, Japan
| | - Masahiro Ozaki
- Department of Orthopaedic Surgery, Saiseikai Yokohamashi Tobu Hospital, 3-6-1 Shimosueyoshi, Tsurumi-ku, Yokohama, Kanagawa 230-8765, Japan
| | - Takeshi Fujii
- Department of Orthopaedic Surgery, Saiseikai Yokohamashi Tobu Hospital, 3-6-1 Shimosueyoshi, Tsurumi-ku, Yokohama, Kanagawa 230-8765, Japan
| | - Yoshiro Yonezawa
- Department of Orthopaedic Surgery, Saiseikai Yokohamashi Tobu Hospital, 3-6-1 Shimosueyoshi, Tsurumi-ku, Yokohama, Kanagawa 230-8765, Japan
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Graillon N, Foletti JM, Godio-Raboutet Y, Guyot L, Varazzani A, Thollon L. Mandibular Titanium Miniplates Change the Biomechanical Behaviour of the Mandible in the Case of Facial Trauma: A Three-Dimensional Finite Element Analysis. Bioengineering (Basel) 2023; 10:994. [PMID: 37760096 PMCID: PMC10525150 DOI: 10.3390/bioengineering10090994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/02/2023] [Accepted: 08/09/2023] [Indexed: 09/29/2023] Open
Abstract
Our study aimed to compare the biomechanical behaviour of mandibles with or without titanium miniplates when subjected to an impact after bone healing using a finite element model (FEM) of the human mandible. We simulated mandibular trauma on an FEM of a human mandible carrying or not two parasymphyseal miniplates and applying a concentrated force of 2000 N to four different areas, including the insertion area, the area straddling the edge of the miniplates and the adjacent bone, at a distance from the miniplates on the symphysis, and on the basilar border of the mandible below the miniplates. Then, we compared the Von Mises stress distributions between the two models. In the case of an impact on the miniplates, the maximum Von Mises stress occurred in two specific areas, on the cortical bone at the posterior border of the two miniplates at a distance from the impact, while in the model without miniplates, the Von Mises stresses were homogenously distributed in the impact area. The presence of titanium miniplates in the case of trauma affects the biomechanical behaviour of the mandible and could cause more complex fractures. We recommend informing patients of this potential risk.
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Affiliation(s)
- Nicolas Graillon
- Laboratoire de Bioméchanique Appliquée (LBA), Gustave Eiffel University/Aix-Marseille University, 13015 Marseille, France; (J.-M.F.); (Y.G.-R.); (L.G.); (L.T.)
- Department of Oral and Maxillofacial Surgery/Assistance Publique-Hopitaux de Marseille (APHM), Conception University Hospital, 13005 Marseille, France
| | - Jean-Marc Foletti
- Laboratoire de Bioméchanique Appliquée (LBA), Gustave Eiffel University/Aix-Marseille University, 13015 Marseille, France; (J.-M.F.); (Y.G.-R.); (L.G.); (L.T.)
- Department of Oral and Maxillofacial Surgery/Assistance Publique-Hopitaux de Marseille (APHM), Conception University Hospital, 13005 Marseille, France
| | - Yves Godio-Raboutet
- Laboratoire de Bioméchanique Appliquée (LBA), Gustave Eiffel University/Aix-Marseille University, 13015 Marseille, France; (J.-M.F.); (Y.G.-R.); (L.G.); (L.T.)
| | - Laurent Guyot
- Laboratoire de Bioméchanique Appliquée (LBA), Gustave Eiffel University/Aix-Marseille University, 13015 Marseille, France; (J.-M.F.); (Y.G.-R.); (L.G.); (L.T.)
- Department of Oral and Maxillofacial Surgery/Assistance Publique-Hopitaux de Marseille (APHM), Conception University Hospital, 13005 Marseille, France
| | - Andrea Varazzani
- Maxillo-Facial Surgery, Facial Plastic Surgery, Stomatology and Oral Surgery, Hospices Civils de Lyon, Lyon-Sud Hospital—Claude-Bernard Lyon 1 University, 69310 Pierre-Benite, France;
| | - Lionel Thollon
- Laboratoire de Bioméchanique Appliquée (LBA), Gustave Eiffel University/Aix-Marseille University, 13015 Marseille, France; (J.-M.F.); (Y.G.-R.); (L.G.); (L.T.)
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Paganotto A, Truttmann A, Rosset É. Successful parturition and lactation after a deslorelin implant removal in a pregnant cat. JFMS Open Rep 2023; 9:20551169231201606. [PMID: 37873522 PMCID: PMC10590539 DOI: 10.1177/20551169231201606] [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] [Indexed: 10/25/2023] Open
Abstract
Case summary The aim of this clinical case presentation was to describe the effect of a 4.7 mg deslorelin implant placement in a pregnant queen during the second half of gestation, and the consequences of its removal on the pregnancy and parturition. A 5-year-old female cat exhibiting nesting behaviour and weight gain 10 days after placement of a deslorelin implant was presented for examination. Gestation was confirmed on ultrasound, with two well-formed kittens of a gestational age of approximately 7 weeks. The deslorelin implant placed on the umbilicus was removed 1 week later. No change in the pregnancy was observed after removal of the implant. The fetuses showed no signs of distress on ultrasound and radiography examination 4 days after removal of the implant. One week after implant removal, the queen naturally delivered two healthy kittens. The queen showed maternal behaviour with normal milk production. Relevance and novel information In the light of the lack of literature on implant injection and removal in the pregnant queen, this case report showcases a successful birth of healthy kittens without any subsequent adverse effect on the queen. Further study is needed to assess the safety of implant removal during pregnancy and potential use as a means to induce fertile oestrus in the queen.
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Affiliation(s)
| | | | - Émilie Rosset
- VetAgro Sup, Université de Lyon, Marcy l’Etoile, France
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Fu S, Ju G, Dai X, Li H, Huang A. Severe major vessel injury during peadicle screw removal: a case report. Front Surg 2023; 10:1187801. [PMID: 37383382 PMCID: PMC10293790 DOI: 10.3389/fsurg.2023.1187801] [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: 03/16/2023] [Accepted: 05/22/2023] [Indexed: 06/30/2023] Open
Abstract
Introduction Pedicle screw fixation (PSF) has been the standard therapy for the treatment of various spinal diseases. Although complications are identified regularly, iatrogenic vascular injury is one of the rare but life-threatening complications. In this literature, we describe the first case of inferior vena cava (IVC) injury during pedicle screw removal. Case description A 31-year-old man was treated by percutaneous pedicle screw fixation for an L1 compression fracture. After a year, the fracture healed well and hardware removal surgery was performed. During the procedure, the hardware on the right was removed unremarkably except for the L2 pedicle screw which slipped into the retroperitoneum because of the improper technique. The CT angiogram revealed the screw had breached the anterior cortex of the L2 vertebral body and penetrated the IVC. After multidisciplinary cooperation, the defect of IVC was reconstructed and the L2 screw was removed from the posterior approach in the end. Result The patient recovered well and was discharged after 3 weeks without further events. The removal of the contralateral implants was unremarkable at 7 months postoperatively. At the 3-year follow-up, the patient returned to his normal daily activity without any complaints. Conclusion Although pedicle screw removal is a rather simple procedure, severe complications may have occurred from this procedure. Surgeons should keep vigilant to avoid the complication noted in this case.
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Affiliation(s)
- ShengYu Fu
- Department of Orthopaedic, The Affiliated Taizhou People’s Hospital of Nanjing Medical University, Taizhou, China
- Postgraduate School, Dalian Medical University, Dalian, China
| | - Gang Ju
- Department of Orthopaedic, The Affiliated Taizhou People’s Hospital of Nanjing Medical University, Taizhou, China
| | - Xiang Dai
- Department of Vascular Surgery, The Affiliated Taizhou People's Hospital of Nanjing Medical University, Taizhou, China
| | - Haijun Li
- Department of Orthopaedic, The Affiliated Taizhou People’s Hospital of Nanjing Medical University, Taizhou, China
| | - Aibing Huang
- Department of Orthopaedic, The Affiliated Taizhou People’s Hospital of Nanjing Medical University, Taizhou, China
- Postgraduate School, Dalian Medical University, Dalian, China
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Samargandi R, Le Nail LR. A Simple Technique to Prevent Screw Stripping During Hardware Removal Using Bone Wax. Cureus 2023; 15:e39683. [PMID: 37265916 PMCID: PMC10231898 DOI: 10.7759/cureus.39683] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2023] [Indexed: 06/03/2023] Open
Abstract
Hardware removal is a common procedure in orthopedics, but it can be challenging and time-consuming. Difficulties in screw removal may arise due to bone growth or cement covering the screw heads, leading to screw damage, and increased surgical time. In this article, we describe a simple and inexpensive technique utilizing bone wax to protect screw heads from bone growth or cement, facilitating future implant removal. The application of bone wax over screw heads acts as a barrier, preventing bone growth or cement from engaging with the screw heads.
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Affiliation(s)
- Ramy Samargandi
- Department of Orthopedic Surgery, Faculty of Medicine, University of Jeddah, Jeddah, SAU
- Department of Orthopedics and Traumatology, Centre Hospitalier Régional Universitaire (CHRU) de Tours, Tours, FRA
| | - Louis-Romée Le Nail
- Department of Orthopedics and Traumatology, Centre Hospitalier Régional Universitaire (CHRU) de Tours, Tours, FRA
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Duckworth AD, Carter TH, Chen MJ, Gardner MJ, Watts AC. Olecranon fractures : current treatment concepts. Bone Joint J 2023; 105-B:112-123. [PMID: 36722062 DOI: 10.1302/0301-620x.105b2.bjj-2022-0703.r1] [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: 02/02/2023]
Abstract
Despite being one of the most common injuries around the elbow, the optimal treatment of olecranon fractures is far from established and stimulates debate among both general orthopaedic trauma surgeons and upper limb specialists. It is almost universally accepted that stable non-displaced fractures can be safely treated nonoperatively with minimal specialist input. Internal fixation is recommended for the vast majority of displaced fractures, with a range of techniques and implants to choose from. However, there is concern regarding the complication rates, largely related to symptomatic metalwork resulting in high rates of implant removal. As the number of elderly patients sustaining these injuries increases, we are becoming more aware of the issues associated with fixation in osteoporotic bone and the often fragile soft-tissue envelope in this group. Given this, there is evidence to support an increasing role for nonoperative management in this high-risk demographic group, even in those presenting with displaced and/or multifragmentary fracture patterns. This review summarizes the available literature to date, focusing predominantly on the management techniques and available implants for stable fractures of the olecranon. It also offers some insights into the potential avenues for future research, in the hope of addressing some of the pertinent questions that remain unanswered.Cite this article: Bone Joint J 2023;105-B(2):112-123.
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Affiliation(s)
- Andrew D Duckworth
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh and University of Edinburgh, Edinburgh, UK
| | - Thomas H Carter
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh and University of Edinburgh, Edinburgh, UK
| | - Michael J Chen
- Department of Orthopaedic Surgery, Stanford University Medical Centre, Stanford, California, USA
| | - Michael J Gardner
- Department of Orthopaedic Surgery, Stanford University Medical Centre, Stanford, California, USA
| | - Adam C Watts
- Upper Limb Unit, Wrightington Hospital, Wrightington, UK
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Nishida K, Nasu Y, Hashizume K, Okita S, Nakahara R, Saito T, Ozaki T, Inoue H. Outcome of unlinked total elbow arthroplasty for rheumatoid arthritis in patients younger than 50 years old. Bone Jt Open 2023; 4:19-26. [PMID: 36636881 PMCID: PMC9887340 DOI: 10.1302/2633-1462.41.bjo-2022-0151.r1] [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: 01/14/2023] Open
Abstract
AIMS There are concerns regarding complications and longevity of total elbow arthroplasty (TEA) in young patients, and the few previous publications are mainly limited to reports on linked elbow devices. We investigated the clinical outcome of unlinked TEA for patients aged less than 50 years with rheumatoid arthritis (RA). METHODS We retrospectively reviewed the records of 26 elbows of 21 patients with RA who were aged less than 50 years who underwent primary TEA with an unlinked elbow prosthesis. The mean patient age was 46 years (35 to 49), and the mean follow-up period was 13.6 years (6 to 27). Outcome measures included pain, range of motion, Mayo Elbow Performance Score (MEPS), radiological evaluation for radiolucent line and loosening, complications, and revision surgery with or without implant removal. RESULTS The mean MEPS significantly improved from 47 (15 to 70) points preoperatively to 95 (70 to 100) points at final follow-up (p < 0.001). Complications were noted in six elbows (23%) in six patients, and of these, four with an ulnar neuropathy and one elbow with postoperative traumatic fracture required additional surgeries. There was no revision with implant removal, and there was no radiological evidence of loosening around the components. With any revision surgery as the endpoint, the survival rates up to 25 years were 78.1% (95% confidence interval 52.8 to 90.6) as determined by Kaplan-Meier analysis. CONCLUSION The clinical outcome of primary unlinked TEA for young patients with RA was satisfactory and comparable with that for elderly patients. A favourable survival rate without implant removal might support the use of unlinked devices for young patients with this disease entity, with a caution of a relatively high complication rate regarding ulnar neuropathy.Level of Evidence: Therapeutic Level IVCite this article: Bone Jt Open 2023;4(1):19-26.
