Cerclage Wire Research Articles

Comparison of wire versus Nylon in Bonny-Mallet Finger treated with pull-out surgery.

Zone I extensor tendon lesion accompanies an avulsion fracture of the bone insertion. A common complication of traditional pull-out is the necrosis of the site of the button in the finger pad. Zhang described an alternative way of anchoring the cerclage to the Kirschner Wire (K-wire) to relieve the pressure in the finger pad. He describes the use of wire cerclage, for fracture reduction. The objective of this paper is to perform a comparison between wire and nylon using Zhang pull-out technique. We performed a cohort study comparing Nylon versus Wire in Zhang technique. Comparing cosmetic satisfaction, stiffness, residual pain, and Crawford scale. When comparing the outcomes between both groups, we found no statistical difference in cosmetic satisfaction (p = 0.285), stiffness (p = 0.460), and residual pain (p =1.000), overall complications (p = 1.000), or Crawford scale (p = 1.000). We only found a significant statistical difference in pain when removing the cerclage, being greater in Group B (p = 0.008). We found no significant outcome difference between nylon and wire cerclage. However, at the time of removing it, patients experience less pain.

Successful treatment of an open incisive bone fracture using a locking compression plate combined with intraoral cerclage wiring

SummaryA 7‐year‐old Warmblood mare presented with bilateral epistaxis, facial swelling and deviation of the nose and upper lip. Upon clinical and computed tomographic examination a complete, oblique, open and displaced fracture of the nasal process of the incisive bone of the left and right maxilla was found. In order to maintain a good alignment and reduction in the fracture, a temporary retention with cerclage wire connecting the incisors of the mandible and maxilla was used. The fracture was then treated surgically with a 3.5‐mm narrow‐locking compression plate on the dorsolateral aspect of the incisive bone in combination with oral cerclage wiring. The intra‐oral cerclage wiring was removed 12 weeks post‐surgery, while the plate remained in situ. Minor post‐surgical complications consisted of transient facial nerve paralysis and swelling. Follow‐up radiographs taken 8 weeks after surgery documented good fracture healing. Nine months after surgery the mare has returned to her intended use and showed excellent cosmesis.

Management of scapular dysfunction in facioscapulohumeral muscular dystrophy: the biomechanics of winging, arthrodesis indications, techniques and outcomes.

Facioscapulohumeral muscular dystrophy (FSHD) is a common hereditary disorder which typically results in scapular winging due to wasting of the periscapular muscles affected by this condition. Scapulothoracic arthrodesis (STA) is the current surgical treatment for FSHD patients with severe winging and preserved deltoid muscle. There are several different techniques in the literature such as multifilament cables alone and cable or cerclage wires combined with single or multiple plates. We prefer cables without plates as it provides independent strong fixation points and strongly recommend utilization of autograft. The functional results of studies report that regardless of the technique used, shoulder elevation and thus quality of life is improved, as shown with outcome scores. There are several complications associated with STA. Pulmonary complications are common and usually resolve spontaneously. Meticulous surgical technique and effective postoperative analgesia may reduce the incidence. Scapular complications which are associated with the fixation may be encountered in the early or late period, which are related to the learning curve of the surgeon. In conclusion, STA is a reliable solution to a major problem in FSHD patients that helps them maintain their activities of daily living until a cure for the disease is found. A successful result is strongly dependent on patient selection, and a multidisciplinary team of neurologists, geneticists and orthopaedic surgeons is required to achieve good results.

Surgical Treatment of Traumatic Posterior Sternoclavicular Joint Dislocation: А Case Report.

Posterior sternoclavicular joint dislocation is a rare condition. In this paper, we present a 51-year-old male patient who was admitted to the emergency department in our hospital after he was hit by a mining railway wagon in the chest. A diagnosis of posterior sternoclavicular dislocation was confirmed after performing a CT scan. Following necessary preparations, the sternoclavicular joint was stabilized with two wire cerclage techniques during open reduction. During control at the postoperative 4th week, the range of motion at the shoulder was satisfactory, but the patient had mild pain at the joint level and was sent to physical therapy to improve the range of motion and to minimize the pain.

