Choice Of Fixation Research Articles

Bioimaging of sense organs and the central nervous system in extant fishes and reptiles in situ: A review.

Bioimaging is changing the field of sensory biology, especially for taxa that are lesser-known, rare, and logistically difficult to source. When integrated with traditional neurobiological approaches, developing an archival, digital repository of morphological images can offer the opportunity to improve our understanding of whole neural systems without the issues of surgical intervention and negate the risk of damage and artefactual interpretation. This review focuses on current approaches to bioimaging the peripheral (sense organs) and central (brain) nervous systems in extant fishes (cartilaginous and bony) and non-avian reptiles in situ. Magnetic resonance imaging (MRI), micro-computed tomography (μCT), both super-resolution track density imaging and diffusion tensor-based imaging, and a range of other new technological advances are presented, together with novel approaches in optimizing both contrast and resolution, for developing detailed neuroanatomical atlases and enhancing comparative analyses of museum specimens. For MRI, tissue preparation, including choice of fixative, impacts tissue MR responses, where both resolving power and signal-to-noise ratio improve as field strength increases. Time in fixative, concentration of contrast agent, and duration of immersion in the contrast agent can also significantly affect relaxation times, and thus image quality. For μCT, the use of contrast-enhancing stains (iodine-, non-iodine-, or nanoparticle-based) is critical, where the type of fixative used, and the concentration of stain and duration of staining time often require species-specific optimization. Advanced reconstruction algorithms to reduce noise and artifacts and post-processing techniques, such as deconvolution and filtering, are now being used to improve image quality and resolution.

NO DIFFERENCE IN SHORT-TERM REVISION RATE AND EARLY MORTALITY IN UNCEMENTED VERSUS CEMENTED TOTAL HIP ARTHROPLASTY: A REGRESSION DISCONTINUITY ANALYSIS IN THE DUTCH ARTHROPLASTY REGISTER DATA

Controversy persists over whether cemented or uncemented fixation is more effective in reducing revision and mortality risks following primary total hip arthroplasty (THA). Despite a shift towards uncemented THA in Europe, Australia, and the US, no consensus exists on superior outcomes. This ambiguity in evidence from randomized controlled trials (RCTs) and observational studies necessitates advanced research methodologies to derive more definitive conclusions.This study investigates the causal impact of THA fixation type on 2-year and 5-year revision rates, along with 90-day mortality, utilizing a regression discontinuity (RD) design in scenarios where fixation choice is guided by patient age.Employing data from the Dutch Arthroplasty Register, we conducted a cohort study on primary THAs for osteoarthritis from 2007 to 2019. A “fuzzy” RD design was executed to compute the Local Average Treatment Effect for subjects around the age-based selection threshold for fixation type. The main outcome of interest was the revision rate at 2 years post-operation.Analysis for the 2-year revision endpoint, covering any cause, included 2,344 females and 1,671 males across 5 hospitals each, with no significant variation in revision rates observed. For the 5-year mark, 1,058 females in 3 hospitals and 214 males in 1 hospital were examined, similarly showing no significant differences. Mortality within 90 days post-operation was also investigated in 5 female and 7 male cohorts, with 2,180 and 2,145 surgeries respectively, yielding no substantial disparities.In conclusion, the RD analysis revealed no notable differences in revision rates at 2 and 5 years or in early mortality based on the fixation method used in THA. These outcomes suggest that the age-based preference for THA fixation may not influence the revision or mortality risk, underscoring the value of RD design in deriving causal insights from observational data.

