Bone Anchors Research Articles

THE BIOMECHANICAL STABILITY OF A NOVEL BIOABSORBABLE MAGNESIUM ALLOY (ZX00:Mg-Zn–Ca) BONE ANCHOR FOR ROTATOR CUFF REPAIRS: A HUMAN EX VIVO STUDY

Introduction: The purpose of this study was to ascertain the primary ex vivo biomechanical stability of a novel bioabsorbable magnesium alloy (ZX00: Mg–Zn–Ca) bone anchor in human cadaveric proximal humeri, indicated in the reconstruction of the rotator cuff. Methods: Twenty human Thiel-embalmed cadaveric humeri were prepared and freed from soft tissue. One [Formula: see text]5.7 × 20.5-mm ZX00 anchor and one [Formula: see text]5.5 mm × 16.3 mm Arthrex Titanium FT Corkscrew (ATC) control anchor were inserted into the footprint of the supraspinatus tendon, 15 mm apart. The humeri were mounted onto a material testing machine and following a 40 N preload, cyclic loading was performed over 400 cycles. If the construct remained intact, ultimate load to failure (ULTF) was measured using an increasing axial load of 1 mm/s, ULTF and mode of failure were recorded. Results: No difference was found in the ability to withstand cyclic loading, mode or load-to-failure strengths between ZX00 and control anchors. The maximum tractional force loaded for the ZX00 anchors had a median of 257.4 N (range 165.3–328.2). The corresponding value for the ATC anchors averaged 239.9 N (range 118.9–306.7). Conclusion: ZX00 alloy anchors appear to provide adequate initial biomechanical stability when compared to an industry-standard control in a cadaveric rotator cuff repair model.

Biomechanical comparison of four isometric prosthetic ligament repair techniques for tarsal medial collateral ligament injury.

To compare the stability, ultimate strength, and isometry of 4 prosthetic ligament repairs for canine tarsal medial collateral ligament injury. 24 cadaveric canine distal hind limbs with induced medial tarsal instability were randomly divided into 4 groups. Simulated medial shearing injury of the collateral and medial malleolus were repaired using 1 of 4 isometric suture techniques: bone tunnels with nylon suture (TN), ultrahigh-molecular-weight polyethylene (UHMWPE) suture (TU), tibial bone anchor with nylon suture (AN), or talar bone anchor with UHMWPE suture (AU). Each repair was evaluated for medial stability before and after cyclic range of motion. 3 of 4 repair configurations allowed string potentiometer isometry data collection during cyclic range of motion. Each construct was subsequently tested to failure; the strength and failure mode were recorded. All repair groups showed statistically increased laxity compared to intact ligament. There was no difference in joint laxity between repair techniques. Cyclic range-of-motion testing did not increase joint laxity at any tested joint angle. Strength to failure was no different between repair groups. Isometry was achieved in the TU and TN groups. All 4 techniques improved medial stability compared to that medial collateral ligament injury; however, no technique returned stability to the tarsal of the intact ligament. All 4 techniques maintained stability after range-of-motion testing. Isometric placement of the prosthetic suture was achievable. The constructs did not provide sufficient resistance to physiologic valgus stress. Isometric placement of a prosthetic ligament is possible; secondary stabilization appears necessary to support the repair postoperatively.

Early Mobility and Rehabilitation Protocol after Internal Brace Ankle Stabilization

Chronic lateral ankle instability is a common diagnosis in foot and ankle clinics. Internal Brace (IB) augmentation is a surgical procedure that utilizes fibertape augmentation of the lateral ankle ligaments. Studies have shown the superiority of fibertape augmentation over traditional lateral ankle stabilization procedures such as the Brostrom or Brostrom-Gould. The IB procedure has been described elsewhere and the fixation involves placing bone anchors with attached suture tape at each end of the Brostrom repair augmenting the fixation. Various studies exist that support the mechanical advantage of the Brostrom with IB over non augmented repair. This technique allows for earlier weight bearing and range of motion which translates into earlier return to activity and sport. While there are guidelines for rehabilitation after Brostrom procedures, there are currently no guidelines regarding rehabilitation after the IB. The purpose of this clinical commentary is to describe an early mobility and rehabilitation protocol after IB augmentation for the ankle. The post operative protocol provides treatment goals, weight bearing status recommendations, and rehabilitation intervention suggestions after IB augmentation. Level of Clinical Evidence V

Proximal Fibula Resection for Tumors-Case Series and Technical Note.

