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申 向, 贾 国. [Research progress in the treatment of distal humeral metaphyseal-diaphyseal junction fracture in children]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2024; 38:613-617. [PMID: 38752250 PMCID: PMC11096876 DOI: 10.7507/1002-1892.202402044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 04/18/2024] [Accepted: 04/22/2024] [Indexed: 05/18/2024]
Abstract
Objective To summarize the research progress in the treatment of distal humeral metaphyseal-diaphyseal junction (DHMDJ) fractures in children and to provide reference for clinical practice. Methods The characteristics and treatment methods of transverse and comminuted DHMDJ fractures in children were summarized and analyzed by referring to relevant literature at home and abroad. Results DHMDJ fractures in children are not uncommon clinically, with high fracture line position, multi-directional instability, difficult closed reduction in treatment, and easy to cause complications such as coronal and sagittal deformity of the elbow. The Kirschner wire technique was effective for DHMDJ fractures with the fracture line at the middle and low levels, but was prone to iatrogenic ulnar nerve injury. Elastic stable intramedullary nail is suitable for higher-position transverse DHMDJ fractures. However, this technique requires a second operation to remove the internal fixator, and may cause iatrogenic epiphysis plate injury in children. External fixator is a new way to treat DHMDJ fractures, and it can show satisfactory results for transverse and comminuted DHMDJ fractures. However, at present, there are few relevant studies, and most of them focus on biomechanical studies, and the efficacy lacks high-quality clinical research support. Conclusion The ultimate goal of DHMDJ fracture treatment in children is to restore the anatomical alignment of the fracture and prevent the loss of reduction. The choice of internal fixator depends on the location of the fracture line and the shape of the fracture to provide personalized treatment.
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Affiliation(s)
- 向阳 申
- 安徽医科大学附属省儿童医院骨科(合肥 230051)Department of Orthopedics, Provincial Children’s Hospital of Anhui Medical University, Hefei Anhui, 230051, P. R. China
| | - 国强 贾
- 安徽医科大学附属省儿童医院骨科(合肥 230051)Department of Orthopedics, Provincial Children’s Hospital of Anhui Medical University, Hefei Anhui, 230051, P. R. China
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Gao W, Wang X, Chen Y, Liu G, Hou P, Guo C, Yang X, Hao Y. Long-term efficacy of Waveflex semi-rigid-dynamic-internal-fixation system in delaying intervertebral disc degeneration at adjacent segments and improving spinal sagittal imbalance. Sci Rep 2024; 14:10437. [PMID: 38714766 PMCID: PMC11076526 DOI: 10.1038/s41598-024-60940-8] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 04/29/2024] [Indexed: 05/10/2024] Open
Abstract
The Waveflex semi-rigid-dynamic-internal-fixation system shows good short-term effects in the treatment of lumbar degenerative diseases, but there are few long-term follow-up studies, especially for recovery of sagittal balance. Fifty patients with lumbar degenerative diseases treated from January 2016 to October 2017 were retrospectively analysed: 25 patients treated with Waveflex semi-rigid-dynamic-internal-fixation system (Waveflex group) and 25 patients treated with double-segment PLIF (PLIF group). Clinical efficacy was evaluated by Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI). Imaging data before surgery and at 3 months, 1 year, and 5 years postoperatively was used for imaging indicator assessment. Local disc degeneration of the cephalic adjacent segment (including disc height index (DHI), intervertebral foramen height (IFH), and range of motion (ROM)) and overall spinal motor function (including lumbar lordosis (LL), pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT), and |PI-LL|) were analysed. Regarding clinical efficacy, comparison of VAS and ODI scores between the Waveflex and PLIF groups showed no significant preoperative or postoperative differences. The comparison of the objective imaging indicators showed no significant differences in the DHI, IFH, LL, |PI-LL|, and SS values between the Waveflex and PLIF groups preoperatively and 3 months postoperatively (P > 0.05). These values were significantly different at 1 and 5 years postoperatively (P < 0.05), and the Waveflex group showed better ROM values than those of the PLIF group (P < 0.05). PI values were not significantly different between the groups, but PT showed a significant improvement in the Waveflex group 5 years postoperatively (P < 0.05). The Waveflex semi-rigid dynamic fixation system can effectively reduce the probability of intervertebral disc degeneration in upper adjacent segments. Simultaneously, patients in the Waveflex group showed postoperative improvements in LL, spinal sagittal imbalance, and quality of life.
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Affiliation(s)
- Wenxin Gao
- The First Affiliated Hospital, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
- Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Xiaoying Wang
- Jinan Vocational College of Nursing, Jinan, Shandon, China
| | - Yungang Chen
- Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Guoyan Liu
- Affiliated Hospital of Shandong University of Traditional Chinese Medicine, 16369 Jingshi Road, Jinan, Shandong, China
| | - Pengfei Hou
- Affiliated Hospital of Shandong University of Traditional Chinese Medicine, 16369 Jingshi Road, Jinan, Shandong, China
| | - Cunliang Guo
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Xu Yang
- Qingzhou People's Hospital, Weifang, Shandong, China
| | - Yanke Hao
- Affiliated Hospital of Shandong University of Traditional Chinese Medicine, 16369 Jingshi Road, Jinan, Shandong, China.
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Lari A, Hassan Y, Altammar A, Esmaeil A, Altammar A, Prada C, Jarragh A. Interlocking intramedullary nail for forearm diaphyseal fractures in adults-A systematic review and meta-analysis of outcomes and complications. J Orthop Traumatol 2024; 25:16. [PMID: 38615140 PMCID: PMC11016039 DOI: 10.1186/s10195-024-00761-7] [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: 01/09/2024] [Accepted: 03/27/2024] [Indexed: 04/15/2024] Open
Abstract
PURPOSE The purpose of this systematic review is to examine the outcomes, complications, and potential advantages of using anatomical interlocking intramedullary nails (IMN) in the treatment of radius and ulnar shaft diaphyseal fractures in adults. METHODS Medline, Embase, Web of Science, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases were searched between January 2000 and January 2023. Studies meeting criteria were observational or randomized controlled trials evaluating outcomes in IMN for adult diaphyseal forearm fractures. Standardized data extraction was performed and a quality assessment tool was used to evaluate individual study methodology. Descriptive statistics for interventions, functional outcomes, and complications were reported. Meta-analysis was performed for patient-reported outcome measures and operative time. RESULTS A total of 29 studies involving 1268 patients were included with 764 (60%) undergoing IMN, 21% open reduction and internal fixation (ORIF), and 9% hybrid fixation. There was no significant difference between groups in DASH and Grace-Eversmann scores. Operative time was significantly shorter in IMN compared with ORIF. The DASH scores were: 13.1 ± 6.04 for IMN, 10.17 ± 3.98 for ORIF, and 15.5 ± 0.63 in hybrids. Mean operative time was 65.3 ± 28.7 in ORIF and 50.8 ± 17.7 in IMN. Complication rates were 16.7% in the IMN group, 14.9% in ORIF, and 6.3% in hybrid constructs. There were 11 cases of extensor pollicis rupture in the IMN group. Average IMN pronation and supination were 78.3° ± 7.9° and 73° ± 5.0°, respectively. Average ORIF pronation and supination was 82.15° ± 1.9° and 79.7° ± 4.5°, respectively. CONCLUSIONS Similar functional outcomes and complication rates along with shorter operative times can be achieved with IMN compared with ORIF. The use of IMN is promising, however, higher quality evidence is required to assess appropriate indications, subtle differences in range of motion, implant-related complications, and cost-effectiveness. Trail Registration PROSPERO (International Prospective Register of Systematic Reviews) (ID: CRD42022362353). LEVEL OF EVIDENCE III
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Affiliation(s)
- Ali Lari
- Department of Orthopedic Surgery, AlRazi National Orthopedic Hospital, Kuwait City, Kuwait.
| | - Yousef Hassan
- Department of Orthopedic Surgery, AlRazi National Orthopedic Hospital, Kuwait City, Kuwait
| | - Abdulwahab Altammar
- Department of Orthopedic Surgery, AlRazi National Orthopedic Hospital, Kuwait City, Kuwait
| | - Ali Esmaeil
- Department of Orthopedic Surgery, AlRazi National Orthopedic Hospital, Kuwait City, Kuwait
| | - Abdulaziz Altammar
- Department of Orthopedic Surgery, AlRazi National Orthopedic Hospital, Kuwait City, Kuwait
| | - Carlos Prada
- St Joseph's Health Care, Hand and Upper Limb Centre, University of Western Ontario, London, ON, Canada
| | - Ali Jarragh
- Department of Orthopedic Surgery, Kuwait University, Kuwait City, Kuwait
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Maimaiti X, Liu K, Yusufu A, Xie Z. Treatment of tibial bone defects caused by infection: a retrospective comparative study of bone transport using a combined technique of unilateral external fixation over an intramedullary nail versus circular external fixation over an intramedullary nail. BMC Musculoskelet Disord 2024; 25:284. [PMID: 38609889 PMCID: PMC11010327 DOI: 10.1186/s12891-024-07377-2] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 03/22/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND The purpose of the study was to assess and compare the clinical efficacy of bone transport with either circular or unilateral external fixators over an intramedullary nail in the treatment of tibial bone defects caused by infection. METHODS Between May 2010 and January 2019, clinical and radiographic data were collected and analyzed for patients with bone defects caused by infection. Thirteen patients underwent bone transport using a unilateral external fixator over an intramedullary nail (Group A), while 12 patients were treated with a circular external fixator over an intramedullary nail (Group B). The bone and functional outcomes of both groups were assessed and compared using the Association for the Study and Application of the Method of the Ilizarov criteria, and postoperative complications were evaluated according to the Paley classification. RESULTS A total of 25 patients were successfully treated with bone transport using external fixators over an intramedullary nail, with a mean follow-up time of 31.63 ± 5.88 months. There were no significant statistical differences in age, gender, previous surgery per patient, duration of infection, defect size, and follow-up time between Group A and Group B (P > 0.05). However, statistically significant differences were observed in operation time (187.13 ± 21.88 min vs. 255.76 ± 36.42 min, P = 0.002), intraoperative blood loss (39.26 ± 7.33 mL vs. 53.74 ± 10.69 mL, P < 0.001), external fixation time (2.02 ± 0.31 month vs. 2.57 ± 0.38 month, P = 0.045), external fixation index (0.27 ± 0.08 month/cm vs. 0.44 ± 0.09 month/cm, P = 0.042), and bone union time (8.37 ± 2.30 month vs. 9.07 ± 3.12, P = 0.032) between Group A and Group B. The excellent and good rate of bone and functional results were higher in Group A compared to Group B (76.9% vs. 75% and 84.6% vs. 58.3%). Statistically significant differences were observed in functional results (excellent/good/fair/poor, 5/6/2/0 vs. 2/5/4/1, P = 0.013) and complication per patient (0.38 vs. 1.16, P = 0.012) between Group A and Group B. CONCLUSIONS Bone transport using a combined technique of external fixators over an intramedullary nail proved to be an effective method in treating tibial bone defects caused by infection. In comparison to circular external fixators, bone transport utilizing a unilateral external fixator over an intramedullary nail resulted in less external fixation time, fewer complications, and better functional outcomes.
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Affiliation(s)
- Xiayimaierdan Maimaiti
- Department of Trauma and Microreconstructive Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830054, China
| | - Kai Liu
- Department of Trauma and Microreconstructive Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830054, China
| | - Aihemaitijiang Yusufu
- Department of Trauma and Microreconstructive Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830054, China.
| | - Zengru Xie
- Department of Trauma and Microreconstructive Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830054, China.