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Affiliation(s)
- Keiichiro Nishida
- Department of Orthopaedic Surgery, Science of Functional Recovery and Reconstruction, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan,Correspondence should be sent to Keiichiro Nishida. E-mail:
| | - Yoshihisa Nasu
- Department of Orthopaedic Surgery, Okayama University Hospital, Okayama, Japan
| | - Kenzo Hashizume
- Department of Orthopaedic Surgery, Chugoku Central Hospital, Fukuyama, Japan
| | - Shunji Okita
- Department of Orthopaedic Surgery, Okayama Saiseikai General Hospital, Okayama, Japan
| | - Ryuichi Nakahara
- Department of Orthopaedic Surgery, Okayama University Hospital, Okayama, Japan
| | - Taichi Saito
- Department of Intelligent Orthopaedic System, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Science of Functional Recovery and Reconstruction, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Hajime Inoue
- Department of Orthopaedic Surgery, Science of Functional Recovery and Reconstruction, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
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Vogt B, Rupp C, Gosheger G, Eveslage M, Laufer A, Toporowski G, Roedl R, Frommer A. A clinical and radiological matched-pair analysis of patients treated with the PRECICE and STRYDE magnetically driven motorized intramedullary lengthening nails. Bone Joint J 2023; 105-B:88-96. [PMID: 36587248 DOI: 10.1302/0301-620x.105b1.bjj-2022-0755.r1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 01/02/2023]
Abstract
AIMS Distraction osteogenesis with intramedullary lengthening devices has undergone rapid development in the past decade with implant enhancement. In this first single-centre matched-pair analysis we focus on the comparison of treatment with the PRECICE and STRYDE intramedullary lengthening devices and aim to clarify any clinical and radiological differences. METHODS A single-centre 2:1 matched-pair retrospective analysis of 42 patients treated with the STRYDE and 82 patients treated with the PRECICE nail between May 2013 and November 2020 was conducted. Clinical and lengthening parameters were compared while focusing radiological assessment on osseous alterations related to the nail's telescopic junction and locking bolts at four different stages. RESULTS Osteolysis next to the telescopic junction was observed in 31/48 segments (65%) lengthened with the STRYDE nail before implant removal compared to 1/91 segment (1%) in the PRECICE cohort. In the STRYDE cohort, osteolysis initially increased, but decreased or resolved in almost all lengthened segments (86%) after implant removal. Implant failure was observed in 9/48 STRYDE (19%) and in 8/92 PRECICE nails (9%). Breakage of the distal locking bolts was found in 5/48 STRYDE nails (10%) compared to none in the PRECICE cohort. Treatment-associated pain was generally recorded as mild and found in 30/48 patients (63%) and 39/92 (42%) in the STRYDE and PRECICE cohorts, respectively. Temporary range of motion (ROM) limitations under distraction were registered in 17/48 (35%) segments treated with the STRYDE and 35/92 segments (38%) treated with the PRECICE nail. CONCLUSION Osteolysis and periosteal reaction, implant breakage, and pain during lengthening and consolidation is more likely in patients treated with the STRYDE nail compared to the PRECICE nail. Temporary ROM limitations during lengthening occurred independent of the applied device. Implant-related osseous alterations seem to remodel after implant removal.Cite this article: Bone Joint J 2023;105-B(1):88-96.
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Affiliation(s)
- Bjoern Vogt
- Paediatric Orthopaedics, Deformity Reconstruction, and Foot Surgery, Münster University Hospital, Münster, Germany
| | - Carolin Rupp
- Paediatric Orthopaedics, Deformity Reconstruction, and Foot Surgery, Münster University Hospital, Münster, Germany
| | - Georg Gosheger
- General Orthopaedics and Tumour Orthopaedics, Münster University Hospital, Münster, Germany
| | - Maria Eveslage
- Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany
| | - Andrea Laufer
- Paediatric Orthopaedics, Deformity Reconstruction, and Foot Surgery, Münster University Hospital, Münster, Germany.,General Orthopaedics and Tumour Orthopaedics, Münster University Hospital, Münster, Germany
| | - Gregor Toporowski
- Paediatric Orthopaedics, Deformity Reconstruction, and Foot Surgery, Münster University Hospital, Münster, Germany.,General Orthopaedics and Tumour Orthopaedics, Münster University Hospital, Münster, Germany
| | - Robert Roedl
- Paediatric Orthopaedics, Deformity Reconstruction, and Foot Surgery, Münster University Hospital, Münster, Germany
| | - Adrien Frommer
- Paediatric Orthopaedics, Deformity Reconstruction, and Foot Surgery, Münster University Hospital, Münster, Germany.,General Orthopaedics and Tumour Orthopaedics, Münster University Hospital, Münster, Germany
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12
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Yuan W, Chua THI, Kwek EBK. Is Elective Implant Removal after Fracture Healing Beneficial? - A Prospective Cohort Study. Malays Orthop J 2022; 16:55-60. [PMID: 36589381 PMCID: PMC9791889 DOI: 10.5704/moj.2211.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 07/20/2022] [Indexed: 12/13/2022] Open
Abstract
Introduction Elective implant removal following healed extremity fractures remains controversial. This study aimed to evaluate the reasons and outcomes of implant removal after uneventful healing of limb fractures. Materials and methods This is a prospective single-centre observational cohort study. Patients who sustained upper or lower extremity fractures that were fixed and healed uneventfully were included in the study when they elected to remove the implants. Patients were followed for six months post-operatively. Outcomes were assessed with patient satisfaction, symptoms resolution, and complications. Results A total of 43 patients were recruited from October 2016 to March 2019. Thirty-six patients (37 implants) were symptomatic. Pain and prominence were the most common complaints, present in 59.5% and 33.3% of patients, respectively. Cold weather pain was also not uncommon (19.0%). Pain improved in 91.3% of the patients who complained of pain. The 94.6% symptomatic patients had at least partial resolution of pre-operative symptoms. All the patients who completed follow-up were satisfied with the procedure. In two patients, there were broken and retained screws intra-operatively. Post-operative complication rate was 23.8%, although no major complications occurred. Conclusions Implant removal after uneventful healing of extremity fractures is a safe procedure that conferred a predictable relief of symptoms and satisfactory outcomes in most.
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Affiliation(s)
- W Yuan
- Department of Orthopaedic Surgery, Woodlands Health Campus, Singapore
| | - THI Chua
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore
| | - EBK Kwek
- Department of Orthopaedic Surgery, Woodlands Health Campus, Singapore,Corresponding Author: Ernest Kwek Beng Kee, Department of Orthopaedic Surgery, Woodlands Health Campus, 2 Yishun Central 2, Singapore 768024
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13
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Hubacher D, Byamugisha J, Kakaire O, Nalubwama H, Emtell Iwarsson K, Bratlie M, Chen PL, Gemzell-Danielsson K. Removal of a well-palpable one-rod subdermal contraceptive implant using a dedicated hand-held device or standard technique: a randomized, open-label, non-inferiority trial. Hum Reprod 2022; 37:2320-2333. [PMID: 35960174 PMCID: PMC9527454 DOI: 10.1093/humrep/deac179] [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: 01/03/2022] [Revised: 06/15/2022] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION Is a mechanical hand-held device for removing a single-rod subdermal contraceptive implant safe for implant users? SUMMARY ANSWER In terms of safety, the device is non-inferior to the standard technique for implant removal. WHAT IS KNOWN ALREADY An easy-to-use device for removing a subdermal contraceptive implant may be helpful in settings where skilled providers are in short supply. Prior to this study, the only report on the world’s first hand-held, mechanical device with build-in incisor was a Swedish study using earlier versions of the product. STUDY DESIGN, SIZE, DURATION From December 2019 to November 2020, we conducted a three-arm, open-label non-inferiority randomized trial involving 225 Ugandan women to assess safety (primary outcome) and measure implant removal efficacy (secondary outcomes) of a newly developed, hand-held device, compared to the standard removal technique. PARTICIPANTS/MATERIALS, SETTING, METHODS We randomized participants desiring removal of their one-rod contraceptive implant in a 1:1:1 ratio: standard technique/lidocaine injection, new device/lidocaine patch or new device/lidocaine injection. For primary safety endpoints, we examined removal complications and grouped them according to severity. For secondary endpoints on efficacy, we defined three device outcomes: intact implant removed without additional tools (primary), implant removed allowing implant breakage, but without tools (secondary) and implant removed allowing implant breakage and non-scalpel tools (tertiary). We assessed provider feedback on the device and used chi-square tests for all comparisons. MAIN RESULTS AND THE ROLE OF CHANCE We recruited 225 participants and randomly assigned (n = 75) to each group. For safety, no primary complications occurred in any treatment group, while only one secondary complication occurred in each treatment group (1%). Primary efficacy was 100% (standard technique), 85% (new device/lidocaine patch) and 73% (new device/lidocaine injection) (P < 0.0001). Secondary efficacy was 100% (standard technique), 92% (new device/lidocaine patch) and 79% (new device/lidocaine injection) (P < 0.0001). Tertiary efficacy was 100% (standard technique), 96% (new device/lidocaine patch) and 91% (new device/lidocaine injection) (P = 0.017). Unsuccessful removals with the new device did not hinder subsequent implant extractions with standard back-up tools. In over 90% of the 150 device procedures, providers agreed or strongly agreed that the product is an acceptable alternative to standard removal technique. LIMITATIONS, REASONS FOR CAUTION We tested a new removal device in the hands of Ugandan nurses who were adept at standard removal techniques; our estimates of removal efficacy may not apply to lower-level providers who arguably may be the prime beneficiaries of this technology. WIDER IMPLICATIONS OF THE FINDINGS The study was conducted in a region of the world where the new device could be used to expand access to implant removal services. Intended beneficiaries of the new product are implant users who cannot easily find skilled providers for traditional scalpel-dependent removals and/or users who are intimidated by scalpel procedures, and lower-level providers who can be trained to help deliver services to meet a growing demand. The new device is a safe, acceptable alternative; efficacy was high, but not on par with standard technique. STUDY FUNDING/COMPETING INTEREST(S) Funding for this study was provided by the RemovAid AS of Norway with grants from Research Council of Norway (GLOBVAC number 228319), Bill & Melinda Gates Foundation (grant INV-007571) and SkatteFUNN. M.B. is founder and former CEO of RemovAid AS, Norway. M.B. holds contraceptive rod remover patents (2012 1307156.8 and 2015), pre-removal test (filed) and shares in RemovAid AS. All of the remaining authors’ institutions received payments in the form of contracts to help conduct the study; the funds for these contracts emanated from RemovAid AS. TRIAL REGISTRATION NUMBER NCT04120337 TRIAL REGISTRATION DATE 9 October 2019 DATE OF FIRST PATIENT’S ENROLMENT 23 December 2019
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Affiliation(s)
| | - Josaphat Byamugisha
- Department of Obstetrics and Gynaecology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Othman Kakaire
- Department of Obstetrics and Gynaecology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Hadija Nalubwama
- Department of Obstetrics and Gynaecology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Karin Emtell Iwarsson
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Division of Gynaecology and Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
| | | | | | - Kristina Gemzell-Danielsson
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Division of Gynaecology and Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
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14
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Wang M, Xu L, Yang B, Du C, Zhu Z, Wang B, Qiu Y, Sun X. Incidence, Management and Outcome of Delayed Deep Surgical Site Infection Following Spinal Deformity Surgery: 20-Year Experience at a Single Institution. Global Spine J 2022; 12:1141-1150. [PMID: 33375859 PMCID: PMC9210238 DOI: 10.1177/2192568220978225] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
STUDY DESIGN A retrospective study. OBJECTIVES To investigate the incidence, management and outcome of delayed deep surgical site infection (SSI) after the spinal deformity surgery. METHODS This study reviewed 5044 consecutive patients who underwent spinal deformity corrective surgery and had been followed over 2 years. Delayed deep SSI were defined as infection involving fascia and muscle and occurring >3 months after the initial procedure. An attempt to retain the implant were initially made for all patients. If the infection failed to be eradicated, the implant removal should be put off until solid fusion was confirmed, usually more than 2 years after the initial surgery. Radiographic data at latest follow-up were compared versus that before implant removal. RESULTS With an average follow-up of 5.3 years, 56 (1.1%) patients were diagnosed as delayed deep SSI. Seven (12.5%) patients successfully retained instrumentation and there were no signs of recurrence during follow-up (average 3.4 years). The remaining patients, because of persistent or recurrent infection, underwent implant removal 2 years or beyond after the primary surgery, and solid fusion was detected in any case. However, at a minimum 1-year follow-up (average 3.9 years), an average loss of 9° in the thoracic curve and 8° in the thoracolumbar/lumbar curves was still observed. CONCLUSIONS Delayed deep SSI was rare after spinal deformity surgery. To eradicate infection, complete removal of implant may be required in the majority of delayed SSI. Surgeons must be aware of high likelihood of deformity progression after implant removal, despite radiographic solid fusion.