C2 pedicle screw insertion assisted by mobilization of the vertebral artery in cases with high-riding vertebral artery

ObjectiveTo describe the feasibility, safety and efficacy of mobilization of the vertebral artery for C2 pedicle screws in cases with the high-riding vertebral artery (HRVA). MethodsDuring the period January 2020 to September 2022, fifteen patients underwent posterior occipitocervical fixation in our department. All patients had unilateral HRVA on at least one side that prohibited the insertion of C2 pedicle screws. There were 2 males and 13 females aged 47 ± 11.9 years (range: 17–64 years). After the correction of the vertical dislocation during the operation, the C2 pedicle screw insertion and occipitocervical fixation and fusion were performed using the vertebral artery mobilization technique. A routine three-dimensional reconstructed CT examination was executed to confirm the trajectory of C2 pedicle screws post-operation, and a CT angiography examination was performed when necessary. Neurological function was assessed using the Japanese Orthopedic Association (JOA) scale. The preoperative and postoperative JOA score and the main radiological measurements, including anterior atlantodental interval (ADI), the distance of odontoid tip above Chamberlain line, and clivus-canal angle (CCA), were collected and compared by paired t-test. ResultsAll 15 patients had atlas assimilation, among which 12 patients had C2–C3 fusion (Klippel-Feil syndrome). Mobilization of the HRVA was successfully completed, and C2 pedicle screws were then fulfilled after the vertebral artery was protected. There was no injury to the vertebral artery during the operation. Meanwhile, no severe surgical complications such as cerebral infarction or aggravated neurological dysfunction occurred during the perioperative period. Satisfactory C2 pedicle screw placement and reduction were reached in all 15 patients. All the patients achieved bone fusion 6 months after surgery. No looseness and shift of internal fixation or reduction loss was observed during the follow-up period. Compared to the preoperative, the postoperative JOA score and the main radiological measurements were remarkably improved and statistically significant. ConclusionsC2 pedicle screw insertion assisted by mobilization of the vertebral artery is safe and considerably effective, providing a choice for internal fixation in cases with high-riding vertebral arteries.

Pediatric-Specific Lesions in Unstable Pelvic Ring Fractures of Skeletally Immature Children: Impact on Diagnosis and Management Decisions.

Surgical fixation of pediatric pelvic ring injuries is gaining popularity to avoid the poor long-term outcomes of pelvic asymmetry. The surgical techniques and fixation choices depend on the individual injuries affecting the anterior and posterior pelvic ring areas. The immature bony pelvis of young children has anatomic differences including soft bones, elastic ligaments, and the presence of growth centers. Understanding the unique pediatric lesions with unstable pelvic fractures is essential for treatment decisions. Anterior lesions include pubic symphysis disruption through the pubic apophysis, single ramus fractures, pubic rami fractures through the triradiate cartilage, and/or the ischiopubic synchondrosis; ischiopubic ramus infolding injury; or the unstable superior and inferior quadrant lesions. Posterior pelvic lesions include iliac wing infolding and sacroiliac joint dislocation or transiliac (crescent) fracture/dislocations through the iliac apophysis growth plate. Pubic symphysis and sacroiliac disruptions are physeal injuries in children, and they have excellent healing potential. External fixation is an ideal choice for anterior ring fixation including bony and pubic symphysis injuries. Posterior lesions are mostly sacroiliac joint disruptions with iliac apophysis separation that can serve as a landmark for vertical displacement correction. Posterior lesions can be treated by percutaneous iliosacral screw fixation or open reduction techniques.

Surgical Management of Complex Ankle Fractures in Patients with Diabetes: A National Retrospective Multicentre Study.