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Mitkovic MM, Korunovic ND, Milenkovic SS, Stojiljkovic PM, Manic MT, Trajanovic MD. Forces required to dynamize sliding screws in gamma nail and selfdynamizable internal fixator. BMC Musculoskelet Disord 2024; 25:271. [PMID: 38589829 PMCID: PMC11000330 DOI: 10.1186/s12891-024-07392-3] [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: 09/13/2023] [Accepted: 03/28/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Single limb support phase of the gait-cycle in patients who are treated for a pertrochanteric fracture is characterized by transversal loads acting on the lag screw, tending to block its dynamization. If the simultaneous axial force overcomes transversal loads of the sliding screw, the dynamization can still occur. METHODS Biomechanical investigation was performed for three types of dynamic implants: Gamma Nail, and two types of Selfdynamizable Internal Fixators (SIF) - SIF-7 (containing two 7 mm non-cannulated sliding screws), and SIF-10 (containing one 10 mm cannulated sliding screw). Contact surface between the stem and the sliding screws is larger in SIF implants than in Gamma Nail, as the stem of Gamma Nail is hollow. A special testing device was designed for this study to provide simultaneous application of a controlled sliding screws bending moment and a controlled transversal load on sliding screws (Qt) without using of weights. Using each of the implants, axial forces required to initiate sliding screws dynamization (Qa) were applied and measured using a tensile testing machine, for several values of sliding screws bending moment. Standard least-squares method was used to present the results through the linear regression model. RESULTS Positive correlation between Qt and Qa was confirmed (p < 0.05). While performing higher bending moments in all the tested implants, Qa was higher than it could be provided by the body weight. It was the highest in Gamma Nail, and the lowest in SIF-10. CONCLUSIONS A larger contact surface between a sliding screw and stem results in lower forces required to initiate dynamization of a sliding screw. Patients treated for a pertrochanteric fracture by a sliding screw internal fixation who have longer femoral neck or higher body weight could have different programme of early postoperative rehabilitation than lighter patients or patients with shorter femoral neck.
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Affiliation(s)
- Milan M Mitkovic
- Clinic for Orthopaedics and Traumatology "Academician Prof. Dr. Milorad Mitkovic", University Clinical Center Nis, Nis, Serbia.
- Faculty of Medicine, University of Nis, Nis, Serbia.
| | | | - Sasa S Milenkovic
- Clinic for Orthopaedics and Traumatology "Academician Prof. Dr. Milorad Mitkovic", University Clinical Center Nis, Nis, Serbia
- Faculty of Medicine, University of Nis, Nis, Serbia
| | - Predrag M Stojiljkovic
- Clinic for Orthopaedics and Traumatology "Academician Prof. Dr. Milorad Mitkovic", University Clinical Center Nis, Nis, Serbia
- Faculty of Medicine, University of Nis, Nis, Serbia
| | - Miodrag T Manic
- Faculty of Mechanical Engineering, University of Nis, Nis, Serbia
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Floros MC, Bortolatto JF, Lausch AJ, Valiente AJ, Sone ED, Santerre JP, Whyne C, Fialkov JA. BoneTape: A novel osteosynthetic device for the stabilization of zygomatic fractures. J Plast Reconstr Aesthet Surg 2024; 91:276-283. [PMID: 38432085 DOI: 10.1016/j.bjps.2024.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 12/15/2023] [Accepted: 02/04/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND The study aims to assess the safety and effectiveness of BoneTape™, a new resorbable bone fixation device, using a zygomatic fracture model in rabbits. METHODS The study followed BoneTape™ samples and control (sham) groups over 2-, 6-, and 12-week periods post-zygomaticomaxillary (ZM) osteotomy and zygomaticofrontal (ZF) disarticulation. The osteotomized segments were analyzed for bone healing, inflammatory response, and tissue healing. µCT imaging and histological analysis were used to examine the axial alignment, offset, and quality of new bone formation. RESULTS BoneTape™ samples demonstrated enhanced maintenance of the initial intraoperative positioning, reduced axial offset, and better alignment when compared with the control group, enabling stable bone healing under physiological loading conditions. Complete union was observed at 12-weeks in both groups. The BoneTape™ group experienced minimal immune and tissue reactions, classically associated with wound healing, and showed an increased number of giant cells at 6 and 12-weeks. CONCLUSION BoneTape™ represents a promising advancement in osteosynthesis, demonstrating efficacy in maintaining stable zygomatic reconstruction and eliciting minimal immune response in a rabbit model. This study introduces BoneTape™ as a disruptive solution specifically designed for clinical application in cranio-maxillofacial fracture fixation, with the potential to eliminate the use of over-engineered solutions while offering benefits such as ease of application and fewer biologically disruptive steps.
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Affiliation(s)
| | | | | | | | - Eli D Sone
- Institute of Biomedical Engineering, University of Toronto, Toronto, Canada; Faculty of Dentistry, University of Toronto, Toronto, Canada; Deparment of Materials Science and Engineering, University of Toronto, Toronto, Canada
| | - J Paul Santerre
- Institute of Biomedical Engineering, University of Toronto, Toronto, Canada; Translational Biology and Engineering Program, Ted Rogers Centre for Heart Research, Toronto, Canada; Faculty of Dentistry, University of Toronto, Toronto, Canada
| | - Cari Whyne
- Institute of Biomedical Engineering, University of Toronto, Toronto, Canada; Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Surgery, University of Toronto, Toronto Canada
| | - Jeffrey A Fialkov
- Institute of Biomedical Engineering, University of Toronto, Toronto, Canada; Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Surgery, University of Toronto, Toronto Canada.
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Mao W, Hong CC, Chang SM. Strategies for Pertrochanteric Fracture Reduction and Intramedullary Nail Placement: Technical Tips and Tricks. J Am Acad Orthop Surg 2024; 32:e267-e268. [PMID: 37418351 DOI: 10.5435/jaaos-d-23-00026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 01/14/2023] [Indexed: 07/09/2023] Open
Affiliation(s)
- Wei Mao
- From the The Department of Orthopaedic Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China (Mao, and Chang), and the Department of Orthopaedic Surgery (Dr. Mao, Dr. Hong), National University Hospital of Singapore, Singapore
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Kelley B, Lee C. Reply to Letter to the Editor: Strategies for Pertrochanteric Fracture Reduction and Intramedullary Nail Placement: Technical Tips and Tricks. J Am Acad Orthop Surg 2024; 32:e269-e273. [PMID: 37561945 DOI: 10.5435/jaaos-d-23-00439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 06/10/2023] [Indexed: 08/12/2023] Open
Affiliation(s)
- Ben Kelley
- From the Department of Orthopaedic Surgery, University of California Los Angeles, Los Angeles, CA
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Kim DY, Jin SR, Hur SM, Chung JH, Lee SM, Kim P. Direct Repair of Symptomatic Lumbar Spondylolysis Using Rod-Screw-Cable System. World Neurosurg 2024; 183:e625-e631. [PMID: 38191055 DOI: 10.1016/j.wneu.2023.12.155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 12/28/2023] [Accepted: 12/29/2023] [Indexed: 01/10/2024]
Abstract
OBJECTIVE To assess the efficacy of a new direct lysis repair technique using internal fixation with rod, screws, and Songer cable in symptomatic lumbar spondylolysis. METHODS Between December 2015 and January 2020, patients who were diagnosed with symptomatic lumbar spondylolysis and surgically treated with a rod-screw-cable system were recruited. Pedicle screwing by the Magerl technique was performed in all included patients, followed by direct lysis repair with bone allograft and demineralized bone matrix by stabilizing the posterior lamina and spinous process using a rod-screw-cable system. Clinical outcome was measured using the visual analog scale and Oswestry disability index preoperatively and 6 weeks, 3 months, 6 months, 1 year, and 2 years postoperatively. RESULTS Sixteen patients were included in this study-11 men and 5 women (mean age: 47 years; range, 26-67 years). The lytic defects were at L4 and L5 in 6 and 10 patients, respectively. The mean follow-up period was 41 months (24-62 months). The visual analog scale values were 7.3, 6.1, 4.3, 3.3, 2.1, and 1.9 preoperatively and 6 weeks, 3 months, 6 months, 1 year, and 2 years postoperatively, respectively. The Oswestry disability index values were 59.8%, 55.4%, 41.7%, 32.4%, 21.1%, and 16.9% for the same periods, respectively. No patient had an increase in the slip after surgery. There were no significant complications such as implant failure. CONCLUSIONS Our technique provides rigid intra-segmental repair of spondylolysis without intersegmental motion interference, even if the patient is older or has disc degeneration.
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Affiliation(s)
- Dae-Yong Kim
- Department of Neurosurgery, JeonJu Wooridul Hospital, JeonJu, Korea
| | - Sang-Ryul Jin
- Department of Neurosurgery, JeonJu Wooridul Hospital, JeonJu, Korea
| | - Sung-Min Hur
- Department of Neurosurgery, JeonJu Wooridul Hospital, JeonJu, Korea
| | - Ji-Hun Chung
- Department of Neurosurgery, JeonJu Wooridul Hospital, JeonJu, Korea
| | - Seung Myung Lee
- Department of Neurosurgery, College of Medicine, Chosun University, Gwangju, Korea
| | - Pius Kim
- Department of Neurosurgery, College of Medicine, Chosun University, Gwangju, Korea.
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10
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Weltsch D, Juels M, Chen KY, Talathi N, Silva M, Thompson RM. Closing-wedge Osteotomies: Can We Do and Teach Better? J Pediatr Orthop 2024; 44:174-178. [PMID: 38009049 DOI: 10.1097/bpo.0000000000002577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2023]
Abstract
BACKGROUND Wedge osteotomies are ubiquitous in pediatric orthopaedics and limb deformity surgery; however, there is no universally preferred methodology for these procedures. This study aims to determine the relative accuracy and effectiveness of several measuring and marking methods to guide best practices for wedge-shaped osteotomies in long bones. METHODS An observational cohort study was completed. Orthopaedic residents (postgraduate years 1 to 5) completed 30-degree wedge osteotomies on a sawbone (Pacific Research Lab) femur utilizing a standard oscillating saw under 3 measuring conditions: (1) no measurement tool, (2) 30-degree triangle, and (3) goniometer, in combination with 2 different marking methods: (1) marking pen or (2) pin placement. Demographic characteristics and osteotomy performance (quality, completion time, and accuracy) were assessed. Quality was ranked as perfect (1), mild step-off (2), or gross surface irregularity (3). Multivariate regressions and analysis of variance were performed comparing demographics, osteotomy performance, and measuring methods. RESULTS Twenty-four residents were included for analysis; 6 were female (25%). Female sex was independently associated with longer completion time when evaluating all combined scenarios (138 vs. 99 s, P =0.003) without differences in surface quality or angle accuracy. There were no significant associations between measuring technique and accuracy or surface quality, but use of the goniometer and the triangle both were associated with significantly longer completion time compared with no visual aid ( P =0.002 and 0.007). When controlling for measuring technique, use of the pen as a marking technique had significantly shorter completion times ( P <0.001), higher surface quality ( P <0.001), and better accuracy ( P <0.001) than guide pins. CONCLUSIONS We recommend the use of a marking pen in combination with the surgeon's preferred measuring guide to optimize trainees' performance of closing wedge osteotomies. Future research is necessary to corroborate these findings in a higher fidelity setting, such as a cadaveric study. Further, while male residents complete wedge osteotomies quicker than female residents, quality and accuracy are comparable among trainees. Slower pace should not be conflated with poor performance but rather should inform effective intraoperative teaching for diverse trainees.
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Affiliation(s)
- Daniel Weltsch
- Department of Orthopedic Surgery, Chaim Sheba Medical Center at Tel Hashomer, Tel Hashomer
- UCLA David Geffen School of Medicine
| | | | | | - Nakul Talathi
- Department of Orthopaedics, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Mauricio Silva
- Department of Orthopaedics, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Rachel M Thompson
- Department of Orthopaedics, David Geffen School of Medicine at UCLA, Los Angeles, CA
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Honda S, Fujibayashi S, Shimizu T, Yamaguchi S, Okuzu Y, Takaoka Y, Masuda S, Takemoto M, Kawai T, Otsuki B, Goto K, Matsuda S. Strontium-loaded 3D intramedullary nail titanium implant for critical-sized femoral defect in rabbits. J Biomed Mater Res B Appl Biomater 2024; 112:e35393. [PMID: 38385959 DOI: 10.1002/jbm.b.35393] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 02/01/2024] [Accepted: 02/08/2024] [Indexed: 02/23/2024]
Abstract
The treatment of critical-sized bone defects has long been a major problem for surgeons. In this study, an intramedullary nail shaped three-dimensional (3D)-printed porous titanium implant that is capable of releasing strontium ions was developed through a simple and cost-effective surface modification technique. The feasibility of this implant as a stand-alone solution was evaluated using a rabbit's segmental diaphyseal as a defect model. The strontium-loaded implant exhibited a favorable environment for cell adhesion, and mechanical properties that were commensurate with those of a rabbit's cortical bone. Radiographic, biomechanical, and histological analyses revealed a significantly higher amount of bone ingrowth and superior bone-bonding strength in the strontium-loaded implant when compared to an untreated porous titanium implant. Furthermore, one-year histological observations revealed that the strontium-loaded implant preserved the native-like diaphyseal bone structure without failure. These findings suggest that strontium-releasing 3D-printed titanium implants have the clinical potential to induce the early and efficient repair of critical-sized, load-bearing bone defects.