Background: The resection of tumors of the proximal fibula includes the removal of the lateral collateral ligament (LCL) and biceps femoris tendon (BFT) attachment. The aim was to describe and evaluate a surgical reconstruction technique in terms of functional outcome and knee joint stability. Methods: We analyzed the outcome of six patients, treated by a proximal fibula resection. The reconstruction of the attachments of the LCL and BFT was performed with two suture anchors, fixed onto the tibia at the level of the proximal tibiofibular joint (PTFJ). The postoperative knee flexion strength as well as the lateral knee joint stability were compared to the contralateral side using a digital scale and stress X-ray. Patient-reported outcome measures and postoperative complications were documented. Results: No lateral instability and no significant loss of knee flexion strength could be observed (p = 0.075). One persistent postoperative peroneus paresis was reported. High functional outcome was achieved with a mean MSTS score of 92.2%. Conclusions: The resection of the proximal fibula with the reinsertion of the LCL and the BFT using bone anchors in the PTFJ seems to provide a good functional outcome, with a low level of associated comorbidities.

Clinical outcomes of arthroscopic suture fixation combined with loop plate vs. posterior approach open reduction and cannulated screw fixation for treating tibial avulsion fractures of the posterior cruciate ligament: a retrospective study.

Comparison of the efficacy of arthroscopic suture fixation combined with loop plate vs. the posterior approach involving open reduction and intramedullary nail fixation in treating posterior cruciate ligament tibial avulsion fractures (PCLTAFs). A retrospective analysis was conducted on the clinical data of patients diagnosed with PCLTAF who were admitted to Northern Jiangsu People's Hospital between June 2019 and March 2022. Based on distinct surgical procedures, the patients were categorized into two groups: arthroscopic group (33 cases), involving a single bone tunnel, high-strength suture, loop plate, and anchor screw fixed under arthroscopy, and open reduction and internal fixation (ORIF) group (13 cases), involving a modified posterior medial approach and fixation using 1-2 cannulated screws. Key parameters, including surgical duration, postoperative fracture alignment, fracture-healing duration, range of motion changes, postoperative Lysholm scores, and VAS scores were documented and compared between the two groups. The study cohort comprised 46 patients, with 28 males and 18 females, and the median age was 29 years old (range: 15-69). There were no significant differences in the baseline characteristics, including knee Lysholm scores, between the two groups. The arthroscopic group exhibited significant improvement in all eight Lysholm score indicators (all P < 0.001). The total Lysholm score also exhibited significant improvement before and after surgery in both groups (P < 0.001). Following surgery, the arthroscopic group demonstrated improvements in all indicators, but had a slightly longer operating time compared to the ORIF group. No significant differences were observed in the Lysholm scores for the knee joint between the two patient groups before and after surgery (P > 0.05). Arthroscopic suture fixation in conjunction with looped plate binding can significantly improve knee function and clinical effect for patients in the treatment of PCLTAF, promotingearly postoperative functional recovery of patients.

Dentofacial and skeletal effects of two orthodontic maxillary protraction protocols: bone anchors versus facemask