Objectives: Patients with ankle fractures associated with diabetes experience more complications following standard open reduction-internal fixation (ORIF) than those without diabetes. Augmented fixation strategies, namely extended ORIF and hindfoot nails (HFNs), may offer better results and early weightbearing in this group. The aim of this study was to define the population of patients with diabetes undergoing primary fixation for ankle fractures. Secondarily, we aimed to assess the utilisation of standard and augmented strategies and the effect of these choices on surgical outcomes, including early post-operative weightbearing and surgical complications. Methods: A national multicentre retrospective cohort study was conducted between January and June 2019 in 56 centres (10 major trauma centres and 46 trauma units) in the United Kingdom; 1360 patients with specifically defined complex ankle fractures were enrolled. The patients' demographics, fixation choices and surgical and functional outcomes were recorded. Statistical analysis was performed to compare high-risk patients with and without diabetes. Results: There were 316 patients in the diabetes cohort with a mean age of 63.9 yrs (vs. 49.3 yrs. in the non-diabetes cohort), and a greater frailty score > 4 (24% vs. 14% (non-diabetes cohort) (p < 0.03)); 7.5% had documented neuropathy. In the diabetes cohort, 79.7% underwent standard ORIF, 7.1% extended ORIF and 10.2% an HFN, compared to 87.7%, 3.0% and 10.3% in the non-diabetes cohort. Surgical wound complications after standard-ORIF were higher in the diabetes cohort (15.1% vs. 8.7%) (p < 0.02), but patients with diabetes who underwent augmented techniques showed little difference in surgical outcomes/complications compared to non-diabetes patients, even though early-weightbearing rates were greater than for standard-ORIF. Conclusions: Ankle fractures in diabetes occur in older, frailer patients, whilst lower-than-expected neuropathy rates suggest a need for improved assessment. Augmented surgical techniques may allow earlier weightbearing without increasing complications, in keeping with modern guidelines in ankle fracture management.

A Systematic Review of Methods of Fixation of Greater Trochanter Fracture during Hip Arthroplasty

Abstract Background The rigid fixation of greater trochanter has been supported by more and more surgeons, but the choice of fixation is still controversial. Traditional steel wires and titanium is widely used because of its relatively simple procedure and low cost. But the high failure rate of internal fixation also led orthopedists to seek for other more effective fixation methods. Objective To compare between methods of fixation of greater trochanter during hip arthroplasty according to type and postoperative outcome. Patients and Methods Studies that meet the inclusion criteria were reviewed and data were analysed. We assessed the participants, methods, and intervention effects of included studies for heterogeneity. This enabled us to determine whether results can be pooled across studies. Results This review was on Non randomized and randomized controlled trials, prospective and retrospective studies which compare different methods of fixation of trochanter during hip arthroplasty. The search strategy identified 780 unique citations. Screening of titles and Abstracts identified 93 potentially relevant articles. Full text review of these articles identified 10 studies meeting the inclusion criteria. 10 studies were included 8 were retrospective and 2 prospective studies. Data Sources Medline databases (PubMed, Medscape, ScienceDirect. EMF-Portal) and all materials available in the Internet till 2021. Data Extraction If the studies did not fulfill the inclusion criteria, they were excluded. Study quality assessment included whether ethical approval was gained, eligibility criteria specified, appropriate controls, and adequate information and defined assessment measures. Conclusion The different fixation methods were successful in achieving proper reduction and fixation of greater trochanteric fractures during hip arthroplasty. We preferred the cable plates, which not only provides strongest fixation but also results in lower rate of postoperative complications. But further prospective randomized and cohort studies are needed to validate their safety and efficacy.

SURGICAL MANAGEMENT OF COMPLEX ANKLE FRACTURES IN PATIENTS WITH DIABETES: A NATIONAL RETROSPECTIVE MULTICENTRE STUDY

BackgroundAnkle fractures associated with diabetes experience more complications following standard Open-Reduction-Internal-Fixation (ORIF) than those without diabetes. Augmented fixation strategies namely extended ORIF and hind-foot-nail (HFN) may offer better results, and early weightbearing in this group. The aim of this study was to define the population of patients with diabetes undergoing primary fixation for ankle fractures. Secondarily, to assess the utilisation of standard and augmented strategies and the effect of these choices on surgical outcomes including early post-operative weight bearing and surgical complications.MethodsA national-multicentre retrospective cohort study was conducted between January to June 2019 in 56 centres (10 Major- Trauma-Centres and 46 Trauma-Units) in the United Kingdom; 1360 specifically defined complex ankle-fractures were enrolled. Demographics, fixation choice, surgical and functional outcomes were recorded. Statistical analysis was performed to compare high-risk patients with/without diabetes.ResultsThere were 316 patients in the diabetes cohort with mean age 63.9yrs (vs. 49.3yrs in non-diabetes cohort), and greater frailty score &gt;4 (24% vs.14% (non-diabetes cohort) (p&lt;0.03); 7.5% had documented neuropathy. In the diabetes cohort, 79.7% underwent standard ORIF, 7.1% extended ORIF and 10.2% a HFN compared to 87.7%, 3.0% and 10.3% in the non-diabetes cohort. Surgical wound complications after standard-ORIF were higher in the diabetes cohort (15.1% vs. 8.7%) (p&lt;0.02) but patients with diabetes who underwent augmented techniques showed little difference in surgical outcomes/complications to non-diabetes, even though early-weight- bearing rates were greater than standard-ORIF.ConclusionAnkle fractures in diabetes occur in older, frailer patients; whilst lower than expected neuropathy rates suggest a need for improved assessment. Augmented surgical techniques may allow earlier weight-bearing without increasing complications in keeping with modern guidelines in ankle fracture management.