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Affiliation(s)
- Shintaro Honda
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shunsuke Fujibayashi
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takayoshi Shimizu
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Seiji Yamaguchi
- Department of Biomedical Sciences, College of Life and Health Sciences, Chubu University, Aichi, Japan
| | - Yaichiro Okuzu
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yusuke Takaoka
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Soichiro Masuda
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Mitsuru Takemoto
- Department of Orthopaedic Surgery, Kyoto City Hospital, Kyoto, Japan
| | - Toshiyuki Kawai
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Bungo Otsuki
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Koji Goto
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
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12
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Zhang J, Zhuang Y, Sheng R, Tomás H, Rodrigues J, Yuan G, Wang X, Lin K. Smart stimuli-responsive strategies for titanium implant functionalization in bone regeneration and therapeutics. Mater Horiz 2024; 11:12-36. [PMID: 37818593 DOI: 10.1039/d3mh01260c] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/12/2023]
Abstract
With the increasing and aging of global population, there is a dramatic rise in the demand for implants or substitutes to rehabilitate bone-related disorders which can considerably decrease quality of life and even endanger lives. Though titanium and its alloys have been applied as the mainstream material to fabricate implants for load-bearing bone defect restoration or temporary internal fixation devices for bone fractures, it is far from rare to encounter failed cases in clinical practice, particularly with pathological factors involved. In recent years, smart stimuli-responsive (SSR) strategies have been conducted to functionalize titanium implants to improve bone regeneration in pathological conditions, such as bacterial infection, chronic inflammation, tumor and diabetes mellitus, etc. SSR implants can exert on-demand therapeutic and/or pro-regenerative effects in response to externally applied stimuli (such as photostimulation, magnetic field, electrical and ultrasound stimulation) or internal pathology-related microenvironment changes (such as decreased pH value, specific enzyme secreted by bacterial and excessive production of reactive oxygen species). This review summarizes recent progress on the material design and fabrication, responsive mechanisms, and in vitro and in vivo evaluations for versatile clinical applications of SSR titanium implants. In addition, currently existing limitations and challenges and further prospective directions of these strategies are also discussed.
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Affiliation(s)
- Jinkai Zhang
- Department of Oral & Cranio-Maxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology; Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, Shanghai 200011, China.
| | - Yu Zhuang
- Department of Oral & Cranio-Maxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology; Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, Shanghai 200011, China.
| | - Ruilong Sheng
- CQM-Centro de Quimica da Madeira, Universidade da Madeira, Campus da Penteada, 9020-105, Funchal, Madeira, Portugal.
| | - Helena Tomás
- CQM-Centro de Quimica da Madeira, Universidade da Madeira, Campus da Penteada, 9020-105, Funchal, Madeira, Portugal.
| | - João Rodrigues
- CQM-Centro de Quimica da Madeira, Universidade da Madeira, Campus da Penteada, 9020-105, Funchal, Madeira, Portugal.
| | - Guangyin Yuan
- School of Materials Science and Engineering, Shanghai Jiao Tong University, Shanghai 200240, China.
| | - Xudong Wang
- Department of Oral & Cranio-Maxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology; Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, Shanghai 200011, China.
| | - Kaili Lin
- Department of Oral & Cranio-Maxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology; Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, Shanghai 200011, China.
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13
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Yin J, Zhang W, Qin L, Yan L. 3D-printed bone-cement mold of intramedullary nail for tibial osteomyelitis: A case report. Asian J Surg 2024; 47:729-730. [PMID: 37914640 DOI: 10.1016/j.asjsur.2023.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 10/06/2023] [Indexed: 11/03/2023] Open
Affiliation(s)
- Junxiang Yin
- Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, 225001, China
| | - Wendong Zhang
- Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, 225001, China
| | - Luyue Qin
- Department of Acupuncture and Moxibustion, Weifang Hospital of Traditional Chinese Medicine, Weifang, 261031, Shandong Province, China
| | - Lianqi Yan
- Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, 225001, China.
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14
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Stenquist DS, McCaskey M, Diaz M, Munassi SD, Ayala G, Donohue D, Mir HR. Do Long-Segment Blocking Screws Increase the Stability of Intramedullary Nail Fixation in Proximal Tibia Fractures, Eliminating the "Bell-Clapper Effect?". J Orthop Trauma 2024; 38:e4-e8. [PMID: 37559221 DOI: 10.1097/bot.0000000000002683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/03/2023] [Indexed: 08/11/2023]
Abstract
OBJECTIVES To determine change in stiffness and horizontal translation of a geriatric extra-articular proximal tibia fracture model after intramedullary nailing with distal (long)-segment blocking screws versus proximal (short)-segment blocking screws. METHODS Unstable extra-articular proximal tibia fractures (OTA/AO 41-A3) were created in 12 geriatric cadaveric tibias. Intramedullary nails were locked with a standard construct (4 proximal screws and 2 distal screws). Specimens were then divided into 2 groups (6 matched pairs per group). Group 1 had a blocking screw placed lateral to the nail in the proximal segment (short segment). Group 2 had a blocking screw placed 1 cm distal to the fracture and medial to the nail (long segment). Specimens were then axially loaded and cycled to failure or cycle completion (50,000 cycles). RESULTS Long-segment blocking screws significantly decreased the amount of horizontal translation at the fracture site compared with short-segment screws (0.77 vs. 2.0 mm, P = 0.039). They also resulted in a greater trend towards greater baseline stiffness, (807.32 ± 216.95 N/mm vs. 583.12 ± 130.1 N/mm, P = 0.072). There was no difference in stiffness after cyclic loading or survival through 50,000 cycles between the long-segment and short-segment groups. CONCLUSION Long-segment blocking screws added to an intramedullary nail construct resulted in decreased horizontal translation at the fracture site compared with short-segment screws in this model of a geriatric proximal tibia fracture. CLINICAL RELEVANCE Blocking screws are commonly used to aid in fracture alignment during intramedullary nailing of proximal tibia fractures. Even when not required to attain or maintain alignment, the addition of a blocking screw in either the proximal or the distal (long) segment may help mitigate the "Bell-Clapper Effect" in geriatric patients.
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Affiliation(s)
- Derek S Stenquist
- Orthopaedic Trauma Service, Tampa General Hospital/Florida Orthopaedic Institute, Tampa, FL; and
| | - Meghan McCaskey
- Orthopaedic Trauma Service, Tampa General Hospital/Florida Orthopaedic Institute, Tampa, FL; and
| | - Miguel Diaz
- Foundation for Orthopaedic Research and Education (FORE), Tampa, FL
| | - Steven D Munassi
- Foundation for Orthopaedic Research and Education (FORE), Tampa, FL
| | - Giovanni Ayala
- Foundation for Orthopaedic Research and Education (FORE), Tampa, FL
| | - David Donohue
- Orthopaedic Trauma Service, Tampa General Hospital/Florida Orthopaedic Institute, Tampa, FL; and
| | - Hassan R Mir
- Orthopaedic Trauma Service, Tampa General Hospital/Florida Orthopaedic Institute, Tampa, FL; and
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15
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Garg V, Gowda AKS, Regmi A, Barik S, Maheshwari VK, Singh V. Management of Length Unstable Femur Fractures in Children by Flexible Intramedullary Nails: A Systematic Review. Acta Chir Orthop Traumatol Cech 2024; 91:44-51. [PMID: 38447564 DOI: 10.55095/achot2024/006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
PURPOSE OF THE STUDY Surgical options for paediatric femoral fractures include fl exible intramedullary nailing (FIN), plating, and external fi xators. Length unstable fractures are usually spiral, long oblique, or comminuted and are often associated with > 2 cm of shortening. The purpose of this study was to see whether FIN is effective for managing unstable femur fractures in children. MATERIAL AND METHODS An electronic literature search was performed up to 25 February 2022 in Cochrane Library, PubMed, and Embase databases using a combination of MeSH search terms and keywords related to the population (e.g., "child" AND "diaphyses" AND "femur"), and intervention (e.g., "nail" OR "ESIN"). The data extracted included the study details, Demographic data, surgical details, postoperative immobilization, complications, and outcome. RESULTS Eight studies with a total sample size of 369 patients were reviewed. The mean operative time, blood loss, and length of stay in the hospital were 67.62±12.32 minutes, 33.82±16.82 ml, and 4.9±1.27 days, respectively. The results were excellent in 61.92% of the patients, satisfactory in 32.61%, and poor in 5.43%. 4.54% of patients had major complications requiring reoperation and 32.46% of patients had minor complications. the most common complication was nail prominence seen in 26.30% of patients. Locked Ender's nail was associated with the least reoperation, malunion, and LLD rate compared to other types of FIN. CONCLUSIONS FIN along with a single walking spica cast is a good choice in all forms of paediatric femoral fracture patterns allowing proper alignment and rotation. Locked Ender's nail is safe and effective for managing unstable paediatric femur fracture. KEY WORDS pediatric femur fracture, length unstable, fl exible intramedullary nailing, submuscular plating, Flynn criterion.
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Affiliation(s)
- V Garg
- Department of Orthopedics, Chacha Nehru Bal chikitsalaya, Geeta colony, Delhi, India
| | - A K S Gowda
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
| | - A Regmi
- Department of Orthopedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - S Barik
- Department of Orthopedics, All India Institute of Medical Sciences, Deoghar, Jharkhand, India
| | - V K Maheshwari
- Department of Orthopedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - V Singh
- Department of Orthopedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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16
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Pivazyan G, Winters CG, Brooks DM, Sandhu FA, Cunningham BW. Biomechanical Analysis of 2 Versus 4 Rods Across the Cervicothoracic Junction in a Human Cadaveric Model. Neurosurgery 2024; 94:217-225. [PMID: 37706689 DOI: 10.1227/neu.0000000000002686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 07/27/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Posterior reconstruction of the cervicothoracic junction poses significant biomechanical challenges secondary to transition from the mobile cervical to rigid thoracic spines and change in alignment from lordosis to kyphosis. After destabilization, the objectives of the current investigation were to compare the rod strain and multidirectional flexibility properties of the cervicothoracic junction using a 4-rod vs traditional 2-rod reconstructions. METHODS Ten human cadaveric cervicothoracic specimens underwent multidirectional flexibility testing including flexion-extension, lateral bending, and axial rotation. After intact analysis, specimens were destabilized from C4 to T3 and instrumented from C3 to T4. The following reconstructions were tested: (1) 3.5-mm titanium (Ti) 2-rod, (2) 3.5-mm Ti 4-rod, (3) 4.0-mm cobalt chrome (CoCr) 2-rod, (4) 4.0-mm CoCr 4-rod, and (5) Ti 3.5- to 5.5-mm tapered rod reconstructions. The operative level range of motion and rod strain of the primary and accessory rods were quantified. RESULTS The addition of accessory rods to a traditional 2-rod construct improved the biomechanical stability of the reconstructions in all three loading modalities for Ti ( P < .05). The accessory CoCr rods improved stability in flexion-extension and axial rotation ( P < .05). The addition of accessory rods in Ti or CoCr reconstructions did not significantly reduce rod strain ( P < .05). CoCr 2 and 4 rods exhibited less strain than both Ti 2 and 4 rods. CONCLUSION Supplemental accessory rods affixed to traditional 2-rod constructs significantly improved stability of Ti alloys and CoCr alloy materials. The 4.0-mm CoCr rods provided greater stability than 3.5-mm Ti rods in flexion-extension, lateral bending, and axial rotation. While rod strain was not significantly reduced by the addition of accessory rods, it was reduced in CoCr rod treatment groups compared with the Ti rods.