BackgroundMaxillary retrognathia and/or mandibular prognathia are resulting in class III malocclusion. Regarding orthodontic class III malocclusion treatment, the literature reports several treatment approaches. This comparative clinical study investigated two maxillary protraction protocols including bone anchors and Delaire type facemask.MethodsCephalometric radiographs of n = 31 patients were used for data acquisition. The patients were divided into two groups according to their treatment protocol: bone anchored protraction (n = 12, 8 female, 4 male; mean age 11.00 ± 1.76 years; average application: 13.50 ± 5.87 months) and facemask protraction (n = 19, 11 female, 8 male; mean age 6.74 ± 1.15 years; average application: 9.95 ± 4.17 months). The evaluation included established procedures for measurements of the maxilla, mandibula, incisor inclination and soft tissue. Statistics included Shapiro-Wilk- and T-Tests for the radiographs. The level of significance was set at p < 0.05.ResultsThe cephalometric analysis showed differences among the two groups. SNA angle showed significant improvements during protraction with bone anchors (2.30 ± 1.18°) with increase in the Wits appraisal of 2.01 ± 2.65 mm. SNA angle improved also during protraction with facemask (1.22 ± 2.28°) with increase in the Wits appraisal of 1.85 ± 4.09 mm. Proclination of maxillary incisors was larger in patients with facemask (3.35 ± 6.18°) and ML-SN angle increased more (1.05 ± 1.51°) than in patients with bone anchors. Loosening rate of bone anchors was 14.58%.ConclusionsBoth treatment protocols led to correction of a class III malocclusion. However, this study was obtained immediately after protraction treatment and longitudinal observations after growth spurt will be needed to verify the treatment effects over a longer period. The use of skeletal anchorage for maxillary protraction reduces unwanted side effects and increases skeletal effects needed for class III correction.

Arthroscopic Dorsal Round-Block Capsulo-Ligamentoplasty for Dynamic Scapholunate Instability: An Anatomical Study and Case Series

Abstract Background Chronic dynamic scapholunate (SL) instability remains difficult to treat. Several treatment options exist. Purpose We propose an arthroscopic dorsal round-block capsulo-ligamentoplasty technique to treat dynamic scapholunate instability: a dorsal purse-string-like suture around the dorsal aspect of the proximal row, following the course of the dorsal intercarpal ligament (DICL). A Fiberwire suture travels between the radiocarpal and midcarpal space, piercing the attachments of the DICL on the triquetrum and of the scaphotrapezial ligament on the distal scaphoid. It reinforces the DICL and the dorso-capsuloscapholunate septum, also inducing a fibrotic healing. Moreover, it produces an extension lever correcting the scaphoid flexion/pronation. Compared with other capsulodesis techniques, the all-inside dorsal round-block capsulo-ligamentoplasty is theoretically likely to produce less stiffness, without additional damage to the SL complex. The wrist remains practically undamaged after surgery: no bone tunnels, bone anchors, or tendon grafts are required, thus enabling all possible secondary procedures. Data of a cadaveric study and case series illustrate the technique. Conclusion The arthroscopic dorsal round-block capsulo-ligamentoplasty can be considered to treat chronic dynamic scapholunate instability.

The management of acute complete ruptures of the ulnar collateral ligament of the thumb.

Complete ruptures of the ulnar collateral ligament (UCL) of the thumb are a common injury, yet little is known about their current management in the UK. The objective of this study was to assess the way complete UCL ruptures are managed in the UK. We carried out a multicentre, survey-based cross-sectional study in 37 UK centres over a 16-month period from June 2022 to September 2023. The survey results were analyzed descriptively. A total of 37 centres participated, of which nine were tertiary referral hand centres and 28 were district general hospitals. There was a total of 112 respondents (69 surgeons and 43 hand therapists). The strongest influence on the decision to offer surgery was the lack of a firm 'endpoint' to stressing the metacarpophalangeal joint (MCPJ) in either full extension or with the MCPJ in 30° of flexion. There was variability in whether additional imaging was used in managing acute UCL injuries, with 46% routinely using additional imaging while 54% did not. The use of a bone anchor was by far the most common surgical option for reconstructing an acute ligament avulsion (97%, n = 67) with a transosseous suture used by 3% (n = 2). The most common duration of immobilization for those managed conservatively was six weeks (58%, n = 65) and four weeks (30%, n = 34). Most surgeons (87%, n = 60) and hand therapists (95%, n = 41) would consider randomizing patients with complete UCL ruptures in a future clinical trial. The management of complete UCL ruptures in the UK is highly variable in certain areas, and there is a willingness for clinical trials on this subject.