Salvage Reconstruction of Oncologic Humeral Defects with Free Fibula Flap after Failure with Prosthesis-based Reconstruction

PURPOSE: Advancements in orthoplastic reconstructive surgery have enabled surgeons to perform limb salvage surgery successfully after long bone tumor extirpation of upper extremities. A variety of reconstructive options (allograft, prosthetics, allograft-prosthetic combination, non-vascularized autografts) exist for surgical rehabilitation of such cases. Even though reconstruction by prosthesis is most commonly used in this setting, the associated risks of mechanical failure, aseptic loosening, and infection, can potentially lead to failure and amputation. Furthermore, revision procedures of the primary surgery after implant failure are complicated by unfavorable local tissue properties like massive bone loss, unreliable local tissue, and osteopenic process of the host bone. Therefore, prosthetic reconstruction is usually undesirable; whereas vascularized bone flaps have proven to be an excellent alternative to restore the biomechanical framework of the limb. Herein, we present the free fibula flap (FFF) used to reconstruct oncological humeral defects previously treated with prosthetic based reconstruction which failed. METHOD: We conducted a retrospective review of patients who underwent salvage of the humeral reconstructions in which the prosthesis failed, during 2009 and 2019. We included patients with previous reconstruction of humeral defects only with prosthetic material and no tissue transfer. All cases were reconstructed with the FFF. The Musculoskeletal Tumor Society (MSTS) scoring system was used to evaluate functional outcomes. RESULTS: The mean age was 24 ± 5.54 years. Six male patients (85.7%) and one female were included (14.3%). None of the patients had comorbidities. Four patients had primitive neuro-ectodermal tumors (57.1%) while three had osteogenic sarcomas (42.9%). All patients had the radial nerve preserved during onco-resection. The average gap between implant surgery and salvage with FFFs was 77.5 ± 49.024 months. The indications for salvage with the FFF were infection of implants (42.9%) and aseptic loosening (57.1%). The defects were located proximally in seven patients (85.7%) and mid-shaft in one patient (14.3%). Seven patients had adjuvant chemotherapy (85.7%), while two had neoadjuvant radiotherapy (28.6%). The defect length after debridement and implant removal was 13 ± 5.62 cm. The fibula head was incorporated in 57.1% of the flaps (n=4). For flap fixation dynamic compression plates was used in one patient (14.3%); number 20 cerclage wiring, prolene mesh, and ethibond was used in another patient (14.3%); K wires were used in four patients (57.1%); and ethibond in 1 patient (14.3%). Only one flap had a double venous anastomosis. Two patients underwent re-exploration of the anastomosis (57.1%), the only flap harvested with a skin paddle required debridement of the cutaneous component (14.3%), and one patient had wound dehiscence (14.3%). Six flaps survived (85.7%). Bone union was achieved at 17 ± 1.25 weeks on average. The average MSTS score was 74.9%. The average follow up was 59.57 ± 43.48 months. CONCLUSION: The FFF is a resourceful alternative for the management of a failed prosthesis after oncologic resection of the proximal and mid-humerus, especially with previously infected prosthetic material. Due to its anatomical shape and the vascularized nature of tissue, the FFF provides a long bone segment for humeral reconstruction.

Multi-planar fixation of displaced, multi-fragmentary patella fractures in elderly patients with anterior locking plates and cerclage wires: preliminary results.

The purpose of this study was to evaluate the outcomes of displaced, multi-fragmentary patella fractures in elderly patients treated with anterior plating and cerclage wires. Between 2018 and 2020, patients aged at least 60years old undergoing anterior plating and circumferential wiring for displaced, multi-fragmentary patella fractures with a minimum of 12months follow-up were included. Fragments were reduced and circumferentially stabilized by loop wires, followed by multi-planar fixation with an anterior locking plate and multi-directional screws. Postoperative outcomes were evaluated with the Böstman scores and range of motion. Patients were also asked about symptomatic hardware as well as satisfaction with postoperative outcomes. Sixteen patients with an average age of 71.8 ± 9.3years old were followed up for an average follow-up was 25.1 ± 8.2months. At the latest follow-up, the average Böstman scores were 27.2 ± 3.4, and active knee flexion was 123 ± 14°. Two patients complained pinpoint implant irritation and underwent implant removal. Another underwent implant removal due to cultural reasons. Fifteen patients were satisfied with the operative outcomes, and one was unsatisfied due to intermittent patellofemoral pain. Cerclage wire breakage was noted in nine patients on postoperative radiographs, but none elicited pinpoint pain. No wound complications, infections, nonunion or loss of reduction were observed. Anterior locking plates and cerclage wires in tandem provide reliable multi-planar fixation for displaced, multi-fragmentary patellar fractures in elderly patients and resulted in favorable clinical outcomes.