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Affiliation(s)
- Gnel Pivazyan
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington , District of Columbia , USA
- Department of Orthopaedic Surgery, Musculoskeletal Research Center, MedStar Union Memorial Hospital, Baltimore , Maryland , USA
| | - Carlynn G Winters
- Georgetown University School of Medicine, Washington , District of Columbia , USA
| | - Daina M Brooks
- Department of Orthopaedic Surgery, Musculoskeletal Research Center, MedStar Union Memorial Hospital, Baltimore , Maryland , USA
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore , Maryland , USA
| | - Faheem A Sandhu
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington , District of Columbia , USA
| | - Bryan W Cunningham
- Department of Orthopaedic Surgery, Musculoskeletal Research Center, MedStar Union Memorial Hospital, Baltimore , Maryland , USA
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore , Maryland , USA
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17
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Pivazyan G, Winters CG, Brooks DM, Sandhu FA, Cunningham BW. Cervicothoracic Reconstruction with Quad Rods, Dual Rods, and Tapered Rods: An in Vitro Human Cadaveric Model. World Neurosurg 2023; 180:243-244. [PMID: 37839569 DOI: 10.1016/j.wneu.2023.10.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Affiliation(s)
- Gnel Pivazyan
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA; Department of Orthopaedic Surgery, Musculoskeletal Research Center, MedStar Union Memorial Hospital, Baltimore, Maryland, USA
| | - Carlynn G Winters
- Georgetown University School of Medicine, Washington, District of Columbia, USA
| | - Daina M Brooks
- Department of Orthopaedic Surgery, Musculoskeletal Research Center, MedStar Union Memorial Hospital, Baltimore, Maryland, USA; Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, Maryland, USA
| | - Faheem A Sandhu
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Bryan W Cunningham
- Department of Orthopaedic Surgery, Musculoskeletal Research Center, MedStar Union Memorial Hospital, Baltimore, Maryland, USA; Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, Maryland, USA
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18
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Labus KM, Wolynski J, Easley J, Stewart HL, Ilic M, Notaros B, Zagrocki T, Puttlitz CM, McGilvray KC. Employing direct electromagnetic coupling to assess acute fracture healing: An ovine model assessment. Injury 2023; 54:111080. [PMID: 37802738 PMCID: PMC10843464 DOI: 10.1016/j.injury.2023.111080] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 09/13/2023] [Accepted: 09/26/2023] [Indexed: 10/08/2023]
Abstract
OBJECTIVES This study explored the efficacy of collecting temporal fracture site compliance data via an advanced direct electromagnetic coupling (DEC) system equipped with a Vivaldi-type antenna, novel calibration technique, and multi-antenna setup (termed maDEC) as an approach to monitor acute fracture healing progress in a translational large animal model. The overarching goal of this approach was to provide insights into the acute healing dynamics, offering a promising avenue for optimizing fracture management strategies. METHODS A sample of twelve sheep, subjected to ostectomies and intramedullary nail fixations, was divided into two groups, simulating normal and impaired healing scenarios. Sequential maDEC compliance or stiffness measurements and radiographs were taken from the surgery until euthanasia at four or eight weeks and were subsequently compared with post-sacrifice biomechanical, micro-CT, and histological findings. RESULTS The results showed that the maDEC system offered straightforward quantification of fracture site compliance via a multiantenna array. Notably, the rate of change in the maDEC-measured bending stiffness significantly varied between normal and impaired healing groups during both the 4-week (p = 0.04) and 8-week (p = 0.02) periods. In contrast, radiographically derived mRUST healing measurements displayed no significant differences between the groups (p = 0.46). Moreover, the cumulative normalized stiffness maDEC data significantly correlated with post-sacrifice mechanical strength (r2 = 0.80, p < 0.001), micro-CT measurements of bone volume fraction (r2 = 0.60, p = 0.003), and density (r2 = 0.60, p = 0.003), and histomorphometric measurements of new bone area fraction (r2 = 0.61, p = 0.003) and new bone area (r2 = 0.60, p < 0.001). CONCLUSIONS These data indicate that the enhanced maDEC system provides a non-invasive, accurate method to monitor fracture healing during the acute healing phase, showing distinct stiffness profiles between normal and impaired healing groups and offering critical insights into the healing process's progress and efficiency.
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Affiliation(s)
- Kevin M Labus
- Orthopaedic Bioengineering Research Laboratory, Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, USA
| | - Jakob Wolynski
- Orthopaedic Bioengineering Research Laboratory, Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, USA
| | - Jeremiah Easley
- Preclinical Surgical Research Laboratory, Department of Clinical Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Holly L Stewart
- Preclinical Surgical Research Laboratory, Department of Clinical Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Milan Ilic
- University of Belgrade, School of Electrical Engineering, Belgrade, Serbia
| | - Branislav Notaros
- Electromagnetic Laboratory, Department of Electrical and Computer Engineering, Colorado State University, Fort Collins, Colorado, USA
| | - Taylor Zagrocki
- Orthopaedic Bioengineering Research Laboratory, Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, USA
| | - Christian M Puttlitz
- Orthopaedic Bioengineering Research Laboratory, Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, USA
| | - Kirk C McGilvray
- Orthopaedic Bioengineering Research Laboratory, Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, USA.
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Abstract
SUMMARY Pertrochanteric nonunion management is a technically challenging problem. When repair is undertaken rather than conversion arthroplasty, successful treatment revolves around accurate deformity correction, preservation of vascularity, and stable durable fixation. The decision to use an extramedullary or intramedullary implant should be influenced by nonunion-specific characteristics and patient-related conditions. Failure to understand these nuances when selecting an implant strategy often results in treatment failure. The primary purpose of this article was to discuss these variables and delineate when an intramedullary implant should be considered for treatment of a pertrochanteric nonunion. The secondary purpose was to describe the author's preferred surgical technique for implant-driven deformity correction and compression when choosing an intramedullary nail.
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Affiliation(s)
- Michael Githens
- Department of Orthopaedic Surgery, Harborview Medical Center, University of Washington, Seattle, WA
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20
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Chan DS, Moghadamian ES. Preventing the Slide in High-Energy Intertrochanteric Fractures With Intramedullary Nails. J Orthop Trauma 2023; 37:S5-S10. [PMID: 37710369 DOI: 10.1097/bot.0000000000002667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/05/2023] [Indexed: 09/16/2023]
Abstract
LEVEL OF EVIDENCE Therapeutic Level V.
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Affiliation(s)
- Daniel S Chan
- Musculoskeletal Care Orthopaedic Trauma, AtriumHealth Navicent, Macon, GA; and
| | - Eric S Moghadamian
- Department of Orthopaedic Surgery, University of Kentucky, Lexington, KY
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21
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Chatterjee S, Brockmeyer D, Zaman SKU, Roy R. Pediatric spinal instrumentation. Childs Nerv Syst 2023; 39:2865-2876. [PMID: 37691035 DOI: 10.1007/s00381-023-06142-5] [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: 07/24/2023] [Accepted: 08/30/2023] [Indexed: 09/12/2023]
Abstract
This article reviews the evolution of spinal instrumentation in the pediatric age group, starting with the cervical spine and atlantoaxial area and ending with the lower spine. The congenital and the acquired conditions which require instrumentation are described. The technical details regarding pediatric instrumentation are alluded to, and finally an attempt is made to predict the future of spinal instrumentation in this age group.
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22
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Chu Z, Wang Z, Zhang J, Tang X. The "PRIME Fix" for an osteogenesis imperfecta patient with intramedullary femoral nail cortical perforation and limb deformity. Asian J Surg 2023; 46:4433-4434. [PMID: 37130774 DOI: 10.1016/j.asjsur.2023.04.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 04/18/2023] [Indexed: 05/04/2023] Open
Affiliation(s)
- Zhenchen Chu
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, 116011, China
| | - Zhuo Wang
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, 116011, China
| | - Jian Zhang
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, 116011, China.
| | - Xin Tang
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, 116011, China.
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23
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Baumgart R, Lenze U. [Treatment with fully implantable intramedullary distraction nails for limb lengthening-a paradigm shift]. Orthopadie (Heidelb) 2023; 52:699-709. [PMID: 37620678 PMCID: PMC10477088 DOI: 10.1007/s00132-023-04418-x] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/10/2023] [Indexed: 08/26/2023]
Abstract
More than almost any other implant, fully implantable intramedullary distraction nails have changed corrective and reconstructive bone surgery. Based on the fundamentals of callus distraction, these new apparatus developments with their novel planning strategies and minimally invasive surgical techniques have opened up a wide range of indications and made the treatment reproducible and safe. The prerequisite, however, is that standardized procedures are adhered to, which concern both the preparation for the surgery, the surgery itself and the subsequent distraction treatment. Treatment with fully implantable intramedullary distraction nails should be performed at specialized centers, so that the paradigm shift in corrective and reconstructive limb surgery, which is already recognizable, will open the door for further developments.
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Affiliation(s)
- Rainer Baumgart
- ZEM - Germany, Zentrum für Extremitätenchirurgie München, Nymphenburger Str. 1, 80335, München, Deutschland.
| | - Ulrich Lenze
- ZEM - Germany, Zentrum für Extremitätenchirurgie München, Nymphenburger Str. 1, 80335, München, Deutschland
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24
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Velicki K, Mazziotti J, Pihl C, Yang S. Flexible Titanium Intramedullary Nail Displacement After Magnetic Resonance Imaging. J Am Acad Orthop Surg Glob Res Rev 2023; 7:01979360-202309000-00013. [PMID: 37747696 PMCID: PMC10519503 DOI: 10.5435/jaaosglobal-d-23-00004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 07/17/2023] [Indexed: 09/26/2023]
Abstract
CASE A previously healthy 7-year-old boy presented with midshaft radius and ulna malunion after 8 weeks of nonsurgical treatment. He underwent open reduction and internal fixation of both bones with titanium alloy nails and was placed in a long arm cast. Four weeks after surgery, the patient underwent sedated brain MRI and woke up from anesthesia with elbow pain. On cast removal, the ulnar flexible nail was noted to have displaced proximally by 1.5 cm. CONCLUSION Despite meeting American Society for Testing and Materials standards, untethered titanium orthopaedic implants are at risk of clinically significant displacement in the early postoperative period.
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Affiliation(s)
- Katherine Velicki
- From the Department of Orthopaedic Surgery, Oregon Health & Science University, Portland, OR
| | - Julianna Mazziotti
- From the Department of Orthopaedic Surgery, Oregon Health & Science University, Portland, OR
| | - Connor Pihl
- From the Department of Orthopaedic Surgery, Oregon Health & Science University, Portland, OR
| | - Scott Yang
- From the Department of Orthopaedic Surgery, Oregon Health & Science University, Portland, OR
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25
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Liu Y, Zheng Y, Huang Y, Yang G, Zhu G, Tan Q, Wu J, Liu K, Mei H. Clinical study of a new type of telescopic rod for the treatment of congenital pseudarthrosis of the tibia in children. J Pediatr Orthop B 2023; 32:405-410. [PMID: 36730032 DOI: 10.1097/bpb.0000000000001040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to investigate the initial efficacy of a new telescopic rod in the treatment of congenital pseudarthrosis of tibia (CPT) in children. A new type of telescopic rod for children was designed and its clinical results were evaluated. There were nine cases of CPT on the right and six cases on the left; there were six females and nine males. The average age at operation was 35.5 months. There were 12 cases with neurofibromatosis type 1 and 4 cases with proximal tibial dysplasia. The initial healing of tibial pseudarthrosis, proximal tibial valgus deformity, tibial length, ankle valgus, ankle function, and intramedullary rod displacement were evaluated during follow-up. All 15 cases were followed up for an average of 18.2 months, 14 cases achieved initial healing, with an average healing time of 4.3 months. Ten cases had unequal lengths of the tibia, with an average of 0.9 cm. Proximal tibial valgus occurred in seven cases and ankle valgus occurred in one child. The average range of motion of the ankle joint was 23° and the average plantar flexion was 42°. The average extension of the new telescopic rod was 1.6 cm. The displacement of the telescopic rod occurred in seven cases, there was no epiphyseal plate tethering and re-fracture. The new children's telescopic rod has a reasonable design and can extend with the growth of tibia. There are no complications of epiphyseal plate tethering and re-fracture. It provides a new choice of intramedullary fixation for the treatment of CPT.