Anterior tibial tendon transfer in idiopathic clubfoot: pull-out vs. other fixations – a systematic review

PurposeReview the literature and describe the complications associated with each of the anterior tibial tendon transfer (ATTT) techniques described.MethodsA systematic review of the literature was performed with the keywords ‘’clubfoot’’, ‘’Ponseti’’ and ‘’anterior tibial’’. Studies in patients with clubfoot recurrence, who underwent ATTT, whose method of tendon fixation was different from the classical method, were included.ResultsSix studies were included in this systematic review, which described multiple techniques for tibialis anterior fixation: bone anchors, interference screws, endobotton, K-wires, transosseous suture, and suture to the plantar fascia. In the papers that described postoperative complications, no major complications were reported, however the samples are generally small.ConclusionSeveral options have now emerged for tendon fixation in tendon transfers around the foot and ankle, including ATTT for treatment of relapsed clubfoot. To our knowledge this is the first paper that questioned the potential complications associated with the use of these new techniques. Due to the scarcity of published works in favor of other fixation methods, we believe that the traditional method is the optimal one for the transfer of the tendon of the tibialis anterior muscle.

Narrative patent review of penile clamp, artificial urinary sphincter, and sling innovation in the management of male stress urinary incontinence.

Stress urinary incontinence (SUI) is the involuntary loss of urine affecting 1-3% of the male population. To manage leakage, patients may try a plethora of penile clamps. and may even consider artificial urinary sphincters (AUS) or sling implantation. We aimed to synthesize the evolution of the modern clamp, AUS, and sling through a comprehensive patent search. Patents were found through the databases of United States Patent and Trademark Office (USPTO), GooglePatents, and the World Intellectual Property Office Patentscope, covering patents published through January 6, 2024. We found 30 different patents (10 clamps, 13 AUS, and 7 slings), including the patents pertaining to the functionalities and design of five commercially available penile clamps, the American Medical System 800 (AMS 800), the InVance, AdVance, AdVance XP, and Virtue Slings. The clamps, spanning back to 1938 with Bard Cunningham's clamp, have undergone significant refinements. For example, inventors such as Edson S. Outwin and Juan F. V. Wiesner, have modified the location of the primary pressure point. Accessibility has also improved with inventors, such as Gerald French and John W. Timmons, fastening the clamps with Velcro®, as opposed to the screw and ratchet catch closing mechanism, as in Cunningham's clamp. Similarly, the AUS has greatly evolved since Foley's 1947 "Artificial Sphincter and Method", which was the primary AUS precedent to Mark Polyak's AUS invention, which covered the essential elements and functionalities, such as the incorporation of a balloon reservoir, for the AMS 800. In addressing AUS limitations, inventors such as David W. Anderson and Louisa Thomas have created non-hydraulic AUSs. Likewise, the male sling has seen an evolution in the method of securement, from the use of fixed bone anchors in the InVance sling to the transobturator route used in the AdVance XP, avoiding bone complications. Additionally, innovation in sling adjustment of urethral compression allows for adjustable urethral elevation and distal compression respectively. Recent patents have claimed technological integration for clamps, AUS, and slings, especially concerning automation. Overall, patents have built upon the limitations of previous devices. However, there is still a need to innovate for increased clamp comfort and reduced reoperation rates for the AUS and sling.

Use of an Osseointegrated Intraosseous Transcutaneous Amputation Prosthesis for Amputated Fingers Is Followed by Frequent Infection and Implant Removal

ABSTRACT Introduction We report on the outcomes of using a custom-built osseointegrated (OI) intraosseous transcutaneous amputation prosthesis (ITAP) as a bone anchor for prosthetic reconstruction of a series of amputated fingers. The aim of ITAP was to reduce the risk of failure due to infection by creating a biological seal at the skin-implant interface. Methods and Results A total of 14 patients who suffered from amputations of their digits at a variety of different levels were recruited. Eleven patients (20 implants) underwent treatment with an implant based on the ITAP principle. With the exception of one patient (1 implant), all implants were removed by 9 years after insertion. Patients requested removal because of recurrent infections, exposure of the flange structure (unique to ITAP), loosening of the implant, and inability to secure a prosthesis to the implant. Conclusions The ITAP principle does not work when used as part of the design of an OI bone anchor for prosthetic reconstruction after finger amputation. Clinical Relevance Statement This study suggests that there are major problems with the principles underlying the design of the ITAP implant when used in humans. Future studies of OI implants using the principles of ITAP may be at risk of similar problems.