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Affiliation(s)
- Muyi Wang
- Spine Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, China
| | - Liang Xu
- Spine Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, China
| | - Bo Yang
- Spine Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, China
| | - Changzhi Du
- Spine Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, China
| | - Zezhang Zhu
- Spine Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, China
| | - Bin Wang
- Spine Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, China
| | - Yong Qiu
- Spine Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, China
| | - Xu Sun
- Spine Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, China
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15
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AK B, Eroğlu EG, Ertugrul AS, Öztürk AB, Yılmaz ŞN. Non-Destructive Removal of Dental Implant by Using the Cryogenic Method. Medicina (Kaunas) 2022; 58:medicina58070849. [PMID: 35888569 PMCID: PMC9319264 DOI: 10.3390/medicina58070849] [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: 05/25/2022] [Revised: 06/15/2022] [Accepted: 06/22/2022] [Indexed: 11/26/2022]
Abstract
Background and Objectives: The gold standard for a successful prosthetic approach is the osseointegration of an implant. However, this integration can be a problem in cases where the implant needs to be removed. Removing the implant with minimal damage to the surrounding tissues is important. Osteocytes cannot survive below −2 °C, but epithelial cells, fibroblasts, and other surrounding tissue cells can. Remodeling can be triggered by cryotherapy at temperatures that specifically affect osteocyte necrosis. In this study, we aimed to develop a method for reversing the osseointegration mechanism and for protecting the surrounding tissues by bone remodeling induced by CO2 cryotherapy. Materials and Methods: In this study, eight 2.8 mm diameter, one-piece mini implants were used in New Zealand rabbit tibias. Two control and six implants were tested in this study. After 2 months of osseointegration, a reverse torque force method was used to remove all osseointegrated implants at 5, 10, 20, and 30 Ncm. The osseointegration of the implants was proven by periotest measurements. Changes in bone tissue were examined in histological sections stained with toluidine blue after rabbit sacrifice. The number of lacunae with osteocyte, empty lacunae, and lacunae greater than 5 µm and the osteon number in a 10,000 µm2 area were calculated. Cryotherapy was applied to the test implants for 1 min, 2 min, and 5 min. Three implants were subjected to cryotherapy at −40 °C, and the other implants were subjected to cryotherapy at −80 °C. Results: Empty lacunae, filled osteocytes, lacunae >5 µm, and the osteon count around the implant applied at −40 °C were not significantly different from the control implants. The application of −40 °C for 1 min was found to cause minimal damage to the bone cells. The implants, which were applied for 1 min and 2 min, were successfully explanted on the 2nd day with the 5 Ncm reverse torque method. Test implants, which were applied cold for 5 min, were explanted on day 1. Tissue damage was detected in all test groups at −80 °C. Conclusions: The method of removing implants with cryotherapy was found to be successful in −40 °C freeze−thaw cycles applied three times for 1 min. To prove implant removal with cryotherapy, more implant trials should be conducted.
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Affiliation(s)
- Burak AK
- Periodontology Department, Faculty of Dentistry, Mersin University, 33343 Mersin, Turkey
- Correspondence:
| | - Emre Gürkan Eroğlu
- Periodontology Department, Faculty of Dentistry, Izmir Katip Çelebi University, 35620 Izmir, Turkey; (E.G.E.); (A.S.E.)
| | - Abdullah Seckin Ertugrul
- Periodontology Department, Faculty of Dentistry, Izmir Katip Çelebi University, 35620 Izmir, Turkey; (E.G.E.); (A.S.E.)
| | - Ayla Batu Öztürk
- Department of Histology and Embryology, School of Medicine, Mersin University, 33343 Mersin, Turkey; (A.B.Ö.); (Ş.N.Y.)
| | - Şakir Necat Yılmaz
- Department of Histology and Embryology, School of Medicine, Mersin University, 33343 Mersin, Turkey; (A.B.Ö.); (Ş.N.Y.)
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16
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Meir H, Sebaoun A, Raz P, Levartovsky S, Arieli A, Pilo R, Dor Z, Beitlitum I. Evaluation of Implant Stability and Trephination Depth for Implant Removal-An In Vitro Study. Materials (Basel) 2022; 15. [PMID: 35744258 DOI: 10.3390/ma15124200] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/25/2022] [Accepted: 06/08/2022] [Indexed: 02/04/2023]
Abstract
Malpositioned and broken implants are usually fully osseointegrated; hence, their removal, especially from the lower arch, can be very challenging. Implant removal techniques include reverse torque and trephination. Trephination is an invasive technique that can jeopardize vital structures, cause mandibular fatigue fractures, or lead to osteomyelitis. In this study, we aimed to assess the relationship between trephination depth and implant stability by recording implant stability quotient (ISQ) readings at varying trephination depths in vitro. Materials and methods: Forty-eight implants were inserted into dense synthetic polyurethane foam blocks as artificial bone. Primary implant stability was measured with a Penguin resonance frequency analysis (RFA) device. Implants of two designs with a diameter of 3.75 mm and a length of 13 or 8 mm were inserted. Twenty-four internal hexagon (IH) (Seven®) and twenty-four conical connection (CC) implants (C1®; MIS® Implants, Ltd., Misgav, Israel) were used. The primary implant stability was measured with the RFA device. Trephination was performed, and implant stability was recorded at depths of 0, 3, and 6 mm for the 8 mm implants and 0, 3, 6, 8, 10, and 11.5 mm for the 13 mm implants. Results: Linear regression revealed a significant relation between the trephination depth and the ISQ (F (1, 213) = 1113.192, p < 0.001, adjusted r2 = 0.839). The trephination depth significantly predicted the ISQ (β = −5.337, p < 0.001), and the ISQ decreased by −5.33 as the trephination depth increased by 1 mm. Conclusion: Implant stability reduction as measured using an RFA device during trephination may be a valuable guide to achieving safe reverse torque for implant removal. Further studies are needed to evaluate these data in clinical settings.
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Abstract
OBJECTIVES The aim of this study was to describe the demography, aetiology, location and classification of physeal fractures in cats, and to describe their management and outcomes. METHODS Clinical records and radiographs of cats referred for management of physeal fractures were retrospectively reviewed. Fractures of the proximal femoral physis were excluded. Descriptive statistics were used to describe signalment, cause of injury, presence of concurrent injuries, fracture description, treatment modality, complications, follow-up, physeal closure, implant removal and outcome. RESULTS Thirty-four cats with 36 fractures were included, of which 17 affected the distal femur, 11 the distal tibia and fibula, five the distal radius and ulna, two the proximal tibia and one the distal humerus. Salter-Harris classification was type I in 14, type II in 16, type III in two and type IV in four fractures. Thirty-four fractures were treated with primary fixation, and the most common method was crossed Kirschner wires (24/34 fractures). Complications were observed in 14 fractures, of which 12 were minor. At radiographic follow-up, physeal closure was reported in 23 fractures, of which 15 were considered premature. Implant removal was performed in three fractures. Outcome was good in 28, fair in four and poor in two fractures. CONCLUSIONS AND RELEVANCE Fracture of the distal femoral physis was the most common physeal fracture seen. Cats presenting with physeal fractures may be skeletally immature or mature with delayed physeal closure. The rate of physeal closure after fracture repair was relatively high but without apparent impact. The frequency of implant removal was very low, indicating that despite having a physeal fracture repair, most cats did not require a second procedure to remove implants. Overall, internal fixation provided a good outcome in most fractures.
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Affiliation(s)
- Carlos Rubinos
- Department of Clinical Science and Services, Queen Mother Hospital for Animals, The Royal Veterinary College, Hatfield, UK
| | - Richard L Meeson
- Department of Clinical Science and Services, Queen Mother Hospital for Animals, The Royal Veterinary College, Hatfield, UK
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18
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Winnen RG, Kniha K, Modabber A, Al-Sibai F, Braun A, Kneer R, Hölzle F. Reversal of Osseointegration as a Novel Perspective for the Removal of Failed Dental Implants: A Review of Five Patented Methods. Materials (Basel) 2021; 14:7829. [PMID: 34947422 DOI: 10.3390/ma14247829] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/08/2021] [Accepted: 12/10/2021] [Indexed: 12/11/2022]
Abstract
Osseointegration is the basis of successful dental implantology and the foundation of cementless arthroplasty and the osseointegrated percutaneous prosthetic system. Osseointegration has been considered irreversible thus far. However, controlled heating or cooling of dental implants could selectively damage the bone at the bone–implant interface, causing the reversal of osseointegration or “osseodisintegration”. This review compares five methods for implant removal, published as patent documents between 2010 and 2018, which have not yet been discussed in the scientific literature. We describe these methods and evaluate their potential for reversing osseointegration. The five methods have several technical and methodological similarities: all methods include a handpiece, a connecting device for coronal access, and a controlling device, as well as the application of mechanical and/or thermal energy. The proposed method of quantifying the temperature with a sensor as the sole means for regulating the process seems inadequate. A database used in one of the methods, however, allows a more precise correlation between a selected implant and the energy needed for its removal, thus avoiding unnecessary trauma to the patient. A flapless, microinvasive, and bone-conserving approach for removing failed dental implants, facilitating successful reimplantation, would benefit dental implantology. These methods could be adapted to cementless medical implants and osseointegrated percutaneous prosthetics. However, for some of the methods discussed herein, further research may be necessary.
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Howett R, Krogstad EA, Badubi O, Gertz AM, Bawn C, Mussa A, Kgaswanyane T, Malima S, Maotwe T, Mokganya L, Ramogola-Masire D, Morroni C. Experiences of Accessing and Providing Contraceptive Implant Removal Services in Gaborone, Botswana: A Qualitative Study Among Implant Users and Healthcare Providers. Front Glob Womens Health 2021; 2:684694. [PMID: 34816231 PMCID: PMC8593984 DOI: 10.3389/fgwh.2021.684694] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 06/03/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction: This study explored implant user and healthcare provider experiences of accessing and providing contraceptive implant removal services in Gaborone, Botswana, following introduction of the implant in the public sector in 2016. We sought to understand reasons for satisfaction and dissatisfaction with services and their potential impact on wider perceptions of the implant, including influence on future uptake. Methods: Qualitative data were collected through in-depth interviews. Participants comprised ten women who had previously undergone implant removal, and ten providers whose work included provision of implant insertion and removal. Data were analyzed using thematic content analysis. Results: Seven of the ten users in this study had experienced a delay between initial request and undergoing implant removal. This interval ranged from <1 week to 3 months. Users identified the principal barriers to accessing implant removal services as lack of access to trained removal providers, inconvenient appointment times, and provider resistance to performing removal. Nine of the ten providers in this study had experienced barriers to providing implant removal, including insufficient training, lack of equipment, lack of time, and lack of a referral pathway for difficult removals. Despite experiencing barriers in accessing removal, users' perceptions of the implant remained generally positive. Providers were concerned that ongoing negative user experiences of removal services would damage wider perceptions of the implant. Conclusion: Introduction of the contraceptive implant in Botswana has been an important strategy in increasing contraceptive choice. Following an initial focus on provision of insertion services, the development of comparable, accessible removal services is critical to ensuring that the implant remains a desirable contraceptive option and is vital to upholding women's reproductive health rights. The experiences of users and providers in this study can inform the ongoing development of services for implant insertion and removal in Botswana and other lower-resource settings.
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Affiliation(s)
| | - Emily A Krogstad
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Opelo Badubi
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Alida M Gertz
- Botswana-UPenn Partnership, Gaborone, Botswana.,Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Caitlin Bawn
- Sexual and Reproductive Health Department, Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, United Kingdom.,Research Department of Primary Care and Population Health, University College London, London, United Kingdom
| | - Aamirah Mussa
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Tiroyaone Kgaswanyane
- Botswana Family Welfare Association, Gaborone, Botswana.,Botswana Training and Education Center for Health, Gaborone, Botswana
| | - Sifelani Malima
- Botswana Ministry of Health and Wellness, Gaborone, Botswana
| | - Tshego Maotwe
- Botswana Ministry of Health and Wellness, Gaborone, Botswana
| | - Lesego Mokganya
- Botswana Ministry of Health and Wellness, Gaborone, Botswana
| | | | - Chelsea Morroni
- Botswana-UPenn Partnership, Gaborone, Botswana.,Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.,Liverpool School of Tropical Medicine, Liverpool, United Kingdom.,Medical Research Council Centre for Reproductive Health, University of Edinburgh, Edinburgh, United Kingdom
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20
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Prins JTH, Leasia K, Dull MB, Lawless RA, Platnick KB, Werner NL, Wijffels MME, Moore EE, Pieracci FM. Surgical Site Infection after Surgical Stabilization of Rib Fractures: Rare But Morbid. Surg Infect (Larchmt) 2021; 23:5-11. [PMID: 34762547 DOI: 10.1089/sur.2021.165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background: Although surgical stabilization for rib fractures (SSRF) has been adopted widely over the past decade, little information is available regarding the prevalence and outcomes of post-operative surgical site infection (SSI). We hypothesized that SSI after SSRF is uncommon but morbid. Patients and Methods: Patients undergoing SSRF at a level 1 trauma center from 2010-2020 were reviewed. The primary outcome was the prevalence of SSI, documented by clinical examination, radiography, systemic markers of infection, and microbiology. Results: Of 228 patients undergoing SSRF, 167 (73.2%) were male, the median age was 53 years (P25-P75; 41-63 years), injury severity score (ISS) was 19 (P25-P75, 13-26), with a median of eight fractured ribs (P25-P75, 6-11). All stabilization plates were titanium. SSRF was typically performed on post-injury day one (P25-P75, 0-2 days) after trauma. All patients received antibiotic agents within 30 minutes of incision, and a median of four ribs (P25-P75, 3-6) were repaired. Four (1.8%) patients developed an SSI and all underwent implant removal. Two patients required implant removal within 30 days (on post-operative day seven and 17) and two for chronic infection at seven and 17 months after SSRF. The causative organism was methicillin-sensitive Staphylococcus aureus (MSSA) bacteria in all patients. After implant removal, three patients received intravenous and oral antibiotic agents, ranging from two to six weeks, without recurrent infection. No patient required additional SSRF. Conclusions: Surgical site infection after SSRF is rare but morbid and can become symptomatic within one week to 17 months. Implant removal results in complete recovery.