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Affiliation(s)
- Yaoxi Liu
- Department of Pediatric Orthopaedics, Hunan Children's Hospital, The School of Pediatrics, Heng Yang Medical School, University of South China, Changsha City, Hunan Province, China
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Chen P, Fan Z, Xu N, Wang H. A biomechanical investigation of a novel intramedullary nail used to salvage failed internal fixations in intertrochanteric fractures. J Orthop Surg Res 2023; 18:632. [PMID: 37641046 PMCID: PMC10463605 DOI: 10.1186/s13018-023-04112-w] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 08/17/2023] [Indexed: 08/31/2023] Open
Abstract
PURPOSE The ideal approach for revision surgery following femoral head salvage treatments for an intertrochanteric fracture is still up for debate. A novel variety of proximal femoral bionic intramedullary nail (PFBN) has been created in clinical practice. We aimed to compare the biomechanical results of the novel implant to conventional intramedullary and extramedullary fixation in the treatment of intertrochanteric fracture following primary internal fixation failure. METHODS Using finite element analysis, we created a three-dimensional model of the intertrochanteric fracture's helical blade cut-out for this investigation. The PFBN 1 group, the PFBN 2 group, the PFNA group, and the DHS group were our four test groups. For each fracture group, the von Mises stress and displacements of the femur and internal fixation components were measured under 2100 N axial loads. RESULTS The values for the femoral displacement in the PFBN1 group, PFBN2 group, PFNA group, and DHS group were 6.802 mm, 6.716 mm, 8.080 mm, and 8.679 mm, respectively. The internal implant displacement values were 6.201 mm, 6.138 mm, 7.396 mm, and 8.075 mm in the PFBN1 group, PFBN2 group, PFNA group, and DHS group, respectively. The maximum von Mises Stress in the femoral was 187.2 MPa, 85.18 MPa, 106.6 MPa, and 386.2 MPa in the PFBN1 groups, PFBN2 groups, PFNA groups, and DHS groups, respectively. In the PFBN1 groups, PFBN2 groups, PFNA groups, and DHS groups, the maximum von Mises Stress in internal fixation was 586.7 MPa, 559.8 MPa, 370.7 MPa, and 928.4.8 MPa, respectively. CONCLUSION Our biomechanical research demonstrates that intramedullary fixation is more stable than extramedullary fixation when salvaging failed internal fixations in intertrochanteric fracture. Compared with PFNA and DHS, PFBN showed better biomechanical stability in the treatment of patients with revised intertrochanteric fractures. In light of this, we advocate PFBN fixation as the method of choice for intertrochanteric fracture revision. This result still has to be confirmed in more clinical research.
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Affiliation(s)
- Ping Chen
- The Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine (Guangdong Provincial Hospital of Traditional Chinese Medicine), Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
| | - Zhirong Fan
- The Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine (Guangdong Provincial Hospital of Traditional Chinese Medicine), Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
| | - Nengneng Xu
- Panyu Hospital of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, 511401, China
| | - Haizhou Wang
- The Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine (Guangdong Provincial Hospital of Traditional Chinese Medicine), Guangzhou University of Chinese Medicine, Guangzhou, 510120, China.
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Fu H, Wu J, Wu X. Intramedullary Nail for Treatment of Proximal Humeral Fracture: A Credible Fixation in Comminuted Calcar. Orthop Surg 2023; 15:2007-2015. [PMID: 36514186 PMCID: PMC10432444 DOI: 10.1111/os.13616] [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: 08/29/2022] [Revised: 10/31/2022] [Accepted: 11/04/2022] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Restoration of the medial support is especially important for the treatment of proximal humeral fractures. The objective of this study was to investigate the radiographic and clinical outcomes of intramedullary nail fixation with a special focus on the presence of calcar comminution. METHODS In this retrospective study of patients with displaced proximal humeral fractures that were treated by intramedullary nail between January 2018 and July 2021, fracture morphology and the calcar integrity were noted on preoperative radiographs. Patients were divided into two groups according to calcar integrity. During follow-up, radiological assessment and functional outcome, including the deltoid tuberosity index (DTI), neck shaft angle (NSA), visual analog scale (VAS), the American Shoulder and Elbow Surgeons (ASES) score, the Simple Shoulder Test (SST) score, active and passive range of motion, were performed. A Student t-test and univariate logistic regression analysis was used. RESULTS A total of 83 patients (54 female, 29 male) had complete follow-up (average, 12.8 months; range, 10 to 33 months) and functional assessment in our study. The average age was 58.6 years (range, 20 to 89 years). The mean loss of NSA was 4° (range, 0°-12°) and no significant difference was found between two groups (p = 0.27). DTI had an average of 1.50 ± 0.19 (range 1.13-2.04). Patients with intact calcar achieved greater range of forward elevation (129.06 ± 11.91 vs. 121.05 ± 11.97, p = 0.01), and higher SST scores (8.61 ± 1.85 vs. 7.37 ± 2.22, p = 0.02). Two groups showed similar outcomes in VAS, ASES score, and range of abduction. One patient demonstrated a proximal interlocking screw cutting through and osteonecrosis of the humeral head, who underwent a second surgery for screw removal. There were no cases of infection, malunion, nonunion, nerve injury, subacromial impingement, or rotator cuff tear during the study period. CONCLUSION Intramedullary nail can favorably be used to manage proximal humeral fractures with good early radiographic and functional outcomes, even for those with comminuted calcar.
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Affiliation(s)
- Huichao Fu
- Department of Orthopaedic Traumatology, Trauma Center, Shanghai General HospitalShanghaiChina
| | - Jianhong Wu
- Department of Orthopaedic Traumatology, Trauma Center, Shanghai General HospitalShanghaiChina
| | - Xiaoming Wu
- Department of Orthopaedic Traumatology, Trauma Center, Shanghai General HospitalShanghaiChina
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Arif H, Molina S, LeBrun C. Removal of a Bent Tibial Intramedullary Nail Through Osteotomy and Partial Sectioning: A Case Report. JBJS Case Connect 2023; 13:01709767-202309000-00047. [PMID: 37590403 DOI: 10.2106/jbjs.cc.23.00186] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
CASE An 18-year-old male patient presented with a closed fracture of the left tibia and fibula and a bent intramedullary nail after a repeat motorcycle accident. The patient was 5 weeks postoperative from intramedullary nailing of a closed left tibia fracture. The site of angulation of the tibial nail was noted to be more proximal than the fracture site. Partial sectioning of the nail through an osteotomy permitted the removal of the nail and revision tibial nailing. CONCLUSION This is the first reported use of an osteotomy and partial sectioning during the extraction of a bent tibial intramedullary nail.
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Affiliation(s)
- Haad Arif
- School of Medicine, University of California Riverside, Riverside, California
| | - Steven Molina
- School of Medicine, University of California Riverside, Riverside, California
| | - Christopher LeBrun
- School of Medicine, University of California Riverside, Riverside, California
- Department of Orthopaedics, Riverside Community Hospital, Riverside, California
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Cavazos DR, Mansour DT, Vaidya R, Oliphant BW. Percutaneous Treatment of Locked Pubic Symphysis with the Anterior Subcutaneous Pelvic Fixator (INFIX): A Case Report. JBJS Case Connect 2023; 13:01709767-202309000-00088. [PMID: 37733912 DOI: 10.2106/jbjs.cc.23.00322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
CASE A 54-year-old woman was involved in a motor vehicle collision and sustained a lateral compression type 1 pelvic ring fracture with pubic symphyseal dislocation or a "locked pubic symphysis." Her injury failed to reduce with closed reduction maneuvers under anesthesia and necessitated a percutaneous reduction using a distraction force applied through supra-acetabular placed pedicle screws. This anterior subcutaneous internal pelvic fixator (INFIX) was also used to stabilize the injury. CONCLUSION This is the first reported case where a locked pubic symphysis, which failed standard closed reduction measures, was reduced and stabilized through a percutaneous technique, using the INFIX.
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Affiliation(s)
- Daniel R Cavazos
- Department of Orthopaedic Surgery, Detroit Medical Center, Detroit, Michigan
- Department of Orthopaedic Surgery, Wayne State University School of Medicine, Detroit, Michigan
| | - Devone T Mansour
- Department of Orthopaedic Surgery, Detroit Medical Center, Detroit, Michigan
| | - Rahul Vaidya
- Department of Orthopaedic Surgery, Detroit Medical Center, Detroit, Michigan
- Department of Orthopaedic Surgery, Wayne State University School of Medicine, Detroit, Michigan
| | - Bryant W Oliphant
- Department of Orthopaedic Surgery, Detroit Medical Center, Detroit, Michigan
- Department of Orthopaedic Surgery, Wayne State University School of Medicine, Detroit, Michigan
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Safi İKA, Samadov F, Kanar M, Tüter İ, Özdemir HM. Deformity correction and limb lengthening with externally controlled motorized extendable intramedullary nails: Comparison of 2 different nails. Acta Orthop Traumatol Turc 2023; 57:169-175. [PMID: 37670451 PMCID: PMC10544650 DOI: 10.5152/j.aott.2023.23026] [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] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 06/20/2023] [Indexed: 09/07/2023]
Abstract
OBJECTIVE The aim of this study was to assess and compare the clinical, radiological, and functional results of patients treated with FITBONE or PRECICE nails due to deformity and length discrepancy in their lower extremities. METHODS This retrospective cohort study included 41 patients with length discrepancy and deformity in their lower extremities, who underwent limb lengthening surgery with either FITBONE (group F) or PRECICE (group P) nails between 2010 and 2020. The mean postoperative follow-up period was 15.95 ± 4.75 months in group F (20 patients) and 20.48 ± 7.57 months in group P (21 patients). Lower extremity mechanical and anatomical axes were measured on x-rays preoperatively and at the end of treatment. Consolidation and distraction indexes were also calculated to assess bone healing. Lower Extremity Functional Scale test was used to evaluate functional outcomes and quality of life. RESULTS Neither of the treatment methods caused deviations in the mechanical axes and femoral distal angles (P > .05). No statistically significant difference in consolidation and distraction indexes was found between the groups (P > .05). Postoperative complications were seen in 3 of the patients in group F and 4 of the patients from group P. There was no significant difference in Lower Extremity Functional Scale scores between groups (P = .425). CONCLUSION This study has demonstrated that treatment with both the FITBONE and PRECICE nails resulted in improved physical and emotional functional outcomes. Both nails had similar radiographic results, complication rates, high patient compliance, and good cosmesis. LEVEL OF EVIDENCE Level III, Therapeutic Study.
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Affiliation(s)
| | - Farid Samadov
- SBU Şişli Hamidiye Etfal Research and Training Hospital, Istanbul, Turkey
| | - Muharrem Kanar
- SBU Şişli Hamidiye Etfal Research and Training Hospital, Istanbul, Turkey
| | - İsmail Tüter
- SBU Şişli Hamidiye Etfal Research and Training Hospital, Istanbul, Turkey
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Fralinger DJ, Kraft DB, Rogers KJ, Thacker MM, Kruse RW, Franzone JM. The Fate of the Bent Rod in Children With Osteogenesis Imperfecta. J Pediatr Orthop 2023; 43:e465-e470. [PMID: 37026790 DOI: 10.1097/bpo.0000000000002409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
BACKGROUND Osteogenesis imperfecta (OI) is a genetic disorder characterized by brittle bones and long bone deformity. Realignment and intramedullary rodding with telescopic rods are indicated for progressive deformity and can help prevent fractures. Rod bending is a reported complication of telescopic rods and a common indication for revision; however, the fate of bent lower extremity telescopic rods in the setting of OI has not been reported. METHODS Patients with OI at a single institution who underwent lower extremity telescopic rod placement with at least 1-year follow-up were identified. Bent rods were identified, and for these bone segments, we collected the location and angle of bend, subsequent telescoping, refracture, increasing angulation of bend, and date of revision. RESULTS One hundred sixty-eight telescopic rods in 43 patients were identified. Forty-six rods (27.4%) bent during follow-up, with an average angulation of 7.3 (range: 1 to 24) degrees. In patients with severe OI, 15.7% of rods bent compared with 35.7% in nonsevere OI ( P =0.003). The proportion of bent rods was different between independent and nonindependent ambulators (34.1% and 20.5%; P =0.035). Twenty-seven bent rods (58.7%) were revised, with 12 rods (26.0%) revised early (within 90 d). The angulation of rods that were revised early was significantly higher than rods not (14.6 and 4.3 degrees, P <0.001). Of the 34 bent rods not revised early, the average time to revision or final follow-up was 29.1 months. Twenty-five rods (73.5%) continued to telescope, 14 (41.2%) increased in angulation (average 3.2 degrees), and 10 bones (29.4%) refractured. None of the refractures required immediate rod revision. Two bones had multiple refractures. CONCLUSIONS Bending is a common complication of telescopic rods in the lower extremities of patients with OI. It is more common in independent ambulators and patients with nonsevere OI, possibly because of the increased demand placed on the rods. Rods with a small bend and maintained fixation can telescope and need not be an indication for immediate revision. LEVEL OF EVIDENCE Level III-Retrospective review.