Surgical repair of posttraumatic injuries of the scapholunate ligament: A literature study.

Scapholunate interosseous ligament rupture can cause wrist issues like pain, strength loss, and cartilage degeneration. While various surgical treatments exist, it's unclear which method is optimal. This study aims to determine the superior treatment approach for scapholunate dissociation. In Pubmed, Embase, Scopus and Web of Science was searched for articles reporting results of surgical repair of scapholunate dissociation. Additional inclusion criteria were English- and Dutch-language articles published between January 2000 and December 2022 with at least 8 patients and at least 1 year of follow-up. Seventeen articles were included, 9 covered tenodesis repair, 2 focused on capsulodesis, 3 on direct scapholunate ligament repair using bone anchors, and 3 on a combination of tenodesis and capsulodesis. No difference could be found between the types of surgical techniques in wrist mobility and grip strength. The Disability of Arm, Shoulder, and Hand score, Visual Analogue Scale for pain and Mayo wrist scores showed no clinically relevant difference. With all methods, normal radiological values were obtained after surgery. The mean scapholunate angle was less than 60° and the scapholunate gap less than 3 mm. However, at longer follow-up an increase in this angle and gap was seen again. This review did not allow to conclude that one technique was better than another to treat scapholunate dissociation because of poor quality of the included studies. Pre- and postoperative values were not always reported, there were insufficient comparative studies, and randomized prospective studies were missing.

Posterolateral Elbow Dislocation: An All-Arthroscopic Reconstruction of the Lateral Ulnar Collateral Ligament

The elbow is one of the most commonly dislocated joints. Although simple dislocations of the elbow usually resolve with conservative management, certain patients can experience residual chronic instability. Posterolateral rotational instability accounts for approximately 80% of elbow chronic instability cases. We propose an all-arthroscopic reconstruction of the posterior, or ulnar, fascicle of the lateral ligament complex using an autograft or allograft, performed with a 5-mm-thick and 8-cm-long graft. The graft is first inserted distally into the supinator crest with an Arthrex 4.75-mm SwiveLock implant and, finally, at its origin in the epicondyle, also with a screw of the same characteristics. Arthroscopic techniques create fewer complications. This procedure allows the surgeon to address intra-articular elbow joint pathology with less chance of wound complications and the ability to use bone anchors if desired.

Ex vivo biomechanical evaluation and comparison of lateral femoro-fabella ligament suture and lateral suture with bone anchor for cranial cruciate ligament repair in cats.

To compare the biomechanical properties of lateral femoro-fabella ligament suture (FFLS) and lateral suture with a bone anchor suture (BAS) for management of feline cranial cruciate ligament disease. 12 femurs from 6 mature cat cadavers. The samples were collected from April to June 2023. The specimens had an FFLS and, subsequently, BAS placed and were positioned into a biomechanical testing machine, preloaded from 5 N to 15 N for 100 cycles, and subsequently, a load to suture failure was applied. The displacement at 5 N and 15 N, the total precycle displacement (millimeters), the force at 3 mm displacement and at failure (newtons), the displacement at failure (millimeters), and the stiffness to failure (Newton:millimiter) were recorded. Nonparametric Wilcoxon signed-rank tests were used to compare data between the 2 groups. The displacement at 5 N and 15 N and the total precycle displacement were significantly higher in the FFLS group compared to the BAS group. Additionally, the FFLS group results showed less consistent displacement and marked variability. The force (newtons) at 3 mm displacement was higher in the BAS group. There was no significant difference in force and no significant difference in displacement at failure between the 2 groups. However, the stiffness to failure (N/mm) was significantly higher in the BAS group. BAS represented a more stable and reliable femur attachment for extracapsular suture in cats. To demonstrate the stability and reliability between BAS and FFLS and influence implant selection in the treatment of cranial cruciate ligament rupture in cats with evaluation of biomechanical properties.