Treatment of a Mandibular Diastemal Fracture Using Locking Compression Plate and Cerclage Wire in a Mare.

This report describes the combination of two surgical fracture repair techniques and the postoperative management of a mandibular diastemal fracture in a two-year-old mare. The mare was referred to a veterinary hospital with a laceration over the body of the right mandible. Radiographic assessment revealed two mesial fracture lines involving the second premolar tooth and a ventrally displaced bone fragment. The mare was treated under general anesthesia and the fracture was corrected using open reduction and plate fixation. A 3.5 mm narrow 15-hole locking compression plate with seven locking screws were used in a bridge form. Cerclage wire was also used to anchor the incisor teeth to the second and third premolar teeth. The cerclage wire and incisor teeth were covered with polymethylmethacrylate to prevent implant failure and avoid injury to the oral mucosa. Implants were removed 55 days after surgery and the mare was discharged from hospital five days later. The mare returned for cerclage wire removal after 90 days and was allowed to resume exercise thereafter. The combination of two surgical techniques, proper implant choice and appropriate postoperative management, including use of pelleted feed, contributed to successful bone healing and return to function.

Biomechanical comparison of screw vs. cerclage refixation in orthogeriatric lesser trochanteric fractures: a cadaveric study

PurposeOsteoporosis-related proximal femur fractures continue to increase significantly due to demographic change. This study was designed to evaluate the biomechanical stability of two different fixation methods (cerclage vs. screw) for refixation of a trochanter minor fragment in the pertrochanteric fractures in cadaveric bones.MethodsArtificial bones (n = 14) and human bones (n = 16) were treated with a DHS and the trochanter minor fragment was reduced by cerclage wiring or direct screw fixation. After preloading the simulated iliopsoas with 10 N, a tensile test was performed, ending with either a 70% loss of strength or avulsion of the fragment. The mean values of the avulsion force and the surface strain were recorded.ResultsAll tensile tests showed no significant differences between refixation using a direct screw or wire cerclage, for both artificial bones and human specimens. Absolute values showed higher avulsion forces after direct screw fixation than refixation with a wire cerclage. The surface tension of specimens treated with direct screw fixation was lower than that of specimens treated with wire cerclage. An opposite effect was seen in artificial bones. Both effects were not statistically significant.ConclusionBased on the equal stability after lag screw placement compared to cerclage wiring, we promote the placement of a lag screw into the lesser trochanter fragment in pertrochanteric femur fractures when using a dynamic hip screw.Level of evidenceLevel III.

In-silico patient-specific and patient-appropriate engineering method to judiciously select an ameliorative implant design in a single-patient using finite element-n-of-1 (fe-n-of-1) empirical test analysis to reconstruct mid-sagittal osteochondrotomy of the sternum following cardiac surgery

Introduction: No two patients have similar normal anatomy and physiology because of genetics, physical development, and age that the same type of surgery and reconstruction implant will perform equally well. Such a notion demands the need for individualization of treatment and a method to select an ameliorative implant prospectively. One such empirically testing method is the finite element-n-of-1 (fe-n-of-1), where a treatment plan is executed specifically and systematically for a single patient as part of pre-operative planning. Objective: It is to evaluate and discuss the method of finite element analysis to carry out the fe-n-of-1 empirical test in a fact-driven manner connecting various scientific domains. It presents a preliminary protocol how to select an ameliorative implant to mitigate sternal instability due to suboptimal standard stainless-steel cerclage wiring to reconstruct the sternum following open-heart surgery. Methodology: The instability following the reconstruction of the sternum is a mechanical problem therefore it is appropriate to apply harmless structural engineering methods to choose a suitable implant design to fix it. This exploratory descriptive research describes finite element n-of-1 empirical testing using in-silico engineering principles applied to patient-specific and patient-appropriate mechanical loading conditions. Conclusion: Single-patient fe-n-of-1 empirical testing is a benign engineering method based on finite element modeling and finite element analysis. It is a safe mathematical evaluation free from subjective bias to select in advance the most ameliorative implant design to opt out of the suboptimal stainless steel cerclage wire as ‘standard of care’ and improve patient-based outcome and surgeon satisfaction.