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Affiliation(s)
- David J Fralinger
- Department of Orthopaedics, Nemours Children's Health, Delaware Valley, Wilmington, DE
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Ye L, Guan J, Wang X, Chen X, Lu H, Xiao Y, Dai X, Wu M. [Modified internal fixator combined with sacroiliac screws in treatment of Tile C1.3 pelvic fracture]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2022; 36:1447-1452. [PMID: 36545850 DOI: 10.7507/1002-1892.202208014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Objective To investigate the effectiveness of modified internal fixator (INFIX) to fix the anterior pelvic ring for Tile C1.3 pelvic fracture by comparing with the traditional INFIX. Methods The patients with Tile C1.3 pelvic fractures admitted between April 2018 and June 2021 were taken as the study objects. Of them, 55 cases were included in the study according to the selection criteria. During operation, the anterior pelvic ring was fixed with the modified INFIX in 30 cases (modified group) and with the traditional INFIX in 25 cases (control group). The posterior pelvic ring in 55 cases was fixed with sacroiliac screws. There was no significant difference between the two groups in gender, age, cause of injury, time from injury to operation, and combined injury ( P>0.05). The operation time, intraoperative blood loss, and complications were recorded and compared between the two groups. The X-ray film was taken to evaluate the reduction of the anterior pelvic ring after operation, grade the reduction according to the Matta scoring standards, and observe the fracture healing and healing time. The function was evaluated according to Majeed scoring standards during follow-up. Results The operation time of the modified group was significantly longer than that of the control group ( Z=-3.837, P<0.001), but there was no significant difference in the intraoperative blood loss between the two groups ( t=-1.831, P=0.076). All patients were followed up 12-18 months (mean, 14 months). X-ray film reexamination showed that the excellent and good rate of Matta scoring for anterior pelvic ring reduction in the modified group was 88.00%, which was significantly better than that in the control group (63.33%) ( χ 2=4.373, P=0.037). All fractures healed, and the fracture healing time of the modified group and the control group was (12.04±3.59) and (14.83±4.83) weeks respectively, with a significant difference ( t=2.401, P=0.020). At last follow-up, the excellent and good rates of Majeed scoring were 80.00% in the modified group and 76.67% in the control group, with no significant difference ( χ 2=0.089, P=0.766). In the modified group, 2 cases (8%) had complications, all of which were incision infection above pubic symphysis. In the control group, 9 cases (30%) had complications, including 5 cases of lateral femoral cutaneous nerve injury, 2 cases of femoral nerve paralysis, and 2 cases of delayed fracture healing. The incidence of complications was significantly lower in the modified group than in the control group ( χ 2=4.125, P=0.042). Conclusion Compared with the traditional INFIX, the modified INFIX to fix the anterior pelvic ring for Tile C1.3 pelvic fracture has fewer complications, better stability, shorter fracture healing time, and lower risk of nerve injury.
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Affiliation(s)
- Longfei Ye
- Department of Orthopaedics, the First Affiliated Hospital of Bengbu Medical College, Anhui Key Laboratory of Tissue Transplantation, Bengbu Anhui, 233000, P. R. China
| | - Jianzhong Guan
- Department of Orthopaedics, the First Affiliated Hospital of Bengbu Medical College, Anhui Key Laboratory of Tissue Transplantation, Bengbu Anhui, 233000, P. R. China
| | - Xiaopan Wang
- Department of Orthopaedics, the First Affiliated Hospital of Bengbu Medical College, Anhui Key Laboratory of Tissue Transplantation, Bengbu Anhui, 233000, P. R. China
| | - Xiaotian Chen
- Department of Orthopaedics, the First Affiliated Hospital of Bengbu Medical College, Anhui Key Laboratory of Tissue Transplantation, Bengbu Anhui, 233000, P. R. China
| | - Hongxin Lu
- Department of Orthopaedics, the First Affiliated Hospital of Bengbu Medical College, Anhui Key Laboratory of Tissue Transplantation, Bengbu Anhui, 233000, P. R. China
| | - Yuzhou Xiao
- Department of Orthopaedics, the First Affiliated Hospital of Bengbu Medical College, Anhui Key Laboratory of Tissue Transplantation, Bengbu Anhui, 233000, P. R. China
| | - Xiusong Dai
- Department of Orthopaedics, the First Affiliated Hospital of Bengbu Medical College, Anhui Key Laboratory of Tissue Transplantation, Bengbu Anhui, 233000, P. R. China
| | - Min Wu
- Department of Orthopaedics, the First Affiliated Hospital of Bengbu Medical College, Anhui Key Laboratory of Tissue Transplantation, Bengbu Anhui, 233000, P. R. China
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Yu Y, Kang J, Kim N, Heo S. Accuracy of a patient-specific 3D-printed drill guide for placement of bicortical screws in atlantoaxial ventral stabilization in dogs. PLoS One 2022; 17:e0272336. [PMID: 35913954 PMCID: PMC9342780 DOI: 10.1371/journal.pone.0272336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 07/18/2022] [Indexed: 11/26/2022] Open
Abstract
Atlantoaxial instability (AAI) in dogs refers to abnormal motion at the C1–C2 articulation due to congenital or developmental anomalies. Surgical treatment options for AAI include dorsal and ventral stabilization techniques. Ventral stabilization techniques commonly utilize transarticular and vertebral body screws or pins. However, accurate screw insertion into the vertebrae of C1 and C2 is difficult because of the narrow safety corridors. This study included 10 mixed dogs, 1 Pomeranian, and 1 Shih-Tzu cadaver. All dogs weighed <10 kg. Each specimen was scanned using computed tomography (CT) from the head to the 7th cervical vertebrae. This study used 12 bone models and 6 patient-specific drill guides. Bone models were made using CT images and drill guides were created through a CAD (computer-aided design) program. A total of six cortical screws were used for each specimen. Two screws were placed at each of the C1, C2 cranial, and C2 caudal positions. Postoperative CT images of the cervical region were obtained. The degree of cortex breaching and angle and bicortical status of each screw was evaluated. The number of screws that did not penetrate the vertebral canal was higher in the guided group (33/36, 92%) than in the control group (20/36, 56%) (P = 0.003). The screw angles were more similar to the reference angle compared to the control group. The number of bicortically applied screws in the control group was 28/36 (78%) compared to 34/36 (94%) in the guided group. Differences between the preoperative plan and the length of the applied screw at the C1 and C2 caudal positions were determined by comparing the screw lengths in the guide group. The study results demonstrated that the use of a patient-specific 3D-printed drill guide for AAI ventral stabilization can improve the accuracy of the surgery. The use of rehearsal using bone models and a drilling guide may improve screw insertion accuracy.
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Affiliation(s)
- Yong Yu
- Department of Veterinary Surgery, Jeonbuk National University, Gobong-ro, Iksan, South Korea
| | - Jinsu Kang
- Department of Veterinary Surgery, Jeonbuk National University, Gobong-ro, Iksan, South Korea
| | - Namsoo Kim
- Department of Veterinary Surgery, Jeonbuk National University, Gobong-ro, Iksan, South Korea
| | - Suyoung Heo
- Department of Veterinary Surgery, Jeonbuk National University, Gobong-ro, Iksan, South Korea
- * E-mail:
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Stotter C, Reiter E, Schretter W, Reuter P, Nehrer S, Klestil T. Influence of the femoral entry point for intramedullary alignment in total knee arthroplasty: A computer-aided design approach. Jt Dis Relat Surg 2022; 33:294-302. [PMID: 35852187 PMCID: PMC9361112 DOI: 10.52312/jdrs.2022.645] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 04/06/2022] [Indexed: 11/14/2022] Open
Abstract
Objectives Materials and methods Results Conclusion
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Affiliation(s)
- Christoph Stotter
- Department For Health Sciences, Medicine and Research, Danube University Krems, 3500 Krems, Austria.
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Hansen CH, Bomar JD, Badrinath R, Upasani VV. Telescoping screw fixation compared to traditional in situ screw fixation for slipped capital femoral epiphysis: clinical, radiographic and patient-reported outcomes. J Pediatr Orthop B 2022; 31:224-231. [PMID: 34050119 DOI: 10.1097/bpb.0000000000000869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study compares clinical, radiographic and patient-reported outcomes among telescoping and traditional screws for the treatment of slipped capital femoral epiphysis (SCFE). We hypothesized that telescoping screws would prevent slip progression and result in preserved femoral neck growth and improved patient-reported outcomes. Traditional screws were compared to telescoping screws in a 2:1 matched cohort based on age at initial surgery, length of radiographic follow-up and whether or not the hip was pinned prophylactically or as a treatment for SCFE. Neck length and telescoping screw length were measured. The patient-reported outcomes were obtained at routine clinic visits. Total 42 hips were included with a mean follow-up of 24.5 ± 3.3 months. No patients developed avascular necrosis, chondrolysis or needed revision surgical procedures. Telescoping screws increased in length for the entire cohort by a mean of 6.0 ± 4.3 mm. Neck length change was not different in SCFE hips when treated with traditional screws vs. telescoping screws (P = 0.527). However, there was a difference in neck length change between the two groups when comparing prophylactically treated hips (P = 0.001). There were no significant differences in patient-reported outcomes among hips treated with telescoping screws compared to traditional screws. Traditional and telescoping screws are both effective for the treatment of SCFE. Telescoping screws have an advantage when prophylactically treating hips that are at risk of slipping as they don't lead to the coxa breva that is seen with traditional screws. However, both treatment methods had similar patient-reported outcomes.
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Affiliation(s)
- Cody H Hansen
- Department of Orthopedics, University of California, San Diego Medical Center, San Diego, California
| | - James D Bomar
- Department of Orthopedics, Rady Children's Hospital, San Diego, California, USA
| | - Raghav Badrinath
- Department of Orthopedics, University of California, San Diego Medical Center, San Diego, California
| | - Vidyadhar V Upasani
- Department of Orthopedics, University of California, San Diego Medical Center, San Diego, California
- Department of Orthopedics, Rady Children's Hospital, San Diego, California, USA
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Affiliation(s)
- Benjamin K Potter
- Norman M. Rich Professor & Chair, Uniformed Services University-Walter Reed Department of Surgery, Bethesda, MD, USA
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Yong B, De Wouters S, Howard A. Complications of Elongating Intramedullary Rods in the Treatment of Lower Extremity Fractures for Osteogenesis Imperfecta: A Meta-Analysis of 594 Patients in 40 Years. J Pediatr Orthop 2022; 42:e301-e308. [PMID: 35034037 DOI: 10.1097/bpo.0000000000002040] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Osteogenesis imperfecta is a collagen mutation-related disease characterized by bone fragility and other extraskeletal manifestations. Intramedullary fixation for deformity correction or fracture is the standard care. Elongating rods are designed to accommodate growth, with the aim of preventing additional operations and/or complications associated with nonelongating rods. Although elongating rods have been in use for many years, estimates of the clinical outcomes vary. We conducted a systematic review and meta-analysis to synthesize the literature on outcomes of elongating rods and nonelongating rods. Meta-analysis was used to compare the complication rates and reoperation rates. METHODS We conducted the literature search, systematic review, and meta-analysis in accordance with Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA) guidelines. Comparative cohort studies and large case series detailing complication rates and reoperation rates of elongating and nonelongating rods were included. Random effect models were used to summarize the complication rates and reoperation rates of intramedullary rod procedures. RESULTS A total of 397 studies were identified and 24 studies were included in the final cohort. Compared with rates from nonelongating rods, osteogenesis imperfecta Patients using elongating rods had a complication rate of 61% and a reoperation rate of 78%. Reoperation rates dropped with succeeding generations of elongating rods. Pooling data from 600 patients, we identified a 9% complication rate per rod per follow up year and 5% reoperation rate per rod and per follow up year in the cohort of elongating rod fixation. The Bailey-Dubow rod had the highest complication rate per rod per follow up year (12%), largely because of its T piece relate problems. The most popular fixator Fassier-Duval rod had a complication rate per rod per follow up year of 9%. About 68% of complications were mechanical-biological related. CONCLUSION Pooling data from published literature demonstrates the advantage of elongating rods over nonelongating rods. However, as high as 9% complication rate per rod per follow up year was associated with elongating fixation. Notably, most complications are both mechanical and biological related. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Bicheng Yong
- Division of Orthopedic Surgery, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
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Keshen S, Lee JM, Khoshbin A, Atrey A. Use of an Intramedullary Nail to Guide Distal Femoral Resection in Primary Total Knee Arthroplasty: A Case Report. JBJS Case Connect 2021; 11:01709767-202109000-00104. [PMID: 34473662 DOI: 10.2106/jbjs.cc.21.00229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 67-year-old female patient presented for total knee arthroplasty (TKA) 4 years after receiving an antegrade femoral nail for bisphosphonate-induced femur fracture. She underwent a single-stage procedure with retention of femoral hardware. The femoral nail was used as a surrogate guide to reference the anatomical axis of the femur to position the distal femoral cutting block with good results. CONCLUSION TKA is possible in patients with femoral intramedullary hardware without the need for hardware removal or extramedullary referencing. This report highlights a technique for the alignment of the femoral component by using the implanted femoral nail as an in situ guide for the placement of the distal femoral cutting block.