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Affiliation(s)
- Jonne T H Prins
- Department of Surgery, Denver Health Hospital & Authority, University of Colorado School of Medicine, Denver, Colorado, USA
| | - Kiara Leasia
- Department of Surgery, Denver Health Hospital & Authority, University of Colorado School of Medicine, Denver, Colorado, USA
| | - Matthew B Dull
- Department of Surgery, Denver Health Hospital & Authority, University of Colorado School of Medicine, Denver, Colorado, USA
| | - Ryan A Lawless
- Department of Surgery, Denver Health Hospital & Authority, University of Colorado School of Medicine, Denver, Colorado, USA
| | - K Barry Platnick
- Department of Surgery, Denver Health Hospital & Authority, University of Colorado School of Medicine, Denver, Colorado, USA
| | - Nicole L Werner
- Department of Surgery, Denver Health Hospital & Authority, University of Colorado School of Medicine, Denver, Colorado, USA
| | - Mathieu M E Wijffels
- Trauma Research Unit, Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Ernest E Moore
- Department of Surgery, Denver Health Hospital & Authority, University of Colorado School of Medicine, Denver, Colorado, USA
| | - Fredric M Pieracci
- Department of Surgery, Denver Health Hospital & Authority, University of Colorado School of Medicine, Denver, Colorado, USA
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21
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Macke C, Lenhof S, Graulich T, Örgel M, Omar-Pacha T, Stübig T, Krettek C, Omar M. Low Diagnostic Value of Synovial Aspiration Culture Prior to Reimplantation in Periprosthetic Joint Infection. In Vivo 2021; 35:2409-2416. [PMID: 34182524 DOI: 10.21873/invivo.12518] [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: 03/16/2021] [Revised: 03/26/2021] [Accepted: 04/12/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM We aimed to determine the diagnostic value of the synovial aspiration culture prior to reimplantation in two- (or more) stage exchange of periprosthetic joint infection. PATIENTS AND METHODS This was a retrospective study, spanning over ten years including all synovial cultures of patients with two- (or more) stage exchange due to periprosthetic joint infection. RESULTS A total of 183 patients were included, mean age was 66.6 years (range=12.8-93.4 years). Overall sensitivity of synovial aspiration cultures before reimplantation was 56.6%, specificity 84.6%, negative predictive value (NPV) 63.8%, positive predictive value (PPV) 80.2%, area under the curve (AUC) 70.6%. Sensitivity of the knee in comparison to the hip culture was significantly higher, as well as the NPV and the AUC (p=0.038). In case of complete removal of prosthesis, the sensitivity and AUC were significantly reduced, whereas the specificity was comparable with prosthesis in situ, partial removal or complete removal. CONCLUSION Due to the low sensitivity, obtaining several synovial cultures in the prosthesis-free interval to exclude persistence of infection, does not seem reasonable.
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Affiliation(s)
- Christian Macke
- Trauma Department, Hannover Medical School (MHH), Hannover, Germany
| | - Stefan Lenhof
- Trauma Department, Hannover Medical School (MHH), Hannover, Germany
| | - Tilman Graulich
- Trauma Department, Hannover Medical School (MHH), Hannover, Germany
| | - Marcus Örgel
- Trauma Department, Hannover Medical School (MHH), Hannover, Germany
| | - Tarek Omar-Pacha
- Trauma Department, Hannover Medical School (MHH), Hannover, Germany
| | - Timo Stübig
- Trauma Department, Hannover Medical School (MHH), Hannover, Germany
| | | | - Mohamed Omar
- Trauma Department, Hannover Medical School (MHH), Hannover, Germany
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22
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Abstract
Syndesmotic injuries can occur with ankle fractures and can lead to destabilization of the ankle joint. As a result, it usually requires a transyndesmotic screw insertion to stabilize it. Currently, there is no consensus on the type, amount and diameter of screws used, the number of cortices needed to be engaged, the recommended time to weight-bearing, and whether the screw should be removed in these types of injuries. The aim of this study is to evaluate the evidence comparing the removal and non-removal of syndesmotic screws in open and closed ankle fractures that are associated with unstable syndesmosis in terms of functional, clinical, and radiological evidence. The study also looked at the evidence behind broken screw effects. The literature search was conducted on March 16, 2021, using the Ovid Medline and Embase databases. The literature was eligible if it aimed to compare syndesmotic screw removal and retention in ankle fractures. One study found that those with a broken screw had a better clinical outcome than those with an intact screw. The studies were excluded if they were biomechanical studies, case reports, or were relevant but had no adequate English translation. Initially, 53 studies were included but after scanning for eligibility, 11 were identified (including those added from references). Nine were cohort studies, seven of which did not find any difference in functional outcome between routine removal and retention of the syndesmotic screw. Two studies found there were better clinical outcomes in the broken screw group. Another study found that there were slightly worse functional outcomes in patients with intact screws as compared with those with broken, loosened, or removed screws. Two studies were randomized control studies that no significant functional outcomes between removed and intact syndesmotic screws. However, the majority of these studies had a high risk of bias. Overall, the current literature provides no evidence to support routine removal of syndesmotic screws. Keeping in mind the clear complications and financial burden, syndesmotic screw removal should not be performed unless there is a clear indication. Furthermore, removal in the clinic, with the use of prophylactic antibiotics should be considered if indicated in cases with pain or loss of function. Further research in a structured randomized controlled trial (RCT) to examine if there is any difference in short- or long-term outcomes between removed, intact, loose, or broken syndesmotic screws might be beneficial. A multinational protocol for randomized control trials (RODEO-trial) is an example of such a study to determine the usefulness of on-demand and routine removal of screws.
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Affiliation(s)
- Omar Desouky
- Trauma and Orthopaedics, Royal Blackburn Hospital, Blackburn, GBR
| | - Amr Elseby
- Family Medicine, Blackpool Victoria Hospital, Blackpool, GBR
| | - Ahmed H Ghalab
- Trauma and Orthopaedics, Royal Blackburn Hospital, Blackburn, GBR
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23
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Anderson JD, Hammond JB, Kosiorek HE, Thorpe CS, Bhangoo RS, Pockaj BA, Gray RJ, Cronin PA, Rebecca AM, Casey WJ, Wong WW, Keole SR, Vern-Gross TZ, McGee LA, Halyard MY, DeWees TA, Vargas CE. Unplanned implant removal in locally advanced breast cancer. Breast J 2021; 27:466-471. [PMID: 33715231 DOI: 10.1111/tbj.14224] [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: 12/09/2020] [Revised: 02/25/2021] [Accepted: 02/25/2021] [Indexed: 11/28/2022]
Abstract
Study conducted to determine frequency and timing of unplanned breast implant removal after mastectomy, reconstruction, and postmastectomy radiation (PMRT). From 2010-2017, 52 patients underwent mastectomy, reconstruction, and PMRT. With median follow-up of 3.1 years, 23 patients (44%) experienced implant removal. Implant removal occurred in 9 (17%) patients before starting PMRT and 14 (27%) patients after starting PMRT. Implant removal rates were similar for hypofractionated PMRT compared with standard fractionation and for proton compared with photon PMRT. Implant removal is common for women undergoing mastectomy and reconstruction followed by PMRT. The risk is clinically significant even before starting radiation.
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Affiliation(s)
| | - Jacob B Hammond
- Department of General Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - Heidi E Kosiorek
- Department of Health Sciences Research, Division of Biostatistics, Mayo Clinic, Scottsdale, AZ, USA
| | | | - Ronik S Bhangoo
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, USA
| | | | - Richard J Gray
- Department of General Surgery, Mayo Clinic, Phoenix, AZ, USA
| | | | | | - William J Casey
- Department of Plastic Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - William W Wong
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Sameer R Keole
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, USA
| | | | - Lisa A McGee
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, USA
| | | | - Todd A DeWees
- Department of Health Sciences Research, Division of Biostatistics, Mayo Clinic, Scottsdale, AZ, USA
| | - Carlos E Vargas
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, USA
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24
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Gómez-Junyent J, Lora-Tamayo J, Baraia-Etxaburu J, Sánchez-Somolinos M, Iribarren JA, Rodriguez-Pardo D, Praena-Segovia J, Sorlí L, Bahamonde A, Riera M, Rico A, del Toro MD, Morata L, Cobo J, Falgueras L, Benito N, Muñez E, Jover-Sáenz A, Pigrau C, Ariza J, Murillo O. Implant Removal in the Management of Prosthetic Joint Infection by Staphylococcus aureus: Outcome and Predictors of Failure in a Large Retrospective Multicenter Study. Antibiotics (Basel) 2021; 10:antibiotics10020118. [PMID: 33530523 PMCID: PMC7911003 DOI: 10.3390/antibiotics10020118] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/19/2021] [Accepted: 01/22/2021] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES To compare the characteristics and outcomes of cases with acute prosthetic joint infection (PJI; early post-surgical or hematogenous) by Staphylococcus aureus managed with implant removal (IRm) or debridement and retention (DAIR). To analyze the outcomes of all cases managed with IRm (initially or after DAIR failure). METHODS Retrospective, multicenter, cohort study of PJI by S. aureus (2003-2010). Overall failure included mortality within 60 days since surgery and local failure due to staphylococcal persistence/relapse. RESULTS 499 cases, 338 initially managed with DAIR, 161 with IRm. Mortality was higher in acute PJI managed initially with IRm compared to DAIR, but not associated with the surgical procedure, after propensity score matching. Underlying conditions, hemiarthroplasty, and methicillin-resistant S. aureus were risk factors for mortality. Finally, 249 cases underwent IRm (88 after DAIR failure); overall failure was 15.6%. Local failure (9.3%) was slightly higher in cases with several comorbidities, but independent of previous DAIR, type of IRm, and rifampin treatment. CONCLUSIONS In a large multicenter study of S. aureus PJI managed with IRm, failure was low, but mortality significant, especially in cases with acute PJI and underlying conditions, but not associated with the IRm itself. Rifampin efficacy was limited in this setting.
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Affiliation(s)
- Joan Gómez-Junyent
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, 08907 L’Hospitalet de Llobregat, Spain; (J.G.-J.); (J.A.)
| | - Jaime Lora-Tamayo
- Department of Internal Medicine, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain;
| | - Josu Baraia-Etxaburu
- Department of Infectious Diseases, Hospital Universitario de Basurto, 48013 Bilbao, Spain;
| | - Mar Sánchez-Somolinos
- Department of Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, 28009 Madrid, Spain;
| | - Jose Antonio Iribarren
- Department of Infectious Diseases, Hospital Universitario Donostia, Universidad del País Vasco (EHU/UPV), 20014 San Sebastián, Spain;
- IIS BioDonostia, 20014 San Sebastián, Spain
| | - Dolors Rodriguez-Pardo
- Infectious Diseases Department, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain; (D.R.-P.); (C.P.)
| | - Julia Praena-Segovia
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Hospital Universitario Virgen del Rocío, 41013 Seville, Spain;
| | - Luisa Sorlí
- Department of Infectious Diseases, Hospital del Mar, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), 08003 Barcelona, Spain;
| | - Alberto Bahamonde
- Department of Internal Medicine, Hospital El Bierzo, 24411 Ponferrada, Spain;
| | - Melchor Riera
- Fundació Institut d’Investigació Sanitària Illes Balears, Hospital Universitari Son Espases, 07120 Palma, Spain;
| | - Alicia Rico
- Unit of Infectious Diseases and Clinical Microbiology, Hospital Universitario La Paz, 28046 Madrid, Spain;
| | - Mª Dolores del Toro
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Hospital Universitario Virgen Macarena, Department of Medicine, Universidad de Sevilla, Instituto de Biomedicina de Sevilla (IBiS), 41009 Seville, Spain;
| | - Laura Morata
- Department of Infectious Diseases, Hospital Clínic de Barcelona, Universitat de Barcelona, IDIBAPS, 08036 Barcelona, Spain;
| | - Javier Cobo
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain;
| | - Luis Falgueras
- Department of Infectious Diseases, Hospital Universitari Parc Taulí, 08208 Sabadell, Spain;
| | - Natividad Benito
- Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau- Institut d’Investigació Biomèdica Sant Pau, 08025 Barcelona, Spain;
- Department of Medicine, Universitat Autònoma de Barcelona, 08025 Barcelona, Spain
| | - Elena Muñez
- Unit of Infectious Diseases, Department of Internal Medicine, Hospital Universitario Puerta de Hierro, 28220 Madrid, Spain;
| | - Alfredo Jover-Sáenz
- Territorial Unit of Nosocomial Infections, Hospital Universitari Arnau de Vilanova, 25198 Lleida, Spain;
| | - Carles Pigrau
- Infectious Diseases Department, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain; (D.R.-P.); (C.P.)
| | - Javier Ariza
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, 08907 L’Hospitalet de Llobregat, Spain; (J.G.-J.); (J.A.)
- Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0005), 41071 Sevilla, Spain
| | - Oscar Murillo
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, 08907 L’Hospitalet de Llobregat, Spain; (J.G.-J.); (J.A.)
- Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0005), 41071 Sevilla, Spain
- Correspondence: ; Tel.: +34-93-260-76-25
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25
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Okuwaki S, Tatsumura M, Gamada H, Ogawa T, Mammoto T, Hirano A, Yamazaki M. Direct reduction and repair of spondylolysis with grade 1 slip using the smiley face rod: a case report. J Rural Med 2021; 16:56-61. [PMID: 33442437 PMCID: PMC7788300 DOI: 10.2185/jrm.2020-039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 08/29/2020] [Indexed: 12/14/2022] Open
Abstract
Objective: Lumbar spondylolysis, caused by stress fracture of the pars
interarticularis may lead to a bony defect or spondylolisthesis. In adolescents, its
surgical treatment employs the smiley face rod method for direct reduction of
pseudoarthrotic spondylolysis and spondylolisthesis. Clinical outcomes of this treatment
have been occasionally described; however, implant removal has not been discussed
previously. We present a patient with lumbar spondylolysis with grade 1 slip at the 5th
lumbar vertebra (L5) per the Meyerding classification. Patient: A 14-year-old boy presented with chronic severe lower back pain.
Since conservative therapy did not resolve pain or enable resuming sports activities, the
smiley face rod repair was performed 7 months after the initial treatment. Result: Anterior slippage of the L5 was surgically reduced. The patient wore
a brace for 3 months postoperatively, and partial bone fusion was noted 6 months
postoperatively. He resumed his sports activity 8 months postoperatively, and absolute
bone fusion was confirmed 18 months postoperatively. Implant removal was performed 3 years
postoperatively. Grade 1 slip was corrected with absolute bone fusion, and long-term
follow-up revealed good results in terms of healing and rehabilitation. Conclusion: Smiley face rod method that allows for implant removal after
bone fusion is suitable for adolescents.
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Affiliation(s)
- Shun Okuwaki
- Department of Orthopedic Surgery, Kenpoku Medical Center Takahagi Kyodo Hospital, Japan
| | - Masaki Tatsumura
- Department of Orthopedics Surgery and Sports Medicine, University of Tsukuba Hospital Mito Clinical Education and Training Center Mito Kyodo General Hospital, Japan
| | - Hisanori Gamada
- Department of Orthopedics Surgery, Faculty of Medicine, University of Tsukuba, Japan
| | - Takeshi Ogawa
- Department of Orthopedics Surgery and Sports Medicine, University of Tsukuba Hospital Mito Clinical Education and Training Center Mito Kyodo General Hospital, Japan
| | - Takeo Mammoto
- Department of Orthopedics Surgery and Sports Medicine, University of Tsukuba Hospital Mito Clinical Education and Training Center Mito Kyodo General Hospital, Japan
| | - Atsushi Hirano
- Department of Orthopedics Surgery and Sports Medicine, University of Tsukuba Hospital Mito Clinical Education and Training Center Mito Kyodo General Hospital, Japan
| | - Masashi Yamazaki
- Department of Orthopedics Surgery, Faculty of Medicine, University of Tsukuba, Japan
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26
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Abstract
This article outlines some promising future concepts against postoperative spinal implant infections on the basis of today available literature. The ever-adapting bacteria causing this common complication compel a corresponding continuous research about best effective treatment. The aim is to give a perspective on several future attack-points: surgical infection prevention strategies such as technical optimization of implants and surgical technique; faster diagnostic tools to detect infection, especially in the context of late infections with low-virulent germs and with regard to decision-making in the course of the surgical workflow; and combined surgical and medical treatment options against implant infections. The surgical treatment section will also state open issues concerning implant removal, and the medical treatment section will give an outlook to promising medical alternatives in a post-antibiotic era. To keep up in this field will be important to retain spine surgery in the future as the state-of-the-art treatment option for mandatory spinal interventions in the presence of tumor or trauma and even more so as an attractive option for patients with degenerative spinal disorder for improvement of their life quality.
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Affiliation(s)
- Max Jägersberg
- Department of Neurosurgery, University Medical Center Mainz, Mainz, Germany
| | - Susanne Feihl
- Department of Medical Microbiology, Immunology and Hygiene, Technische Universität München, Munich, Germany
| | - Florian Ringel
- Department of Neurosurgery, University Medical Center Mainz, Mainz, Germany
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27
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Blanc O, Krasovsky A, Shilo D, Capucha T, Rachmiel A. A life-threatening floor of the mouth hematoma secondary to explantation attempt in the anterior mandible. Quintessence Int 2020; 52:66-71. [PMID: 32954387 DOI: 10.3290/j.qi.a45265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
<p>Implant dentistry is considered to be a safe and routine surgical procedure. However, cases of life-threatening hematoma of the floor of the mouth resulting in airway obstruction were previously reported as a complication of implant placement in the anterior mandible. Massive bleeding in this anatomical site may be caused by perforating the lingual cortex and/or damaging the lingual perimandibular vessels. In the long term, dental implants can fail, mainly due to peri-implantitis, and must be removed. Explantation procedure may occasionally become a complex challenge, with a risk for various complications.<br /> Case report: This report presents the first case of life-threatening hematoma of the floor of the mouth, as a complication secondary to a failed attempt of dental implant removal at the anterior mandible. The proximity of the implant to the lingual vascular canal might have served as a cause for vascular damage during explantation.<br /> Conclusions: Implant removal complications are scarcely described in the literature. Nonetheless, damaging blood vessels during explantation should not be underestimated. Computed tomography (CT) may be of value not only in preoperative implant planning but also before implant removal in jeopardized anatomical zones such as the anterior mandible. Lingual vascular canals should be looked for on computed tomography scans.</p>.
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28
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Agarwal A, Kelkar A, Agarwal AG, Jayaswal D, Schultz C, Jayaswal A, Goel VK, Agarwal AK, Gidvani S. Implant Retention or Removal for Management of Surgical Site Infection After Spinal Surgery. Global Spine J 2020; 10:640-646. [PMID: 32677561 PMCID: PMC7359681 DOI: 10.1177/2192568219869330] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [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: 12/11/2022] Open
Abstract
STUDY DESIGN A literature review. OBJECTIVE To summarize the implant removal rate, common bacterial organisms found, time of onset, ratio of superficial to deep infection, and regurgitating the prevalence among all the retrospective and prospective studies on management and characterization of surgical site infections (SSIs). METHODS PubMed was searched for articles published between 2000 and 2018 on the management or characterization of SSIs after spinal surgery. Only prospective and retrospective studies were included. RESULTS A total of 49 articles were found relevant to the objective. These studies highlighted the importance of implant removal to avoid recurrence of SSI. The common organisms detected were methicillin-resistant Staphylococcus aureus, methicillin-resistant Staphylococcus epidermis, Staphylococcus epidermis, Staphylococcus aureus, and Propionibacterium acnes, with prevalence of 1% to 15%. A major proportion of all were deep SSI, with minority reporting on late-onset SSI. CONCLUSION Long-term antibiotics administration, and continuous irrigation and debridement were common suggestion among the authors; however, the key measure undertaken or implied by most authors to avoid risk of recurrence was removal or replacement of implants for late-onset SSI.
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Affiliation(s)
- Aakash Agarwal
- University of Toledo, Toledo, OH, USA,Aakash Agarwal, Department of Bioengineering and Orthopaedics Surgery, University of Toledo, 5051 Nitschke Hall, MS 303, 2801 West Bancroft Street, Toledo, OH 43606, USA.
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29
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Howett R, Gertz AM, Kgaswanyane T, Petro G, Morroni C. Case Report: Traumatic Incomplete Fracture of an Implanon NXT® Contraceptive Implant. Afr J Reprod Health 2020; 23:124-128. [PMID: 32227747 DOI: 10.29063/ajrh2019/v23i4.14] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The etonogestrel (ENG) subdermal contraceptive implant (Implanon NXT®) is a safe and highly effective method of contraception which is increasing in popularity globally. This case report describes a 26-year-old woman who requested removal of the Implanon NXT® contraceptive implant. She reported that her implant had bent following direct trauma. The implant was removed in accordance with her request and without complication, but was noted to be incompletely fractured. We compare this case with a summary of the existing literature on fractured or damaged contraceptive implants. Structural damage detected whilst the implant is in situ is one potential complication of contraceptive implant use. The incidence of this complication and the implications for contraceptive efficacy are unknown. Damaged implants may present healthcare providers with more technically challenging "difficult removals". With the scale-up of services for implant provision, consideration should be given to this issue in order to inform counselling and removal services.
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Affiliation(s)
| | | | | | - Gregory Petro
- Department of Obstetrics and Gynaecology, New Somerset Hospital, University of Cape Town, Cape Town, South Africa
| | - Chelsea Morroni
- Botswana-UPenn Partnership, Gaborone, Botswana.,Botswana Harvard AIDS Institute, Gaborone, Botswana.,Wits Reproductive Health and HIV Institute (Wits RHI), University of the Witwatersrand, Johannesburg, South Africa.,Women's Health Research Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.,Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
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30
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Howett R, Gertz AM, Kgaswanyane T, Petro G, Mokganya L, Malima S, Maotwe T, Pleaner M, Morroni C. Closing the Gap: Ensuring Access to and Quality of Contraceptive Implant Removal Services is Essential to Rights-based Contraceptive Care. Afr J Reprod Health 2020; 23:19-26. [PMID: 32227736 DOI: 10.29063/ajrh2019/v23i4.3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The use of the subdermal contraceptive implant is increasing globally, and particularly so in lower- and middle-income countries in sub-Saharan Africa. For initiation or discontinuation of the implant, users need to have access to services for insertion and removal by healthcare providers. Providing access to safe and effective contraceptive implant removal services presents both clinical and programmatic challenges. The most challenging implant removal cases, termed -difficult removals‖, place additional demands upon removal services. In this commentary, we outline challenges for the provision of removal services. Based on our experience in this field, we make recommendations on how healthcare providers and health services can plan for these challenges. Through maximising the provision of comprehensive and accessible implant removal services, including those for difficult removals, implant users can be empowered to discontinue their use of this method of contraception if they choose, thus upholding the principles of rights-based contraceptive care.
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Affiliation(s)
| | - Alida M Gertz
- Botswana-UPenn Partnership, Gaborone, Botswana.,Botswana Harvard AIDS Institute, Gaborone, Botswana
| | | | - Gregory Petro
- Department of Obstetrics and Gynaecology, New Somerset Hospital, University of Cape Town, Cape Town, South Africa
| | - Lesego Mokganya
- Botswana Ministry of Health and Wellness, Gaborone, Botswana
| | - Sifelani Malima
- Botswana Ministry of Health and Wellness, Gaborone, Botswana
| | - Tshego Maotwe
- Botswana Ministry of Health and Wellness, Gaborone, Botswana
| | - Melanie Pleaner
- Wits Reproductive Health and HIV Institute (Wits RHI), University of the Witwatersrand, Johannesburg, South Africa
| | - Chelsea Morroni
- Botswana-UPenn Partnership, Gaborone, Botswana.,Botswana Harvard AIDS Institute, Gaborone, Botswana.,Wits Reproductive Health and HIV Institute (Wits RHI), University of the Witwatersrand, Johannesburg, South Africa.,Women's Health Research Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.,Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
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31
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Abstract
INTRODUCTION The removal of bent intramedullary (IM) nail can become a challenge. Therefore, various methods have been reported for the extraction of nails after femoral refracture. We want to share our successful treatment. PATIENT CONCERNS Case 1. A 44-year-old man was admitted to our clinic after falling while playing soccer. He complained severe right thigh pain with a visible deformity of the femur. His medical history revealed a right femoral shaft fracture caused in a traffic accident which had been treated with intramedullary nailing. Case 2. A 27-year-old man, who had suffered a right femur fracture after a motorcycle accident and been treated with an IM nail, presented after falling down the stairs. He had severe right thigh pain without any open wound or neurologic deficit. DIAGNOSIS Case 1. Plain radiographs revealed a refracture of the right femoral shaft and a bent IM nail. The initial varus deformity of the nail was 60.1° in the coronal plane. Case 2. The valgus deformity of the nail was 16.1° with an apex-posterior angulation of 34.8° in the sagittal image of plain radiographs. INTERVENTIONS Case 1. Initial manual reduction was tried in emergency room. Then, under general anesthesia closed reduction of the fracture and bent IM nail was done. After closed reduction, the nail was straightened and extracted smoothly. Case 2. Closed manipulation was attempted initially. But no difference in the deformity was achieved. Therefore, via skin incision, the bent nail was progressively sectioned with high-speed cutting burr until the nail could be straightened. OUTCOMES Case 1. The patient was mobilized with partial-weight bearing assisted with a crutch on postoperative day two. One year after surgery, the fracture union was complete and the patient was pain-free. Case 2. Six months after surgery, the fracture union was complete with sufficient callus formation around the fracture site. CONCLUSION There is no gold standard method to remove a bent IM nail. However, since manual reduction to straighten the bent nail causes minimal soft tissue damage, it should be considered first. If it fails, other methods should be attempted, progressing from the minimally invasive technique to more invasive methods.