HINDFOOT ANKLE RECONSTRUCTION NAIL TRIAL (HARNT): POPULATION ANALYSIS OF SURGICAL TREATMENT OF COMPLEX ANKLE FRACTURES IN THE UNITED KINGDOM

IntroductionThe management of open or unstable ankle and distal tibial fractures pose many challenges. In certain situations, hindfoot nailing (HFN) is indicated, however this depends on surgeon preference and regional variations exist. This study sought to establish the current management and outcomes of complex ankle fractures in the UK.MethodsA National collaborative study in affiliation with BOTA was conducted and data retrospectively collected between January 1st – June 30th 2019. Adult patients with open and closed complex ankle fractures (AO43/44) were included. Complex fractures included the following patient characteristics: diabetes ± neuropathy, rheumatoid arthritis, alcoholism, polytrauma and cognitive impairment. We obtained data on fixation choice and patient outcomes. Institutional approval was obtained by all centres, and statistical analysis was performed including propensity matching.ResultsFifty-six centres provided data for 1360 patients. The average age of the cohort was 53.9 years ±19 (SD) with a male/female ratio of 1:1.3. 920 patients were ASA 1/2, 440 were ASA 3/4; 316 had diabetes, and 275 were open fractures. Most fractures were AO44 (71.2%) and more commonly associated with diabetes (P&lt;0.001), alcoholism (P&lt;0.007), open (P&lt;0.013), and advanced age (55.7 vs. 46.3). 1227 patients underwent primary-fixation (111 HFN), with the remainder treated with external-fixation (84 definitive). Of the 111 HFN, 35% underwent primary fusion. Wound complication and thromboembolic rates were greater in the HFN group compared to ORIF groups (P&lt;0.003), being more evident in the HFN group with primary fusion even after propensity matching. However, 1081 patients were non-weightbearing post-op contrary to the BOAST guidance.ConclusionThis is the first National collaborative audit of complex ankle fractures. Hindfoot nails were used in 9% of patients and we observed more complications in this group when compared to other cohorts. Despite BOAST guidance, only 21% of patients undergoing operative management were instructed to fully weightbear post-operatively.

Radiographic Evidence of Bone Changes Around Intraosseous Transcutaneous Amputation Prosthesis: An 11-Year Retrospective Cohort Study