Thumb reconstruction after radical tumor resection using free osteocutaneous lateral arm flap with secondary humerus fracture—a case report

IntroductionMalignant diseases with infiltration of bony structures in the area of the phalanges or metacarpals require either amputation or complex reconstruction. The decision for reconstruction means to restore length, mobility, sensibility, stability as well as aesthetics.MethodsWe present a case of complex first ray reconstruction of the left hand using a free osteocutaneous lateral arm flap from the ipsilateral side. The reconstruction was performed after radical resection of an exulcerated squamous cell carcinoma, including the first metacarpal bone, trapezium, partial trapezoid and distal scaphoid as well as partial resection of the extensor pollicis longus, extensor pollicis brevis, abductor pollicis longus and flexor carpi radialis tendons. The osteosynthetic restoration was achieved distally by a double wire cerclage and a proximally by temporary K-wire suspension. Moreover, to reconstruct the extensor pollicis longus tendon the ipsilateral palmaris longus tendon was harvested and used. Postoperatively, a secondary humerus fracture occurred, which was initially attended by plate osteosynthesis. The fracture showed delayed healing, which was treated by re-plating and autologous cancellous bone.Results12 months postoperatively, the patient showed an excellent outcome with length preservation and good range of motion, sensibility, stability and aesthetic of the thumb. Furthermore, the quarterly tumor aftercare showed no evidence of recurrence.ConclusionThis case report showed that the free osteocutaneous lateral arm flap is a reliable solution for the reconstruction of the first ray with a great functional and aesthetic outcome. To prevent a secondary humerus fracture, a preventive plate osteosynthesis simultaneous with the osteocutaneous flap elevation should be considered.

Standing oral surgery for the management of mandible and maxilla fractures in horses: a case series of 15 horses

Fractures of the mandible and maxilla are common in horses. The present study was conducted on fifteen horses referred for the management of mandible or maxilla fractures. Fixation methods were used to repair the fractures in these horses, including tension band and cerclage wires, dynamic compression plates, and lag screw fixation. All procedures were performed under chemical restraint and regional nerve block anesthesia in the standing position. According to the results, the long term follow-up of the horses was satisfactory, and no severe complications were observed. Jaw fractures are most successfully treated by early diagnosis and fracture fixation. The surgical management of most oral region injuries may be readily performed in the standing position, to avoid the risks associated with general anesthesia in horses.

Novel hardening bone putty enhances sternal closure and accelerates postoperative recovery

ObjectivesRegaining and maintaining sternal stability are key to recovery after cardiac surgery and resuming baseline quality of life. Montage (ABYRX) is a moldable, calcium phosphate–based putty that adheres to bleeding bone, hardens after application, and is resorbed and replaced with bone during the remodeling process. We evaluate the feasibility, safety, and efficacy of enhanced sternal closure with this novel putty to accelerate recovery in patients after sternotomy. MethodsA single-center, single-blinded, randomized controlled trial was performed (NCT03365843). Patients undergoing elective cardiac surgery via sternotomy received sternal closure with either Montage bone putty and wire cerclage (enhanced sternal closure; n = 33) or wire cerclage alone (control; n = 27). Standardized patient-reported outcomes assessed health-related quality of life (EQ-5D Index) and physical disability (Health Assessment Questionnaire). A Likert-type 11-point scale quantified pain. Spirometry assessed respiratory function. Patients reached 6-week follow-up, with 1-year follow-up for safety end points. ResultsThere were no device-related adverse events. Enhanced sternal closure improved physical functional recovery (reduced Healthcare Index and Quality) and quality of life (increased EQ-5D Index) at day 5/discharge, week 2, and week 4. Enhanced sternal closure reduced incisional pain while resting, breathing, sleeping, and walking at day 5/discharge. Enhanced sternal closure reduced chest wall and back pain at day 3 and day 5 discharge. A higher proportion of patients with enhanced sternal closure recovered to 60% of their baseline forced vital capacity by day 5/discharge. Enhanced sternal closure shortened hospital stay. ConclusionsEnhanced sternal closure improves and accelerates postoperative recovery compared with conventional wire closure. Earlier discharge may provide substantial cost benefits for the healthcare system.