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Affiliation(s)
- You-Sung Suh
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Seoul
| | - Won-Seok Lee
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Seoul
| | - Joonghyun Ahn
- Department of Orthopaedic surgery, Kyung Hee University hospital at Gangdong
| | - Hyung-Suk Choi
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Seoul
| | - Min Jung Baek
- Department of Obstetrics and Gynecology, Bundang CHA Hospital
| | - Sung-Woo Choi
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Seoul
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Solderer A, Al‐Jazrawi A, Sahrmann P, Jung R, Attin T, Schmidlin PR. Removal of failed dental implants revisited: Questions and answers. Clin Exp Dent Res 2019; 5:712-724. [PMID: 31890309 PMCID: PMC6934347 DOI: 10.1002/cre2.234] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [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: 04/04/2019] [Revised: 07/19/2019] [Accepted: 07/22/2019] [Indexed: 12/14/2022] Open
Abstract
Objectives This narrative review is aiming on showing reasons for implant failure, removal techniques, and respective clinical considerations; further, the survival rate of implants in previous failed sites is examined. Materials and methods Questions have been formulated, answered, and discussed through a literature search including studies assessing implant failure and removal up to 2018. Results Studies describing reasons for implant failure, implant removal techniques, and the reinsertion of implants in a previous failed site (n = 12) were included. To date, peri-implantitis is the main reason for late implant failure (81.9%). Trephine burs seem to be the best-known method for implant removal. Nevertheless, the counter-torque-ratchet-technique, because of the low invasiveness, should be the first choice for the clinician. Regarding zirconia implant removal, only scarce data are available. Implantation in previously failed sites irrespective of an early or late failure results in 71% to 100% survival over 5 years. Conclusion If removal is required, interventions should be based on considerations regarding minimally invasive access and management as well as predictable healing. (Post)Operative considerations should primarily depend on the defect type and the consecutive implantation plans.
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Affiliation(s)
- Alex Solderer
- Clinic of Conservative and Preventive DentistryUniversity of ZurichZurichSwitzerland
| | | | - Philipp Sahrmann
- Clinic of Conservative and Preventive DentistryUniversity of ZurichZurichSwitzerland
| | - Ronald Jung
- Clinic of Reconstructive DentistryUniversity of ZurichZurichSwitzerland
| | - Thomas Attin
- Clinic of Conservative and Preventive DentistryUniversity of ZurichZurichSwitzerland
| | - Patrick R. Schmidlin
- Clinic of Conservative and Preventive DentistryUniversity of ZurichZurichSwitzerland
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Wang WC, Lagoudis M, Yeh CW, Paranhos KS. Management of peri-implantitis - A contemporary synopsis. ACTA ACUST UNITED AC 2019; 38:8-16. [PMID: 29229078 DOI: 10.1016/j.sdj.2017.10.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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: 10/03/2016] [Revised: 05/07/2017] [Accepted: 10/06/2017] [Indexed: 11/25/2022]
Abstract
Prevalence of peri-implant complication is expected to be on the rise with the increased number of implants being placed. Depending on the degree of osseous involvement, the clinician needs to decide if the treatment goal is to arrest the disease progression, regeneration or explantation and replacement. Host's medical status, defect configuration, aesthetic outcome, ability to access for plaque control post-treatment, and the patient's wishes are key factors to consider. The purpose of this review is to provide a contemporary synopsis on the management of peri-implantitis with emphasis on explantation. Guidance on the identification of factors/situations where salvaging an implant may be less favourable is discussed and the various techniques to remove a fractured, or peri-implantitis-affected non-mobile implant are described.
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Affiliation(s)
- Wendy Cw Wang
- Department of Periodontology and Implant Dentistry, New York University, United States.
| | - Miltiadis Lagoudis
- Department of Periodontology and Implant Dentistry, New York University, United States
| | - Che-Wei Yeh
- Department of Periodontology and Implant Dentistry, New York University, United States
| | - Klenise S Paranhos
- Department of Periodontology and Implant Dentistry, New York University, United States
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Proietti L, Perna A, Schirò GR, Noia G, Fumo C, Tamburrelli FC. Residual mobility after removal of instrumentation in patient, with type a2-a3 vertebral fractures, treated with percutaneous pedicle screw fixation. J BIOL REG HOMEOS AG 2019; 33:133-139. XIX Congresso Nazionale S.I.C.O.O.P. Societa' Italiana Chirurghi Ortopedici Dell'ospedalita' Privata Accreditata. [PMID: 31172730 DOI: pmid/31172730] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Percutaneous techniques for treatment of thoraco-lumbar fractures type A2 and A3 are widely used. These techniques are considered temporary fixations and instrumentation must be removed with fracture healing. The aim of the study is to analyze clinical results, motility of treated segments and any loss of correction after the removal of instrumentation. We evaluated 36 patients who underwent surgery for removal of the instrumentation. Standard and dynamics x-ray before surgery and at 1 and 12 months after surgery were obtained. Radiographic evaluation was performed by comparing loss of correction after removal of the instrumentation, residual mobility of fractured vertebra, upper and lower level with values defined by Dvorak. For clinical assessment were used SF-12, Oswestry Disability Index (ODI) and Visual Analog Scale (VAS), administered before surgery and at 1 and 12 months after the removal. We analyzed a total of 108 levels in 36 patients. After removal of the instrumentation a normal range of motion was restored in the proximal and distal segment of the fracture, while at level of fractured segment we noticed a decrease in motility. Clinically, patients had a significant decrease in VAS and ODI at 1 month after removal. Our study shows that percutaneous fixation for treatment of thoraco-lumbar fractures type A2 and A3, allows to preserve motility of the treated segments after the removal of the instrumentation until 12 months. The removal of instrumentation is associated with good clinical results without of loss of correction in treated segment.
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Affiliation(s)
- L Proietti
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Division of Spinal Surgery, Catholic University of Sacred Heart, Rome, Italy
| | - A Perna
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Division of Spinal Surgery, Catholic University of Sacred Heart, Rome, Italy
| | - G R Schirò
- Orthopaedic Department, Niguarda Hospital, Milan, Italy
| | - G Noia
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Division of Spinal Surgery, Catholic University of Sacred Heart, Rome, Italy
| | - C Fumo
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Division of Spinal Surgery, Catholic University of Sacred Heart, Rome, Italy
| | - F C Tamburrelli
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Division of Spinal Surgery, Catholic University of Sacred Heart, Rome, Italy
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Abouljoud MM, Backstein D, Battenberg A, Dietz M, Erice A, Freiberg AA, Granger J, Katchky A, Khlopas A, Kim TK, Kjaersgaard-Andersen P, Koo KH, Kosashvili Y, Lazarovski P, Leighton J, Lombardi A, Malizos K, Manrique J, Mont MA, Papanagiotoy M, Sierra RJ, Sodhi N, Stammers J, Stiehler M, Tan TL, Uchiyama K, Ward D, Ziogkou A. Hip and Knee Section, Treatment, Surgical Technique: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34:S445-S451. [PMID: 30348548 PMCID: PMC6607902 DOI: 10.1016/j.arth.2018.09.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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36
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Williams BR, McCreary DL, Chau M, Cunningham BP, Pena F, Swiontkowski MF. Functional Outcomes of Symptomatic Implant Removal Following Ankle Fracture Open Reduction and Internal Fixation. Foot Ankle Int 2018; 39:674-680. [PMID: 29460644 DOI: 10.1177/1071100718757719] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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 Orthopedic implant removal following open reduction internal fixation of a fracture is a common procedure, especially in the foot and ankle. The purpose of this study was to evaluate functional change after the removal of symptomatic implants following ankle fracture open reduction internal fixation (ORIF) using the Short Musculoskeletal Function Assessment (SMFA) outcome score. We hypothesized that implant removal after ankle fracture would result in improved functional outcomes. METHODS Retrospective review of prospectively collected data on patients with a closed ankle fracture between 2013 and 2016 was performed. Inclusion criteria were skeletal maturity, symptomatic ankle implants and completion of the SMFA questionnaire prior to and 6 months after removal. Exclusion criteria were development of a nonunion, prior or current infection, peripheral neuropathy or ongoing litigation surrounding the surgery. The primary outcome was change in SMFA score from baseline to follow-up using Wilcoxon signed-rank test. Additional logistic regression models evaluated the effects of age, sex, body mass index, smoking status, and patient American Society of Anesthesiologists scores. RESULTS The study population consisted of 43 patients. There was a statistically significant improvement in function, represented by a decrease in SMFA scores from baseline to the 6-month follow-up period (∆ = -4.1 [95% confidence interval, -7.0, -1.3]; P = .003). Secondary outcome measures of the bother index and daily activities domain also demonstrated significant improvements ( P = .005 and P = .002, respectively). Additional logistical regression models identified no significant effects by assessed covariates for change in SMFA scores. CONCLUSION Patients with symptomatic implants following ankle fracture ORIF had a statistically significant improvement in function following implant removal. There appears to be value in removing implants from the ankle in patients who report discomfort during daily activities. Further investigation into the specific indications for implant removal and the impact of injury and fracture pattern on outcomes is warranted. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Benjamin R Williams
- 1 Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Dylan L McCreary
- 1 Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA.,2 Department of Orthopaedic Surgery, Regions Hospital, St. Paul, MN, USA
| | - Michael Chau
- 1 Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Brian P Cunningham
- 1 Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA.,2 Department of Orthopaedic Surgery, Regions Hospital, St. Paul, MN, USA
| | - Fernando Pena
- 1 Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA.,3 TRIA Orthopaedic Center, Minneapolis, MN, USA
| | - Marc F Swiontkowski
- 1 Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA.,3 TRIA Orthopaedic Center, Minneapolis, MN, USA
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Maniar H, Kempegowda H, Tawari AA, Rutter MR, Borade A, Cush G, Horwitz DS. Medial Malleoli Fractures: Clinical Comparison Between Newly Designed Sled Device and Conventional Screws. Foot Ankle Spec 2017; 10:296-301. [PMID: 28719778 DOI: 10.1177/1938640016677809] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The Trimed Medial Malleolar Sled is a newer device designed to treat medial malleolus fracture. The purpose of this study was to compare the outcome of medial malleolar fractures treated with the sled and conventional malleolar screws. METHODS After obtaining an institutional review board approval, we conducted a retrospective study to identify all skeletally mature patients who sustained an ankle fracture with medial malleolar involvement treated with the sled and we identified a matched cohort treated with conventional malleolar screws. The patients were divided into 2 groups: group A included patients treated with malleolar screws and group B included patients treated with the sled device. The outcomes measured included rate of union, implant removal, and pain over the implant site. RESULTS Eighty-five medial malleolar ankle fractures were divided into 2 groups: group A included patients (n = 64) treated with malleolar screws and group B included patients (n = 21) treated with the sled device. In group A (n = 64), 62 patients (96.8%) achieved radiological union with a mean union rate of 11 weeks and 10 (15%) patients underwent repeat surgery for implant removal of which 3 patients (4.6%) had pain specifically over the medial implant. In group B (n = 21), all of the patients (100%) achieved radiological union with a mean union rate of 10.8 weeks and 3 patients (14.2%) underwent repeat surgery of which 1 (4.7%) was related to the medial pain. There is no significant difference between the groups for the outcomes measured, including rate of union ( P = .93), visual analog scale score for pain ( P = .07), implant removal ( P = .41), and pain over the implant site ( P = .88). CONCLUSION Based on the data from our study, we conclude that there are no major differences between the sled devices and conventional screws relating to union rate and complications. LEVELS OF EVIDENCE Level III: Observational study.