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Affiliation(s)
- Sam Keshen
- Division of Orthopaedic Surgery, St. Michael's Hospital, Toronto, Ontario, Canada
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Holler JT, Kandemir U. Intraoperative Fluoroscopy for Correcting Rotational Malalignment After Fixation of Tibial Shaft Fracture: A Case Report. JBJS Case Connect 2021; 11:01709767-202109000-00087. [PMID: 34398844 DOI: 10.2106/jbjs.cc.21.00234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 29-year-old man previously treated with closed reduction and intramedullary nail (IMN) fixation for a right tibial shaft fracture presented with complaint of the foot pointing outward compared with uninjured side. He was diagnosed with tibial malrotation, and a novel intraoperative imaging technique was used for correction. CONCLUSION Literature suggests that the prevalence of tibial malrotation after IMN fixation is greater than previously thought. This case highlights the need for a simple and reliable intraoperative approach to guide and confirm correction of tibial malrotation after IMN fixation, and it demonstrates a technique that can be implemented with immediate results.
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Affiliation(s)
- Jordan T Holler
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California
- UCSF School of Medicine, University of California, San Francisco, San Francisco, California
| | - Utku Kandemir
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California
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Rabau O, Addar A, Saran N, Quellet J. The Use of Growing Rods in the Treatment of Early Onset Scoliosis for Patients with Type 4 Osteogenesis Imperfecta: A Case Report. Isr Med Assoc J 2021; 23:529-530. [PMID: 34392632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Oded Rabau
- Department of Orthopedic Surgery, McGill Scoliosis and Spine Centre, McGill University, Shriners Hospital for Children Canada, Quebec, Canada
- Department of Orthopedic Surgery, Spine Unit, Shamir Medical Center, Assaf Harofeh, Israel
| | - Abdullah Addar
- Department of Orthopedic Surgery, McGill Scoliosis and Spine Centre, McGill University, Shriners Hospital for Children Canada, Quebec, Canada
| | - Neil Saran
- Department of Orthopedic Surgery, McGill Scoliosis and Spine Centre, McGill University, Shriners Hospital for Children Canada, Quebec, Canada
| | - Jean Quellet
- Department of Orthopedic Surgery, McGill Scoliosis and Spine Centre, McGill University, Shriners Hospital for Children Canada, Quebec, Canada
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Franzone JM, Sargent BM, Dang Do AN, Knue M, Marini JC, Kruse RW. Stress Shielding in the Setting of Osteogenesis Imperfecta and the Effect of Downsizing an Intramedullary Rod: A Case Report. JBJS Case Connect 2021; 11:01709767-202109000-00042. [PMID: 34297706 DOI: 10.2106/jbjs.cc.20.00680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE Cortical atrophy, or stress shielding, secondary to a large-diameter femoral intramedullary rod was noted over almost a decade in a now 14-year-old girl with osteogenesis imperfecta (OI). After an initial minimally invasive unsuccessful revision, we downsized the left femur rod with realignment and noted restoration of the left femur cortical thickness. CONCLUSION We demonstrate the significant functional impact of stress shielding and its evolution over a protracted period and outline treatment principles. To our knowledge, this is the first report of treatment of stress shielding of a long bone in the setting of OI.
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Affiliation(s)
- Jeanne M Franzone
- Department of Orthopaedic Surgery, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - Brandi M Sargent
- Heritable Disorders of Bone and Extracellular Matrix, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
- Pediatric Residency Program, University of Maryland Medical Center, Baltimore, Maryland
| | - An N Dang Do
- National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Marianne Knue
- Pediatric Residency Program, University of Maryland Medical Center, Baltimore, Maryland
| | - Joan C Marini
- Heritable Disorders of Bone and Extracellular Matrix, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Richard W Kruse
- Department of Orthopaedic Surgery, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware
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Lee J, Chang SH, Cho HC, Song KS. Anterior Bridging Bone in a Newly Designed Cage for Lumbar Interbody Fusion: Radiographic and Finite Element Analysis. World Neurosurg 2021; 154:e389-e397. [PMID: 34284159 DOI: 10.1016/j.wneu.2021.07.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 07/08/2021] [Accepted: 07/09/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To evaluate the distribution of multiple anterior bridging bone (ABB) patterns using a newly designed interbody cage with 4 anterior holes that enable communication between the inside and outside of the cage and to estimate its mechanical effect by finite element analysis (FEA). METHODS Patients underwent single-level lumbar interbody fusion using ABB cages. Two raters evaluated the distribution patterns of ABB on computed tomography scans 1 year after surgery. We defined the term H-fusion as the presence of complete anterior extracage and intracage bone bridging, with ≥1 ABBs between them. We performed finite element analysis to investigate the effect of ABB on maximal stiffness. RESULTS The study enrolled 98 patients. ABB was most frequently observed in the medial hole of the cages (73.7%). The mean number of ABBs was 3.65, and H-fusion was observed at 135 levels (34%). Postoperative improvement in the Oswestry Disability Index was significantly higher in patients who achieved interbody fusion and H-fusion than in patients who did not. As ABB was added, the increment in the relative maximal stiffness was most affected under flexion and extension forces. CONCLUSIONS We observed an average of 3.65 complete ABBs. Finite element analysis demonstrated that ABB could increase the stability in fused segments, especially under flexion and extension stress. Our results suggest that the ABB cage, which allows communicating cross-bridging between inside and outside of the cage, may facilitate a more stable fusion process than a conventionally designed cage.
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Affiliation(s)
- Jeongik Lee
- Department of Orthopedic Surgery, Chung-Ang University Hospital, College of Medicine, Chung-Ang University, Seoul, South Korea
| | - Seung-Hwan Chang
- School of Mechanical Engineering, Chung-Ang University, Seoul, South Korea
| | - Hyung-Chul Cho
- Department of Orthopedic Surgery, Chung-Ang University Hospital, College of Medicine, Chung-Ang University, Seoul, South Korea
| | - Kwang-Sup Song
- Department of Orthopedic Surgery, Chung-Ang University Hospital, College of Medicine, Chung-Ang University, Seoul, South Korea.
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Xu D, Shi Y, Luo P, Wang W, Guo W, Lou W, Chen J. Influential factors of subacromial impingement syndrome after hook plate fixation for acromioclavicular joint dislocation: A retrospective study. Medicine (Baltimore) 2021; 100:e26333. [PMID: 34115049 PMCID: PMC8202590 DOI: 10.1097/md.0000000000026333] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 05/16/2021] [Indexed: 01/04/2023] Open
Abstract
Subacromial impingement syndrome (SIS) after hook plate fixation for acromioclavicular joint (AC) dislocation was the most common complication. However, the researches on its' influential factors were rare. The purpose of this study was to identify the risk factors by analyzing the influencing factors of postoperative SIS and minimize the incidence of SIS in clinical surgery.We retrospectively analyzed the prospectively collected data from 330 consecutive patients with AC joint dislocation between August 2014 and August 2017 at our institute. The SIS was presented as the dependent variable at the last follow-up when the internal fixation was removed. The independent variables included age, gender, body-mass index (BMI), smoking status, alcohol consumption, type of injury, Rockwood Classification, site of injury, operation time, injury-to-surgery, the distance between the hook body and the acromion (DBA), the depth of hook tip (DHT), the distance between the hook plate and the humeral head (DHH), the distance between the acromion and the humeral head (DAH), the hook plate angle (AHP) and acromial shape. Logistic regression analysis was performed to identify independent influential factors of SIS.A total of 312 cases were included and 18 cases were lost. The follow-up rate was 94.5%. In without SIS group, there were 225 cases (123 males and 102 females). In with SIS group, a total of 87 cases were included (56 males and 31 females). The incidence of SIS was 27.8%. DHT (OR = 9.385, 95% CI = 4.883 to 18.040, P < .001) and DBA (OR = 2.444, 95% CI = 1.591 to 3.755, P < .001) were the significant independent risk factor for SIS of AC dislocation treat with hook plate. DAH (OR = 0.597, 95% CI = 0.396 to 0.900, P = .014) and acromial shape with flat and straight (OR = 0.325, 95% CI = 0.135 to 0.785, P = .012) were also independent factors of SIS, but they were all protective.The SIS had a high incidence in fixation of clavicular hook plate for AC dislocation. DHT and DBA were two independent risk factors, DAH and acromial shape with flat and straight were two independent protective factors for SIS. In clinical surgery, we should avoid risk factors to reduce the incidence of SIS.
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Affiliation(s)
- Ding Xu
- Department of Orthopedic Trauma Surgery, Ningbo No.6 Hospital
- Department of Orthopedic Trauma Surgery, Shangyu people's Hospital
| | - Yulong Shi
- Department of Orthopedic Trauma Surgery, RWTH Aachen University, Germany
| | - Peng Luo
- Department of Orthopedic Trauma Surgery, The Second Affiliated Hospital and Yuying Children's hospital of Wenzhou Medical University, China
| | - Weikang Wang
- Department of Orthopedic Trauma Surgery, RWTH Aachen University, Germany
| | - Weijun Guo
- Department of Orthopedic Trauma Surgery, The Second Affiliated Hospital and Yuying Children's hospital of Wenzhou Medical University, China
| | - Weigang Lou
- Department of Orthopedic Trauma Surgery, Ningbo No.6 Hospital
| | - Jianming Chen
- Department of Orthopedic Trauma Surgery, Ningbo No.6 Hospital
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Abstract
PURPOSE OF REVIEW The purpose of this review is to precise the indications for intramedullary rodding of long bones in osteogenesis imperfecta, the classic treatment for fractures and deformities in this condition. RECENT FINDINGS The use of plates and screws alone is not recommended, but its use in conjunction with rodding is becoming more popular as demonstrated in recent literature. The different types of rods are reviewed and their advantages/disadvantages exposed. There is a clear advantage for telescopic rods in terms of incidence of revision surgery but complications are still to be expected. An interdisciplinary approach combining a medical treatment with a surgical correction of deformities as well as a rehabilitation program is the key for success in the treatment of osteogenesis imperfecta children.
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Affiliation(s)
- François R Fassier
- Shriners Hospitals for Children® - Canada, 1003 Décarie Boulevard, Office 6.56, Montréal, Québec, H4A 0A9, Canada.
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Kılıçaslan ÖF, Akalın S, Tokgöz MA, Çetin H, Etli İ. Comparison of Pedicle Screws Versus Hybrid Fixation With Sublaminar Polyester Bands in the Treatment of Neuromuscular Scoliosis. World Neurosurg 2021; 151:e672-e681. [PMID: 33940277 DOI: 10.1016/j.wneu.2021.04.097] [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] [Received: 03/09/2021] [Revised: 04/20/2021] [Accepted: 04/21/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND The choice of implants in neuromuscular scoliosis (NMS) surgery remains controversial. Sublaminar polyester bands (SPBs) seem to be a promising alternative implant. The purpose of current study was to compare clinical and radiologic results of posterior instrumentation and fusion using hybrid constructs versus only pedicle screws for NMS treatment. METHODS In 24 patients, pedicle screws were used in all segments, and 18 patients underwent hybrid fixation. Cobb angle, thoracic kyphosis, lumbar lordosis angles, and pelvic obliquity were compared before and immediately after surgery, at the last follow-up radiographs. Demographic, clinical information, duration of surgery, estimated blood loss (EBL), blood transfusion, and complications were compared between groups. Additionally, patients were assessed for pain with visual analog scale (VAS) and quality of life with Short Form 36 (SF-36) and the Oswestry scale. RESULTS Baseline characteristics of patients were similar except for EBL (P = 0.002) and follow-up duration (P = 0.004). The mean curve correction was 58.1% in the hybrid group, and 67.6% in the screw group (P = 0.07), and loss of correction was significantly lower in hybrid group (2.72° ± 1.48° vs. 3.66° ± 1.52°, P = 0.049). Functional scores at final follow-up were equal in both groups (VAS P = 0.865, Oswestry P = 0.097, SF-36 Physical P = 0.358, SF-36 Mental P = 0.145). CONCLUSIONS SPBs might be a better fixation alternative at the apex of rigid spinal deformity in NMS. The deformity can be corrected with less blood loss and at a similar rate of correction, with similar rate complications compared with pedicle screws.