Comparison of five methods for locked-plate fixation of complex diaphyseal fractures

BackgroundPeri-prosthetic fractures (PPFs) are steadily rising in number due to population ageing and increased performance of joint replacement procedures. Although PPFs without implant loosening are usually managed by internal fixation, no consensus exists regarding the optimal construct. The primary objective of this study was to compare five constructs, and the secondary objective was to compare sub-groups of mono-cortical screw constructs, with the goal of identifying the method most appropriate for diaphyseal fracture fixation when prosthetic material is present within the intra-medullary canal. HypothesisThe primary hypothesis was that fixation using bi-cortical screws, i.e., the current reference standard, was superior over other fixation methods. The secondary hypothesis was that adding double cerclage to mono-cortical screw fixation provided the greatest mechanical strength. Materials and methodsSynthetic osteoporotic bone was used to compare five methods for locking-screw fixation of a femoral diaphyseal plate. One method involved bi-cortical screws and four methods mono-cortical screws, with no cerclage wire, a single cerclage wire on either side positioned near or at a distance from the fracture, and two cerclage wires on both sides of the fracture. A complex fracture was simulated by creating a 2-cm diaphyseal gap. Load-to-failure was determined by applying compression loading along the anatomical axis of the femur. ResultsBi-cortical screw fixation provided greater mechanical strength than did three of the four mono-cortical screw constructs. The exception was the mono-cortical-screw and double-cerclage construct, for which no significant difference was found compared to bi-cortical screw fixation. Thus, mono-cortical screw fixation with double cerclage may be the best alternative when presence of an implant in the intra-medullary canal precludes bi-cortical screw fixation. ConclusionThe findings from this study have clear implications for clinical practice. The study hypotheses were partly confirmed. The absence of a significant difference between the reference-standard bi-cortical screw fixation method and mono-cortical screw fixation with double cerclage, combined with the results regarding the secondary objective, suggest that mono-cortical screws plus double cerclage deserve preference in patients with an intra-medullary implant. Clinical studies are needed to assess the results of this bench study. Level of evidenceIV, bench study.

Fast Curing Multifunctional Tissue Adhesives of Sericin-Based Polyurethane-Acrylates for Sternal Closure.

The use of wire cerclage after sternal closure is the standard method because of its rigidity and strength. Despite this, they have many disadvantages such as tissue trauma, operator-induced failures, and the risk of infection. To avoid complications during sternotomy and promote tissue regeneration, tissue adhesives should be used in post-surgical treatment. Here, we report a highly biocompatible, biomimetic, biodegradable, antibacterial, and UV-curable polyurethane-acrylate (PU-A) tissue adhesive for sternal closure as a supportive to wire cerclage. In the study, PU-As were synthesized with variable biocompatible monomers, such as silk sericin, polyethylene glycol, dopamine, and an aliphatic isocyanate 4,4′-methylenebis(cyclohexyl isocyanate). The highest adhesion strength was found to be 4322 kPa, and the ex vivo compressive test result was determined as 715 kPa. The adhesive was determined to be highly biocompatible (on L-929 cells), biodegradable, and antibacterial (on Escherichia coli, Pseudomonas aeruginosa, and Staphylococcus aureus bacteria). Finally, after opening the sternum of rats, the adhesive was applied to bond the bones and cured with UV for 5 min. According to the results, there was no visible inflammation in the adhesive groups, while some animals had high inflammation in the cyanoacrylate and wire cerclage groups. These results indicate that the adhesive may be suitable for sternal fixation by preventing the disadvantages of the steel wires and promoting tissue healing.