Enhancing spinal bone anchor pull-out resistance with an L-shaped anchor.

The success rate of spinal fusion surgery is mainly determined by the fixation strength of the spinal bone anchors. This study explores the use of an L-shaped spinal bone anchor that is intended to establish a macro-shape lock with the posterior cortical layer of the vertebral body, thereby increasing the pull-out resistance of the anchor. The performance of this L-shaped anchor was evaluated in lumbar vertebra phantoms (L1-L5) across four distinct perpendicular orientations (lateral, medial, superior, and inferior). During the pull-out experiments, the pull-out force, and the displacement of the anchor with respect to the vertebra was measured which allowed the determination of the maximal pull-out force (mean: 123 N ± 25 N) and the initial pull-out force, the initial force required to start motion of the anchor (mean: 23 N ± 16 N). Notably, the maximum pull-out force was observed when the anchor engaged the cortical bone layer. The results demonstrate the potential benefits of utilising a spinal bone anchor featuring a macro-shape lock with the cortical bone layer to increase the pull-out force. Combining the macro shape-lock fixation method with the conventional pedicle screw shows the potential to significantly enhance the fixation strength of spinal bone anchors.

Clinical outcomes after primary repair for thumb ulnar collateral ligament ruptures: a systematic review and meta-analysis.

There is no consensus on the best surgical technique for treating thumb ulnar collateral ligament (UCL) ruptures. This systematic review and meta-analysis investigates which primary repair technique and postoperative immobilization protocol result in the best clinical outcomes. A literature search was conducted in Embase, Medline ALL Ovid, Web of Science Core Selection and Cochrane Central Register of Controlled Trials. Pain, stability, tip pinch strength, key pinch strength, grip strength, return to work and metacarpophalangeal joint range of motion were collected as postoperative outcomes. In total, 29 studies were included. All surgical techniques resulted in satisfactory clinical outcomes, with no significant differences between bone anchor reinsertion, suture fixation, K-wire fixation and a combination of techniques. K-wire immobilization resulted in worse postoperative pain, but similar stability compared to immobilization without a K-wire. Clinical outcomes after thumb UCL repair are excellent, with no differences in clinical outcomes noted among surgical techniques.

An All-Arthroscopic Technique of Repairing Foveal Tears of the Triangular Fibrocartilage Complex Using a Bone Anchor-Repair Made Simple.

Traumatic foveal tears of the triangular fibrocartilage complex lead to ulnar-sided wrist pain and instability, resulting in painful motion and loss of grip strength with a severe impact on the overall function of the upper limb. Surgical repair is nothing new and has traversed through the realm of open repair to arthroscopic assisted to all arthroscopic repair techniques over the many decades, with arthroscopic repairs showing better visualization, lesser trauma, and equally favorable patient outcomes. Techniques had varied from using trans osseous tunnels to bone anchors, with or without the usage of special jigs. Here, we describe a simple and fast 3 portal arthroscopic technique of repairing the torn foveal insertion of the triangular fibrocartilage complex using a bone anchor inserted under arthroscopic and fluoroscopic guidance into the fovea. Both the dorsal and volar limbs of the triangular fibrocartilage complex are repaired arthroscopically, resulting in a strong anatomic repair resulting in a stable and pain-free wrist.