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Affiliation(s)
- Hemil Maniar
- Department of Orthopaedic Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | - Harish Kempegowda
- Department of Orthopaedic Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | - Akhil A Tawari
- Department of Orthopaedic Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | - Michael R Rutter
- Department of Orthopaedic Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | - Amrut Borade
- Department of Orthopaedic Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | - Gerard Cush
- Department of Orthopaedic Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | - Daniel S Horwitz
- Department of Orthopaedic Surgery, Geisinger Medical Center, Danville, Pennsylvania
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38
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Hoppe S, Aghayev E, Ahmad S, Keel MJB, Ecker TM, Deml M, Benneker LM. Short Posterior Stabilization in Combination With Cement Augmentation for the Treatment of Thoracolumbar Fractures and the Effects of Implant Removal. Global Spine J 2017; 7:317-324. [PMID: 28815159 PMCID: PMC5546680 DOI: 10.1177/2192568217699185] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 12/16/2022] Open
Abstract
STUDY DESIGN Retrospective case series. OBJECTIVE Short posterior stabilization with vertebroplasty is one treatment option for thoracolumbar burst fractures (AO A3). Whether it avoids progression in segmental kyphosis, especially after implant removal, is unclear. In a retrospective case-control study, its stability and the effect on intervertebral discs with and without implant removal was studied. METHODS Fifty-nine consecutive patients were treated with bisegmental short posterior instrumentation and additional vertebroplasty of the fractured vertebra. Twenty-nine patients (male/female 17/12; age: 41.7 ± 15.4 years) underwent implant removal. Changes of segmental kyphosis and disc heights between both groups (with and without implant removal) were compared on lateral X-rays preoperative, postoperative, after 1 year and after implant removal. Risk factors for loss of reduction were analyzed. RESULTS Kyphosis increased up to 12 months after implant removal. The loss of bisegmental correction was 6.0 ± 4.2 (range 0° to 16°) 12 months after implant removal. Risk factors for loss of reduction are younger patient age, fractures of the thoracolumbar junction (Th12), and degree of traumatic kyphosis. Intervertebral discs traversed by the stabilization lose height and don't recover within 1 year after implant removal. Without implant removal, disc height of the lower adjacent level is reduced after 24 months. CONCLUSIONS Short posterior stabilization in combination with vertebroplasty is a treatment alternative for thoracic and lumbar AO A3 fractures. After implant removal kyphosis increases, predominantly in the segment above the augmented vertebra. Risk factors for loss of reduction include younger age, fractures of the thoracolumbar junction (T12), and higher fracture kyphosis.
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Affiliation(s)
- Sven Hoppe
- Inselspital, Department of Orthopedic Surgery, University of Bern, Bern, Switzerland,Sven Hoppe, Department of Orthopedic Surgery and Traumatology, Inselspital Bern, CH-3010 Bern, Switzerland.
| | - Emin Aghayev
- Institute of Social and Preventative Medicine, University of Bern, Bern, Switzerland
| | - Sufian Ahmad
- Inselspital, Department of Orthopedic Surgery, University of Bern, Bern, Switzerland
| | | | - Timo Michael Ecker
- Inselspital, Department of Orthopedic Surgery, University of Bern, Bern, Switzerland
| | - Moritz Deml
- Inselspital, Department of Orthopedic Surgery, University of Bern, Bern, Switzerland
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Abstract
BACKGROUND While trans-syndesmotic fixation with metal screws is considered the gold standard in treating syndesmotic injuries, controversy exists regarding the need and timing of postoperative screw removal. Formal recommendations have not been well established in the literature and clinical practice is highly variable in this regard. The purpose of this systematic review is to critically examine the most recent literature regarding syndesmotic screw removal in order to provide surgeons an evidence-based approach to management of these injuries. METHODS The Cochrane Library and PubMed Medline databases were explored using search terms for syndesmosis and screw removal between October 1, 2010 and June 1, 2016. RESULTS A total of 9 studies (1 randomized controlled trial and 8 retrospective cohort studies) were found that described the outcomes of either retained or removed syndesmotic screws. Overall, there was no difference in functional, clinical or radiographic outcomes in patients who had their syndesmotic screw removed. There was a higher likelihood of recurrent syndesmotic diastasis when screws were removed between 6 and 8 weeks. There was a higher rate of postoperative infections when syndesmotic screws were removed without administering preoperative antibiotics. CONCLUSION Removal of syndesmotic screws is advisable mainly in cases of patient complaints related to the other implanted perimalleolar hardware or malreduction of the syndesmosis after at least 8 weeks postoperatively. Broken or loose screws should not be removed routinely unless causing symptoms. Antibiotic prophylaxis is recommended on removal. Radiographs should be routinely obtained immediately prior to removal and formal discussions should be had with patients prior to surgery to discuss management options if a broken screw is unexpectedly encountered intraoperatively. Radiographs and/or computed tomography imaging should be obtained after syndesmotic screw removal when indicated for known syndesmotic malreduction. LEVELS OF EVIDENCE Level IV: Systematic review.
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Affiliation(s)
- Kempland C Walley
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Kurt J Hofmann
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Brian T Velasco
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - John Y Kwon
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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40
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Chang DG, Yang JH, Lee JH, Lee JS, Suh SW, Kim JH, Oh SY, Cho W, Park JB, Suk SI. Revision surgery for curve progression after implant removal following posterior fusion only at a young age in the treatment of congenital scoliosis: A case report. Medicine (Baltimore) 2016; 95:e5266. [PMID: 27893663 PMCID: PMC5134856 DOI: 10.1097/md.0000000000005266] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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: 12/04/2022] Open
Abstract
RATIONALE Congenital scoliosis due to a hemivertebra creates a wedge-shaped deformity, which progresses and causes severe spinal deformities as an individual grows. The treatment of congenital scoliosis focuses on early diagnosis and appropriate surgical management before the development of severe deformity. PATIENT CONCERNS We report the case of a 4-year-old male child with a left thoracolumbar scoliosis of 27° (T10-T12) due to a T11 hemivertebra who was treated by posterior fusion and pedicle screw fixation at the age of 4 years. The implant was removed due to pain secondary to implant prominence after 4 years without definitive revision surgery, which led to significant progression of the scoliosis, to 50°. The indication for posterior vertebral column resection (PVCR) is a congenital spinal deformity with a curve magnitude greater than 30° with fast progression. This includes documented progression of the curve by more than 5° in a 6- month period, failure of conservative treatment, or both. OUTCOMES The patient underwent PVCR of the T11 hemivertebra. Nine years after the revision surgery with PVCR, the patient showed satisfactory results and his spine was well balanced. LESSONS This case shows that removal of an implant that was not the only cause of curve progression at a young age may lead to progression of scoliosis and, therefore, should be avoided unless it is absolutely necessary. CONCLUSION Congenital scoliosis due to a hemivertebra at a young age could be treated by hemivertebra resection or anterior and posterior epiphysiodesis as definitive surgical treatment. The patient was eventually treated with PVCR, which achieved satisfactory correction without curve progression in a long-term follow-up.
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Affiliation(s)
- Dong-Gune Chang
- Department of Orthopaedic Surgery, Sanggye Paik Hospital, College of Medicine, Inje University
| | - Jae Hyuk Yang
- Department of Orthopaedic Surgery, Korea University Guro-Hospital, College of Medicine, Korea University
| | - Jung-Hee Lee
- Department of Orthopaedic Surgery, Kyung Hee Hospital, College of Medicine, Kyung Hee University
| | - Jung-Sub Lee
- Department of Orthopaedic Surgery, Pusan National University Hospital, College of Medicine, Pusan National University, Busan, Korea
| | - Seung-Woo Suh
- Department of Orthopaedic Surgery, Korea University Guro-Hospital, College of Medicine, Korea University
| | - Jin-Hyok Kim
- Department of Orthopaedic Surgery, Sanggye Paik Hospital, College of Medicine, Inje University
| | - Seung-Yeol Oh
- Department of Orthopaedic Surgery, Sanggye Paik Hospital, College of Medicine, Inje University
| | - Woojin Cho
- Department of Orthopaedic Surgery, The University Hospital for Albert Einstein College of Medicine, Albert Einstein College of Medicine, New York, NY
| | - Jong-Beom Park
- Department of Orthopaedic Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Se-Il Suk
- Department of Orthopaedic Surgery, Sanggye Paik Hospital, College of Medicine, Inje University
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Eroglu CN, Ertugrul AS, Eskitascioglu M, Eskitascioglu G. Changes in the surface of bone and acid-etched and sandblasted implants following implantation and removal. Eur J Dent 2016; 10:77-81. [PMID: 27011744 PMCID: PMC4784159 DOI: 10.4103/1305-7456.175679] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [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] [Indexed: 11/14/2022] Open
Abstract
Objective: The aim of this study was to determine whether there are any changes in the surface of bone or implant structures following the removal of a screwed dental implant. Materials and Methods: For this, six individual samples of acid-etched and sandblasted implants from three different manufacturers’ implant systems were used. They were screwed in a D1 bovine bone, and they were removed after primary stabilization. The bone and implant surfaces are evaluated with scanning electron microscope. Results: Through examination of the surfaces of the bone prior to implantation and of the used and unused implant surfaces, it was found that inhomogeneity in the implant surface can cause microcracking in the bone. Conclusions: This is attributed to the stress induced during the implantation of self-tapping implants and suggests that a tap drill may be required in some instances to protect the implant surface.
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Affiliation(s)
- Cennet Neslihan Eroglu
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Yuzuncu Yil University, Van, Turkiye
| | - Abdullah Seckin Ertugrul
- Department of Periodontology, Faculty of Dentistry, Izmir Katip Celebi University, Izmir, Turkiye
| | - Murat Eskitascioglu
- Department of Prosthodontics, Faculty of Dentistry, Yuzuncu Yil University, Van, Turkiye
| | - Gurcan Eskitascioglu
- Department of Prosthodontics, Faculty of Dentistry, Yuzuncu Yil University, Van, Turkiye
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Backes M, Schep NWL, Luitse JSK, Goslings JC, Schepers T. High Rates of Postoperative Wound Infection Following Elective Implant Removal. Open Orthop J 2015; 9:418-21. [PMID: 26401166 PMCID: PMC4578132 DOI: 10.2174/1874325001509010418] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 06/24/2015] [Accepted: 08/05/2015] [Indexed: 12/22/2022] Open
Abstract
Introduction : Metal implants placed during fracture surgery are often removed for various reasons (i.e. pain, prominent material, patients request). The removal of implants is considered a ‘clean’ procedure and as low risk surgery. The incidence of wound infections following implant removal has received little attention in the literature. The aim of the current study was to assess the incidence and risk factors of postoperative wound infections (POWIs) following implant removal. Material and Methods : All consecutive adult patients in a Level 1 and Level 2 Trauma Center who had their implants removed during a 6.5 years period were included. Exclusion criteria were removal of implants because of an ongoing infection or fistula and removal followed by placement of new implants. Primary outcome measure was a POWI as defined by the US Centers for Disease Control and Prevention. Patient characteristics and peri-operative characteristics were collected from the medical charts. Results : A total of 452 patients were included (512 procedures). The overall POWI rate was 11.6% (10% superficial, 1.6% deep). A total of 403 procedures (78.7%) comprised of implant removal below the knee joint with a 12.2% POWI rate. A POWI following initial fracture treatment was associated with a higher rate of POWI following implant removal (p=0.012). A POWI occurred more often in younger patients (median age 36 versus 43 years; p=0.004). Conclusion : The overall incidence of postoperative wound infection was 11.6% with 10% superficial and 1.6% of deep infections in patients with elective implant removal. A risk factor for POWI following implant removal was a previous wound infection.
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Affiliation(s)
- M Backes
- Trauma Unit, Department of Surgery, Academic Medical Center, University of Amsterdam, The Netherlands ; Department of Surgery, St Lucas Andreas Hospital, Amsterdam, The Netherlands
| | - N W L Schep
- Trauma Unit, Department of Surgery, Academic Medical Center, University of Amsterdam, The Netherlands
| | - J S K Luitse
- Trauma Unit, Department of Surgery, Academic Medical Center, University of Amsterdam, The Netherlands
| | - J C Goslings
- Trauma Unit, Department of Surgery, Academic Medical Center, University of Amsterdam, The Netherlands
| | - T Schepers
- Trauma Unit, Department of Surgery, Academic Medical Center, University of Amsterdam, The Netherlands
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43
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Chen Y, Giri KP, Pearce CJ. A Novel Surgical Technique for Removing Buried Cannulated Screws Using a Guidewire and Countersink: A Report of Two Cases. Open Orthop J 2015; 9:210-3. [PMID: 26161159 PMCID: PMC4493633 DOI: 10.2174/1874325001509010210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 03/25/2015] [Accepted: 04/20/2015] [Indexed: 12/02/2022] Open
Abstract
Removal of metal implants is a common procedure that is performed for a variety of indications. However, problems such as a buried screw head may occasionally arise and render hardware removal difficult or even impossible. The problem is further compounded when the initial screw was inserted percutaneously or via a minimally-invasive (MIS) technique. In the present paper, we introduce a novel, minimally invasive technique to remove buried cannulated screws which obviates the need for excessive extension of the skin incision, surgical exploration, soft tissue dissection or excess bone removal, which surgeons may otherwise have to undertake to uncover the buried screw head. This technique is especially useful in removing cannulated screws which have been inserted using small stab incisions and MIS techniques initially. This technique can be applied to the removal of buried cannulated screws which are placed into any bone in the body.