Mandibular fractures in cattle - a review of 108 cases

Mandibular fractures are among the most common fractures in cattle. The medical records of 108 cattle with a mandibular fracture, that were referred to the University of Zurich Veterinary Hospital from 2005 to 2019, were analysed to document the types of treatment, complications and long-term outcomes. Cattle, still alive at the time of retrospective analysis, underwent clinical and radiographic examinations. A fall was the single most common cause of a mandibular fracture (48,1 %), and a third of all cattle had a concomitant disease at the time of referral. Seventy-five cattle (69,4 %) had a single fracture, 26 (24,1 %) had two fractures and seven (6,5 %) had three fractures of the mandible. The molar part of the mandibular body was most commonly (40,7 %) fractured followed by the diastema (23,6 %), the pars incisiva (13,4 %), the ramus (12,1 %) and the symphysis (10,2 %) of the mandible. The majority of cattle (84/108, 77,8 %) had open fractures. Treatment was instituted in 63/108 animals (58,3 %) with 77/148 fractures. Of these fractures, 28 were treated with plate osteosynthesis, 25 with an external fixator, 8 with cerclage wire, 7 using mixed techniques, 4 with fragment excision, 4 underwent conservative treatment and one a mucosal suture. In total, 45/108 animals (41,7 %) were culled because of multiple fractures, concomitant diseases and because of economic reasons. Complications occurred in 34 (54,0 %) treated cattle; 22 had abnormal wound healing of which 18 developed osteomyelitis complicated by a sequestrum (14). Of the treated 63 cattle, 56 (88,9 %) were discharged. The mean postoperative productive life was 46 ± 29,2 months for animals that were deceased at the time of the study. Thirteen of the cattle with a sequestrum remained in the herd for 15 to 92 months (mean, 47 months) and one for 2 months. The life expectancy after treatment did not differ significantly from that of the Brown Swiss and Swiss Holstein dairy cattle populations, where the cattle of this study mainly came from. Eleven cattle were available for long-term follow-up; all had a good general health status but nine had dental abnormalities including missing teeth, steps or enamel points, which did not noticeably affect the body condition of the animals. Surgical treatment of selected mandibular fractures had a favourable prognosis (52/63 healed, 82,5 %) in cattle.

Treatment of Periprosthetic Joint Infection and Fracture-Related Infection With a Temporary Arthrodesis Made by PMMA-Coated Intramedullary Nails - Evaluation of Technique and Quality of Life in Implant-Free Interval.

BackgroundAntimicrobial coating of intramedullary nails with polymethyl methacrylate (PMMA) bone cement promises infection control and stabilization for subsequent bone healing. However, when removing the implant, bone cement can debond and remain in the medullary cavity of the long bones, representing a nidus for reinfection. This work presents a technique comprising reinforcement of PMMA-coated intramedullary nails with cerclage wire to prevent such problems in patients treated for fracture-related infection (FRI) or knee periprosthetic joint infection (PJI) with a static spacer as temporary arthrodesis allowing weight-bearing in the implant-free interval. Outcomes of this surgical treatment were evaluated in terms of (i) associated complications and (ii) patient-reported quality of life.MethodsIn this retrospective case series, 20 patients with PJI (n = 14, 70%) and FRI (n = 6, 30%) treated with PMMA-coated intramedullary nails reinforced with cerclage wire between January 2021 and July 2021 were included. Quality of life during the implant-free interval was evaluated with the EQ-5D, SF-36, and an ICD-10 based psychological symptom rating and compared with previously analyzed cohorts of successfully treated PJI and FRI patients in whom eradication of infection and stable bone consolidation was achieved.ResultsComplications during the implant-free interval comprised a broken nail in one case (5.0%) and a reinfection in one case (5.0%). Coating-specific side effects and cement debonding during removal did not occur. The mean physical health component score of SF-36 was 26.1 ± 7.6, and the mean mental health component score reached a value of 47.1 ± 18.6. The mean EQ-5D index value was 0.36 ± 0.32 and the mean EQ-5D visual analogue scale rating was 47.4 ± 19.4. The scores were significantly lower than those in the successfully treated FRI cohort but not in the PJI cohort. The mean ICD-10-based symptom rating scores revealed psychological symptom burden on the depression scale and enhanced levels of anxiety in comparison with healed FRI and PJI patients.ConclusionReinforcement of PMMA bone cement-coated implants seems to be a reasonable treatment option to create a temporary arthrodesis, preventing detachment of the bone cement when the implant was removed.Level of Evidence: IV.

Surgical Management of Acute Rockwood Grade III Acromioclavicular Joint Dislocations: A Systematic Review.