(141) Surgical Outcomes of Infrapubic Insertion of the Inflatable Penile Prosthesis in 175 Transmen After Phalloplasty

Abstract Introduction Historically, inflatable penile prostheses (IPP) insertion in a neophallus has an estimated 40-50% surgical revision rate. Objective To review the surgical outcomes of a single center’s experience with the infrapubic approach to insertion of the IPP after phalloplasty in transmen. Methods The infrapubic prosthesis insertion after phalloplasty (IPIP) technique involves a horizontal incision anterior to the pubic symphysis, which allows dissection of the neophallus channel, the Space of Retzius, and the scrotal pocket. Surgical outcomes using the Titan (Coloplast, Minneapolis, MN) IPP by a single surgeon (MLC) were analyzed between October 2017 and June 2023. Complications were reviewed and categorized into erosions, infections, device malposition and malfunction, and less common events like necrosis and urinary tract injury. Results The IPIP technique was performed on 175 phalloplasty patients by a single surgeon (MLC): 156 patients had a prior RF phalloplasty, and 19 had a prior ALT phalloplasty. The mean followup was 32.8 months. Surgical revision was required in 35 patients (20%). There were 10 pump erosions through the neoscrotum, 1 glans erosion, 9 infections, 6 pump malpositions in the neoscrotum, 6 cylinder malposition in the neophallus, 3 mechanical malfunctions with broken tubing, 2 urethral injuries, 2 bladder injuries, and 1 glans necrosis. There were no instances of implant detachment from the pubic bone anchor site, osteomyelitis, nor total phallus loss. Conclusions Data for the IPIP technique using the commercially available Coloplast Titan IPP suggest a reduction in neophallus prosthetic surgical revision rates compared to previous reports. Longer term studies with patient reported outcomes are required for further evaluation. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast, Boston Scientific.

SURFACE MATTERS THAN THE IMPLANT ITSELF-A REVIEW

Nowadays dental implants are a predictable and popular treatment option for tooth replacement in completely or partially edentulous patients. Implants are preferred over conventional treatment due to certain advantages it offers like preservation of bone; preservation of adjacent teeth, durability, better mastication and speech etc.Implant comes in direct bone contact and anchors through osseointegration. Successful osseointegration revolves around many factors such as biocompatibility of the implant material, quality and quantity of the available bone, surface treatment of the implant, loading and surgical protocol and various other systemic and local factors. Predictability of clinical success of dental implants can be enhanced by using newer materials or alterations in designs, surgical or loading protocols on the basis of available literature. Various studies have suggested that rough surface of implant enhances its integration with bone than a smooth implant surface. Several approaches are used to attain a rough surface and to improve the process of osseointegration of titanium dental implants. The present paper reviews different methods of treating implant surfaces to enhance bone implant interaction starting from the basic material used in dental implant manufacture.

Bone Anchor Fixation in the Repair of Blunt Traumatic Abdominal Wall Hernias: A Western Trauma Association Multicenter Study.

Blunt traumatic abdominal wall hernias (TAWHs) are rare but require a variety of operative techniques to repair including bone anchor fixation (BAF) when tissue tears off bony structures. This study aimed to provide a descriptive analysis of BAF technique for blunt TAWH repair. Bone anchor fixation and no BAF repairs were compared, hypothesizing increased hernia recurrence with BAF repair. A secondary analysis of the WTA blunt TAWH multicenter study was performed including all patients who underwent repair of their TAWH. Patients with BAF were compared to those with no BAF with bivariate analyses. 176 patients underwent repair of their TAWH with 41 (23.3%) undergoing BAF. 26 (63.4%) patients had tissue fixed to bone, with 7 of those reinforced with mesh. The remaining 15 (36.6%) patients had bridging mesh anchored to bone. The BAF group had a similar age, sex, body mass index, and injury severity score compared to the no BAF group. The time to repair (1 vs 1 days, P = .158), rate of hernia recurrence (9.8% vs 12.7%, P = .786), and surgical site infection (SSI) (12.5% vs 15.6%, P = .823) were all similar between cohorts. This largest series to date found nearly one-quarter of TAWH repairs required BAF. Bone anchor fixation repairs had a similar rate of hernia recurrence and SSI compared to no BAF repairs, suggesting this is a reasonable option for repair of TAWH. However, future prospective studies are needed to compare specific BAF techniques and evaluate long-term outcomes including patient-centered outcomes such as pain and quality of life.