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Affiliation(s)
- Yongsheng Chen
- Department of Orthopaedic Surgery, Alexandra Hospital, Singapore
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Morata L, Tornero E, Martínez-Pastor JC, García-Ramiro S, Mensa J, Soriano A. Clinical experience with linezolid for the treatment of orthopaedic implant infections. J Antimicrob Chemother 2015; 69 Suppl 1:i47-52. [PMID: 25135090 DOI: 10.1093/jac/dku252] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [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: 01/30/2023] Open
Abstract
Gram-positive cocci are commonly isolated in orthopaedic implant infections and their resistance to β-lactams and fluoroquinolones is increasing. The high oral bioavailability of linezolid makes it an attractive oral alternative to glycopeptides and its use has increased in the last decade. To evaluate experience with linezolid in orthopaedic implant infections a systematic review of the literature available in English was undertaken. Only those articles describing series of ≥10 patients with acute or chronic orthopaedic implant infections treated with linezolid and with a clear definition of diagnosis and outcome were selected. A total of 293 patients (79.9% had prosthetic joint infections) were analysed in the 10 articles included. The overall remission rate with at least 3 months of follow-up was 79.9%, depending on whether the implant was removed or not (94% versus 69.9%). The addition of rifampicin was described in only two articles and no significant difference was observed. Adverse events were frequent during prolonged administration of linezolid (34.3%), requiring treatment discontinuation in 12.8%. The most common event was anaemia (13.4%) followed by gastrointestinal symptoms (11.1%). In conclusion, linezolid seems a good oral treatment alternative for orthopaedic implant infections due to Gram-positive cocci resistant to β-lactams and fluoroquinolones. However, close monitoring of adverse events is required.
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Affiliation(s)
- Laura Morata
- Department of Infectious Diseases, Hospital Clinic of Barcelona, IDIBAPS, Villarroel 170, 08036 Barcelona, Spain
| | - Eduard Tornero
- Department of Orthopaedic and Trauma Surgery, Hospital Clinic of Barcelona, Villarroel 170, 08036 Barcelona, Spain
| | - Juan C Martínez-Pastor
- Department of Orthopaedic and Trauma Surgery, Hospital Clinic of Barcelona, Villarroel 170, 08036 Barcelona, Spain
| | - Sebastián García-Ramiro
- Department of Orthopaedic and Trauma Surgery, Hospital Clinic of Barcelona, Villarroel 170, 08036 Barcelona, Spain
| | - Josep Mensa
- Department of Infectious Diseases, Hospital Clinic of Barcelona, IDIBAPS, Villarroel 170, 08036 Barcelona, Spain
| | - Alex Soriano
- Department of Infectious Diseases, Hospital Clinic of Barcelona, IDIBAPS, Villarroel 170, 08036 Barcelona, Spain
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NAKASHIMA HIROAKI. Grafted vertebral fracture after implant removal in a patient with spine-shortening vertebral osteotomy. Nagoya J Med Sci 2015; 77:315-20. [PMID: 25797997 PMCID: PMC4361534] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 12/24/2014] [Indexed: 11/24/2022]
Abstract
We experienced the rare complication of a vertebral fracture that was caused by implant removal after bony fusion had been achieved in a patient who underwent spine-shortening osteotomy (SSO) for tethered cord syndrome (TCS). We propose that the removal of the implant used for SSO should be contraindicated. The patient (a 27-year-old female) presented to our institution with a history of progressive severe lower back pain, gait disturbance, and urinary incontinence. As an infant, she had undergone surgery for spina bifida with lipoma. Magnetic resonance imaging of the spine revealed tethering of the spinal cord to a lipoma. We performed SSO at the level of the L1 vertebra level. After spine shortening and fixation using a posterior approach, the L1 vertebral body was completely removed anteriorly and replaced with a left iliac bone graft. The patient's symptoms improved after surgery. After bony fusion was achieved after surgery, we decided to remove the spinal implant after we explained the advantages and disadvantages of the procedure to the patient. We performed implant removal surgery safely 2 years later; however, the patient complained of severe lower back pain 10 days after the surgery without any history of trauma. Reconstruction computed tomography showed fracture of the grafted vertebra. We performed a repeat posterior fixation, which relieved the lower back pain; she has experienced no complications in the subsequent 5 years. In summary, we report a case of a rare complication of the fracture of a grafted vertebra after removal of an implant used in SSO for TCS. Spinal stability could not be maintained without the spinal posterior implant after SSO. Postoperative fracture after spinal implant removal is rare but possible, and patients must be informed of this potential risk.
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Affiliation(s)
- HIROAKI NAKASHIMA
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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46
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Anitua E, Murias-Freijo A, Piñas L, Tejero R, Prado R, Orive G. Nontraumatic Implant Explantation: A Biomechanical and Biological Analysis in Sheep Tibia. J ORAL IMPLANTOL 2014; 42:3-11. [PMID: 25536339 DOI: 10.1563/aaid-joi-d-14-00193] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 11/22/2022]
Abstract
Preclinical research in a sheep tibia model has been conducted to evaluate the underlying mechanisms of the nontraumatic implant explantation of failed implants, which allow placing a new one in the bone bed. Twelve dental implants were placed in sheep diaphysis tibia and once osseointegrated they were explanted using a nontraumatic implant explantation approach. Implant osseointegration and explantation were monitored by means of frequency resonance, removal torque, and angle of rotation measurement. The host bone bed and the explanted implant surface were analyzed by conventional microscopy and scanning electron microscope. Results show that osseointegration was broken with an angular displacement of less than 20°. In this situation the implant returns to implant stability quotient values in the same range of their primary stability. Moreover, the explantation technique causes minimal damage to the surrounding bone structure and cellularity. This nontraumatic approach allows the straightforward replacement of failed implants and emerges as a promising strategy to resolve clinically challenging situations.
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Affiliation(s)
- Eduardo Anitua
- 1 Private practice in implantology and oral rehabilitation, Vitoria, Spain.,2 Biotechnology Institute (BTI), Vitoria, Spain
| | - Alia Murias-Freijo
- 1 Private practice in implantology and oral rehabilitation, Vitoria, Spain
| | - Laura Piñas
- 1 Private practice in implantology and oral rehabilitation, Vitoria, Spain
| | | | | | - Gorka Orive
- 2 Biotechnology Institute (BTI), Vitoria, Spain
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Anitua E, Murias-Freijo A, Alkhraisat MH. Conservative Implant Removal for the Analysis of the Cause, Removal Torque, and Surface Treatment of Failed Nonmobile Dental Implants. J ORAL IMPLANTOL 2014; 42:69-77. [PMID: 25436836 DOI: 10.1563/aaid-joi-d-14-00207] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This study was performed to study the effect of implant surface treatment on the cause and removal torque of failed nonmobile implants. Implant explantation was achieved by the application of countertorque at the implant-bone interface. The explantation socket was examined carefully and curetted to remove any granulation tissue. Immediate implant placement was accomplished when primary stability could be achieved. Eighty-one patients were treated according to the described treatment protocol for the explantation of 158 nonmobile implants in the maxilla and the mandible. The patient's mean age was 62 ± 11 years. The main cause of implant explantation was peri-implantitis (131 implants; 82.9%) followed by malpositioning of the implants (22 implants; 13.9%). The explantation of 139 implants at 146 ± 5 Ncm was performed without the need for trephine bur. However, the use of trephine burs to cut into the first 3 to 4 mm was necessary in 19 explantations, and the removal torque was 161 ± 13 Ncm. All titanium plasma-sprayed implants were removed due to peri-implantitis at a significantly lower torque when compared to acid-etched, particle-blasted, and oxidized implants. The postoperative recovery of the patients was uneventful and the conservation of the available hard and soft tissues was successfully achieved. The protocol followed in this study could constitute a real alternative to other traumatic technique for the removal of failed implants and advanced stages of peri-implantitis. The type of implant surface treatment could influence the value of removal torque and the occurrence of peri-implantitis.
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Affiliation(s)
- Eduardo Anitua
- 1 Private practice in oral implantology, Vitoria, Spain.,2 Eduardo Anitua Foundation, Vitoria, Spain
| | - Alia Murias-Freijo
- 1 Private practice in oral implantology, Vitoria, Spain.,2 Eduardo Anitua Foundation, Vitoria, Spain
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Li CH, Chou CT. Bone sparing implant removal without trephine via internal separation of the titanium body with a carbide bur. Int J Oral Maxillofac Surg 2013; 43:248-50. [PMID: 24176547 DOI: 10.1016/j.ijom.2013.09.010] [Citation(s) in RCA: 7] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Revised: 07/20/2013] [Accepted: 09/17/2013] [Indexed: 11/15/2022]
Abstract
A novel technique was developed to remove osseointegrated implants without enlarging the bony socket. Immediate replacement was performed simultaneously using a same-size implant with good primary stability. The prosthesis was delivered after 6 months of healing with good loading function. Good bone stability was found at the 12-month follow-up.
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Affiliation(s)
- C H Li
- Chuan Sheng Dental Clinic, Ji'an Township, Hualien County, Taiwan.
| | - C T Chou
- Dental Department, Taipei Medical University, Da'an District, Taipei City, Taiwan
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Backes M, Schep NWL, Luitse JSK, Goslings JC, Schepers T. Indications for implant removal following intra-articular calcaneal fractures and subsequent complications. Foot Ankle Int 2013; 34:1521-5. [PMID: 24038057 DOI: 10.1177/1071100713502466] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Implant removal following operative calcaneal fracture treatment has received little attention in the literature. The aim of the current retrospective cohort study was to assess the indications and number of wound complications following calcaneal plate removal. METHODS All consecutive adult patients who had their plate and screws removed following the operative treatment of a closed uni- or bilateral intra-articular calcaneal fracture using a stainless steel nonlocking calcaneal plate between 2000 and 2011 were included. RESULTS In 102 patients (46% of the total number of operated calcaneal fractures) implants were removed. Implant removal was performed in 75 patients for symptomatic reasons, in 10 patients due to implant malposition and in 19 patients because of a persistent wound infection or fistula. Following implant removal 17 (16%) patients had a wound complication (2 wound dehiscence, 15 culture positive wound infections). In 6 patients (9%) a wound complications was seen following implant removal after uncomplicated fracture surgery. Implant removal for active infection or plate fistula displayed an infection rate of 8 out of 19 (42%). CONCLUSION Implant removal after an intra-articular calcaneal fracture treated with open reduction and internal fixation via an extended lateral approach was followed by a wound complication in 1 of every 10 patients without a preexisting wound infection. Infection rates were especially high in patients in whom the implants were removed for an active wound problem. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Manouk Backes
- Trauma Unit, Department of Surgery, Academic Medical Center, Amsterdam, Netherlands
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50
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Gurunluoglu R, Kubek E, Arton J. Dual pedicle mastopexy technique for reorientation of volume and shape after subglandular and submuscular breast implant removal. Eplasty 2013; 13:e48. [PMID: 24058719 PMCID: PMC3776568] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND The purpose of this article was to report our experience in achieving satisfactory breast shape and volume using dual pedicle mastopexy technique after subglandular and submuscular breast implant removal. METHODS Breast implant-related problems in 51 breasts included capsular contracture (Baker grade III-IV), 76%; implant rupture/bleed, 41%; breasts undergoing repeat surgery more than once, 22%. The size of the breast implants removed ranged from 240 to 525 cc (average size: 320 ± 65 cc) (saline-filled, 40%; silicone-filled, 60%; subglandular, 40%; submuscular, 60%). Capsulectomy, implant removal, and dual pedicle mastopexy were performed for reconfiguration of breast shape and reorientation of volume. RESULTS Mean follow-up was 14.5 months. On average, 65.0% of breast implant volume was achieved. There was 1-cup reduction in brassiere size in 21 patients, and the cup size remained the same in 5 patients. Postoperative pain scores were no pain or mild pain in 26 patients who initially in the preoperative evaluation reported having mild pain (11), moderate pain (12), and severe pain (3). Overall patient satisfaction scores were 3 (neutral) in 1 patient, 4 (satisfied) in 12 patients, and 5 (very satisfied) in 13 patients. CONCLUSION The dual pedicle mastopexytechnique provided a reliable way of reorienting breast volume and configuring breast shape in patients who opted to have implants removed without replacement. The results demonstrated that a pleasing outcome could be obtained using the described technique with additional benefits of elimination of breast tenderness and discomfort secondary to implant removal and/or capsulectomy.
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Affiliation(s)
- Raffi Gurunluoglu
- Plastic and Reconstructive Surgery, Denver Health Medical Center, University of Colorado Health Sciences Center, Denver,Correspondence:
| | - Edward Kubek
- Plastic and Reconstructive Surgery, Denver Health Medical Center, University of Colorado Health Sciences Center, Denver
| | - Jamie Arton
- Plastic and Reconstructive Surgery, Denver Health Medical Center, University of Colorado Health Sciences Center, Denver
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