Injuries of the acromioclavicular joint (ACJ) occur frequently in young and active people. The best management of acute grade III injuries has been a source of controversy and extensive debate. When surgery is indicated, there is still no gold standard surgical technique for treating acute grade III ACJ injuries.The methodology of this review was a comprehensive search of PubMed, Medline, Cochrane, and EMBASE databases using various combinations of the keywords “Rockwood,” “type III,” “grade III,” “treatment,” “surgery,” “acromioclavicular joint,” and “dislocation,” since the inception of the databases to December 2020. Surgical techniques were divided into two groups. In group 1 were ACJ fixation techniques using hardware such as the hook plate, Kirschner wires, and wire cerclage; group 2 included coracoclavicular (CC) ligament fixation/reconstruction techniques using double buttons, TightRope®, suture anchors, Endobuttons, the Infinity-LockTM Button System, etc. Fourteen studies were selected for the final review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.This review showed better outcome scores in group 2. Overall, complication rates were higher in group 1 compared to group 2. The results of this review show that CC fixation, using suspensory or loop devices, of Rockwood grade III injuries, has better outcomes and fewer complications than fixation of the ACJ with hardware.

The History of Surgical Stabilization of Rib Fractures (SSRF)

• The earliest account of open reduction and internal stabilization of rib fractures comes from Dr. Charles Locke Scudder in 1900 when he published, the treatment of fractures . • Surgical stabilization of rib fractures (SSRF) has evolved over 120 years with numerous advancements and lessons learned along the way. • Materials have evolved from sutures to wires to external and internal plates. • Rib fixation methods have evolved from open suture and wire cerclage to minimally invasive video assisted thoracoscopic surgery internal plating. Responsible for approximately 35% of all trauma-related deaths in the United States, thoracic trauma is one of the leading causes of death among trauma patients. Furthermore, traumatic rib fractures represent the most frequently encountered injury following thoracic trauma with mortality rates ranging from 8% among the elderly to 13% for patients with a flail chest. This manuscript reviews the history of SSRF as well as the contributions of the pioneering surgeons who championed this treatment. Rib fractures are a marker for severe injury as indicated by a recent National Trauma Data Bank (NTDB) retrospective analysis of 564,798 patients with one or more rib fractures. Approximately half of these patients were found to have multiple injuries with worse outcomes observed in patients with polytrauma and flail chest [1]. In addition, age, male gender, injury severity score (ISS), Glasgow Coma Scale (GCS), preexistent comorbidities, and number of rib fractures are independently associated with significantly higher rates of morbidity and mortality [1, 2]. Recently, studies have demonstrated surgical stabilization of rib fractures (SSRF) improves outcomes for ventilated as well as non-ventilated patients with flail chest, elderly patients, and select patients with multiple rib fractures without a flail injury or non-flail fracture pattern [2–6]. SSRF applies orthopedic principles of reduction and fixation to restore the architecture of the thoracic skeleton and re-establish normal respiratory physiology and minimize pain [7]. There has been a recent increase in prevalence of SSRF operations, however, SSRF is not a new technique, and progress has been anything but mundane or linear [3, 6]. This manuscript reviews the history of SSRF (Figure 1) as well as the contributions of the pioneering surgeons who championed this treatment. This review was conducted utilizing multiple national experts and a thorough literature review of related SSRF was performed. The sources chosen are considered by the authors to be highly influential and include the first publication for each distinctive method of SSRF.

Mechanical Properties and Comparisons of Cerclage Wires of Various Diameters in Different Knot Methods

Mechanical Properties and Comparisons of Cerclage Wires of Various Diameters in Different Knot Methods

Surgical management of metatarsal fracture using wire suture in a sheep: A case report

Background: The most frequent orthopedic condition that prevents animals from moving normally is a long-bone fracture. The diagnosis and surgical treatment of closed metatarsal fracture in sheep are the main goals of this study. Materials and Methods: A three-month-old female sheep was presented with a history of the left metatarsal bone losing its function, pain at the fracture site, aberrant motion in the affected leg, and fluid or exudate flowing from the fracture site. While radiographs indicated an oblique metatarsal fracture of the left hind limb, palpation of the left metatarsal bone revealed discomfort and fracture fragments. Following internal stabilization with cerclage wire suture, the fracture was treated. Surgery was carried out following the proper immobilization, aseptic procedure, and anesthetic protocol (atropine 0.04 mg/kg BW intramuscularly, five minutes later: xylazine 0.06 mg/kg BW intravenously). Results: The sheep was released from the hospital after the procedure bearing weight on the limb effectively and without any issues. A successful clinical outcome was obtained after surgical alteration. Conclusions: Open fractures necessitate swift, aggressive debridement, stability of the fracture, and early soft tissue restoration. The only practical method for managing fractures may be early surgical treatment and post-operative care.