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Affiliation(s)
- Ömer Faruk Kılıçaslan
- Department of Orthopaedics and Traumatology, Antalya Training And Research Hospital, Ankara, Turkey
| | - Serdar Akalın
- Department of Orthopaedics and Traumatology, Antalya Training And Research Hospital, Ankara, Turkey
| | - Mehmet Ali Tokgöz
- Department of Orthopaedics and Traumatology, Ankara Keçiören Training and Research Hospital, Ankara, Turkey.
| | - Hakan Çetin
- Department of Orthopaedics and Traumatology, Antalya Training And Research Hospital, Ankara, Turkey
| | - İbrahim Etli
- Department of Orthopaedics and Traumatology, Antalya Training And Research Hospital, Ankara, Turkey
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Tu P, Gao Y, Lungu AJ, Li D, Wang H, Chen X. Augmented reality based navigation for distal interlocking of intramedullary nails utilizing Microsoft HoloLens 2. Comput Biol Med 2021; 133:104402. [PMID: 33895460 DOI: 10.1016/j.compbiomed.2021.104402] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [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] [Received: 01/31/2021] [Revised: 03/24/2021] [Accepted: 04/11/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND OBJECTIVE The distal interlocking of intramedullary nail remains a technically demanding procedure. Existing augmented reality based solutions still suffer from hand-eye coordination problem, prolonged operation time, and inadequate resolution. In this study, an augmented reality based navigation system for distal interlocking of intramedullary nail is developed using Microsoft HoloLens 2, the state-of-the-art optical see-through head-mounted display. METHODS A customized registration cube is designed to assist surgeons with better depth perception when performing registration procedures. During drilling, surgeons can obtain accurate and in-situ visualization of intramedullary nail and drilling path, and dynamic navigation is enabled. An intraoperative warning system is proposed to provide intuitive feedback of real-time deviations and electromagnetic disturbances. RESULTS The preclinical phantom experiment showed that the reprojection errors along the X, Y, and Z axes were 1.55 ± 0.27 mm, 1.71 ± 0.40 mm, and 2.84 ± 0.78 mm, respectively. The end-to-end evaluation method indicated the distance error was 1.61 ± 0.44 mm, and the 3D angle error was 1.46 ± 0.46°. A cadaver experiment was also conducted to evaluate the feasibility of the system. CONCLUSION Our system has potential advantages over the 2D-screen based navigation system and the pointing device based navigation system in terms of accuracy and time consumption, and has tremendous application prospects.
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Affiliation(s)
- Puxun Tu
- School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Yao Gao
- School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Abel J Lungu
- School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Dongyuan Li
- School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Huixiang Wang
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
| | - Xiaojun Chen
- School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China; Institute of Medical Robotics, Shanghai Jiao Tong University, Shanghai, China.
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Yeung CY, Hung SH, Hsu KH, Chiu FY. Early full weight-bearing in patients with isolated displaced lateral malleolar fracture after rigid internal fixation with locking plates. J Chin Med Assoc 2021; 84:438-440. [PMID: 33496516 DOI: 10.1097/jcma.0000000000000494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The timing of post-operative full weight-bearing in patients of isolated displaced lateral malleolar fractures remains controversial. The aim of this study was to evaluate the outcomes of early full weight-bearing after rigid internal fixation of such fractures with locking plates. METHODS From 2012 to 2018, 46 patients who had closed isolated displaced lateral malleolar fractures were included in the study. All fractures were managed with open reduction and internal fixation with locking plates. The patients were allowed to walk bearing their full weight 2 weeks after the operation. The follow-up period was 41.5 months on average (range: 12-70 months). The patients were available to evaluate union conditions, functional results, and complications. RESULTS The fractures united smoothly with an average union time of 10.5 weeks (range: 8-16). At the final follow-up, the average American Orthopaedic Foot and Ankle Score Ankle-Hindfoot Score was 91 (range: 85-98). No complications were observed. CONCLUSION For patients with isolated displaced lateral malleolar fractures, full weight-bearing is safe and effective, without an increase in the rate of complications, 2 weeks after open reduction and rigid fixation with locking plates.
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Affiliation(s)
- Chi-Yung Yeung
- Department of Orthopaedics and Traumatology, National Yang Ming Chiao Tung University and Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Shih-Hsin Hung
- Department of Nursing, National Yang Ming Chiao Tung University and Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Kuei-Hsiang Hsu
- Department of Orthopaedics and Traumatology, National Yang Ming Chiao Tung University and Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Fang-Yao Chiu
- Department of Orthopaedics and Traumatology, National Yang Ming Chiao Tung University and Taipei Veterans General Hospital, Taipei, Taiwan, ROC
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Aprato A, Secco DC, D'Amelio A, Grosso E, Massè A. Nailing femoral shaft fracture with postless distraction technique: a new technique enabled by shape-conforming pad. J Orthop Traumatol 2021; 22:14. [PMID: 33738638 PMCID: PMC7973345 DOI: 10.1186/s10195-021-00573-z] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 02/23/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Femoral shaft fractures are usually treated with nailing using a traction table and a perineal post, but this may occasionally result in various groin-related complications, including pudendal nerve neurapraxia. Although most of them are transient, complication rates of up to 26% are reported. Recently, postless distraction technique has been described for elective hip arthroscopy. In this study we compared post and postless distraction technique in femoral shaft fracture nailing in terms of (1) quality of reduction, (2) outcome, and (3) complications. METHODS We reviewed 50 patients treated with postless distraction nailing technique for femoral shaft fractures and compared them with our historical case series (95 patients). The following data were collected for all patients: age, gender, weight, height, diagnoses (fractures were classified according to the 2018 revision of AO classification), type and size of nail surgical timing, Trendelenburg angles during surgery, quality of reduction according to Baumgaertner and Thoresen classifications, Modified Harris Hip Scores at 6 months, and perineal complications. RESULTS Median age was 53 years, and median weight was 70 kg (range 50-103 kg). We found no significant difference in terms of quality of reduction (72 versus 74% "excellent" reduction for subtrochanteric fractures, while 81 versus 79% "excellent" reduction for femoral shaft fractures) and functional outcomes (Modified Harris Hip Score 74 versus 79). One patient in the control group had a failure of the fixation, and one patient in the postless group had a deep infection. Two patients in the control group reported pudendal nerve neurapraxia for 4 months, while none reported complication linked to the postless technique. CONCLUSIONS Our results using the postless distraction technique show a sufficient distraction to allow reduction and internal fixation of the femoral fracture with a standard femoral nail. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Alessandro Aprato
- University of Turin, Viale 25 aprile 137 int 6, 10133, Torino, Italy.
| | | | - Andrea D'Amelio
- University of Turin, Viale 25 aprile 137 int 6, 10133, Torino, Italy
| | - Elena Grosso
- University of Turin, Viale 25 aprile 137 int 6, 10133, Torino, Italy
| | - Alessandro Massè
- University of Turin, Viale 25 aprile 137 int 6, 10133, Torino, Italy
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Deng L, Zhang YW, Xiong LY, Zhang SL, Ni WY, Xiao Q. Extreme lateral interbody fusion and percutaneous pedicle screw fixation in the minimally invasive treatment of thoracic tuberculosis. J Int Med Res 2021; 48:300060520925992. [PMID: 32459154 PMCID: PMC7278100 DOI: 10.1177/0300060520925992] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE As a minimally invasive intervertebral fusion technique popularized in recent years, extreme lateral interbody fusion (XLIF) has various advantages. In this study, we describe the application and efficacy of XLIF for the treatment of thoracic tuberculosis (TB), as this may be an emerging treatment option for thoracic TB in the future. METHODS We present the case of a 75-year-old man who had suffered from chest and back pain for 1 month. Imaging studies showed destruction of the T12 and L1 vertebral bodies and the T12-L1 intervertebral disc, accompanied by formation of a paravertebral abscess. After 2 weeks of standard anti-TB treatment, the patient underwent debridement of the lesions, XLIF, and percutaneous pedicle screw fixation. RESULTS The patient's chest and back pain were significantly alleviated after the operation. The patient recovered well, and as of the most recent follow-up had no obvious limitation in thoracolumbar spine function. CONCLUSIONS XLIF combined with percutaneous pedicle screw fixation for the treatment of thoracic TB can allow for TB lesion debridement, discectomy, and interbody fusion under direct visualization, and can effectively improve patient prognosis.
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Affiliation(s)
- Liang Deng
- Department of Orthopedics, Jiangxi Provincial People’s Hospital Affiliated
to Nanchang University, Nanchang, Jiangxi, China
| | - Yuan-Wei Zhang
- Department of Orthopedics, Jiangxi Provincial People’s Hospital Affiliated
to Nanchang University, Nanchang, Jiangxi, China
- Medical Department of Graduate School, Nanchang University, Nanchang,
Jiangxi, China
| | - Liang-Yu Xiong
- Department of Orthopedics, Zhangshu Municipal People’s Hospital, Yichun,
Jiangxi, China
| | - Su-Li Zhang
- Department of Surgery, Wujin Hospital Affiliated to Jiangsu University,
Changzhou, Jiangsu, China
| | - Wen-Yan Ni
- Department of Surgery, Wujin Hospital Affiliated to Jiangsu University,
Changzhou, Jiangsu, China
| | - Qiang Xiao
- Department of Orthopedics, Jiangxi Provincial People’s Hospital Affiliated
to Nanchang University, Nanchang, Jiangxi, China
- Qiang Xiao, Jiangxi Provincial People’s Hospital
Affiliated to Nanchang University, No. 152 Aiguo Road, Nanchang, Jiangxi 330006, China.
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Napora JK, Morris WZ, Gilmore A, Hardesty CK, Son-Hing J, Thompson GH, Liu RW. Purposeful Closed Reduction and Pinning in Unstable Slipped Capital Femoral Epiphysis Results in a Rate of Avascular Necrosis Comparable to the Literature Mean. Orthopedics 2021; 44:92-97. [PMID: 33561873 DOI: 10.3928/01477447-20210201-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The standard treatment of stable slipped capital femoral epiphysis (SCFE) is generally accepted to be in situ pinning. Controversy exists regarding the treatment of unstable SCFE, including the role of a purposeful closed reduction or open reduction. The objective of this study was to investigate the rate of avascular necrosis (AVN) with purposeful closed reduction and in situ pinning of unstable SCFE. The authors retrospectively reviewed 221 patients with 302 SCFE hips treated with in situ pinning between 2000 and 2014. Forty-eight patients (50 hips) presented with an unstable SCFE. All unstable SCFEs were treated by a gentle reduction method with traction and hip internal rotation followed by pinning. Southwick angles were measured prior to reduction and at the first postoperative visit. No stable SCFEs developed AVN. Thirteen (26%) unstable SCFEs developed AVN. Avascular necrosis developed in 7 of 17 (41%) hips screened with magnetic resonance imaging vs 6 of 33 (18%) hips screened with plain radiographs alone. Mean change in Southwick angle was 28°±8° in the AVN group vs 18°±18° in the no AVN group (P=.18). Despite potentially inflating the rate with the use of early detection magnetic resonance imaging, the authors found an AVN rate comparable to that in the published literature with the use of gentle purposeful reduction on a fracture table, and no statistical differences in reduction amount between patients with and without AVN. Gentle purposeful reduction appears to be a reasonable low morbidity option in the treatment of unstable SCFE without a clear increase in risk of AVN. [Orthopedics. 2021;44(2):92-97.].
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