ABSTRACT Introduction Percutaneous Osseointegrated Implants (POIs) influence the load transfer path to the host bone. In turn, mechano-regulatory processes (strain adaptive bone remodeling) drive periprosthetic bone changes that influence implant stability and fixation outcome. These bone changes have not yet been reported for the Intraosseous Transcutaneous Amputation Prosthesis (ITAP) clinical trial. Objectives This study will first standardize the zoning and reporting of periprosthetic bone change in POI radiographs. Second, it will retrospectively measure periprosthetic bone change from radiographs of 12 participants with an ITAP up to 11 years. Finally, the results will be qualitatively compared with those from participants with different POI designs. Materials and Methods Twenty participants with unilateral transfemoral amputations received an ITAP in a 2-center UK clinical trial in either 2008/09 or 2013/14. Participant radiographs from one center were available (n = 12) over 11 years and have been collated and processed in a repeatable way. Transverse plane periprosthetic bone change measurements at 3 equidistant points along the implant stem were measured in AP and ML. Results Total median bone growth in AP was double that in ML (57.6 mm and 31.12 mm, respectively). Median lateral and posterior bone change (1.44 mm and 1.09 mm) was greater than median medial and anterior (0.83 mm and −0.005 mm) bone changes, respectively. The greatest change in radial bone growth was observed distally and the least proximally. Conclusions Bone changes were similar to other collared pressfit POIs in the literature. We demonstrate the influence of stem design and mechano-regulatory remodeling in stable fixation; however, additional influences on periprosthetic bone change were inferred from the results and further investigations are necessary. Clinical Relevance To identify ITAP design features and fixations that minimize endosteal resorption, thus promoting implant stability and contributing to clinical guidelines for rehabilitation and future design and fixation choices.

A comparative study of INSM1 (clone MRQ70) immunoreactivity on CytoLyt® pretreated cytology and resection specimens of pancreatic neuroendocrine tumors.

Insulinoma-associated protein 1 (INSM1) is a newly characterized sensitive and specific immunohistochemical marker for neuroendocrine (NE) tumors. Whereas more traditional NE markers, such as chromogranin A and synaptophysin, are cytoplasmic, INSM1 is uniquely nuclear and thus could serve as a useful addition to NE tumor workup. While application of immunohistochemical studies to cytology specimens is becoming increasingly relevant, knowledge of the effects of the certain fixatives as well as the pattern and intensity of immunoexpression are important considerations. Sixteen cases of pancreatic neuroendocrine tumor (PanNET) diagnosed between 2015 and 2021 underwent both fine-needle aspiration, which was subsequently prepared in CytoLyt®-fixed cytology cell block (CCB), and surgical resection, in which specimens were prepared into formalin-fixed paraffin embedded blocks (FFPE). For all samples, INSM1 immunoreactivity was classified according to staining intensity and extent, then compared between CCBs and matched FFPEs. All 16 FFPE specimens demonstrated strong and diffuse INSM1 immunoreactivity, while only 10/16 (62.5%) CCBs were positive. Of those 10, only 2/10 (20%) demonstrated strong and diffuse reactivity. The choice of fixative has a demonstrable effect on the immunoreactivity of INSM1 in PanNET. Even though the sensitivity is lower in CytoLyt®-fixed cell block specimens, the addition of INSM1 is useful, especially in challenging cases that may be negative for one or more of the traditional NE markers.

The Attallah screw: Where safety meets robustness in posterior subaxial cervical instrumentation.

Posterior fixation of the subaxial cervical spine (SCS) commonly relies on the application of lateral mass screws (LMS), with pedicle screws being a less prevalent alternative. The present study provides another option: A recently introduced novel approach, the Attallah screw, intended to ensure a safety profile comparable to that of LMS, combined with a strength profile similar to that of pedicle screws. The focus of the present study is the comparative analysis of peak insertion torques for these three screw types. Employing standard surgical techniques and instruments, Attallah screws were scheduled for insertion on the right side of the SCS in 15 cadavers, pedicle screws on the left side in 8 cadavers, and LMS on the left side in the remaining 7 cadavers. The peak insertion torque was recorded using an electronic torque screwdriver. The results revealed that the peak insertion torques were similar in the pedicle and the Attallah screw at C3, C4 and C7, but differed at C5 (mean ± SD; pedicle, 79.5±19.6 cNm; Attallah, 56.7±18.5 cNm; P=0.029) and C6 (pedicle, 85.4±28.7 cNm; Attallah, 49.8±17.9 cNm; P=0.004) in favor of the superior pedicle screw measurements. The peak insertion torques of the pedicle screw were superior to the corresponding data from the LMS from C4 to C7. By contrast, the peak insertion torques of the Attallah screw were only superior to those of the LMS at C7 (Attallah, 69.5±24.5 cNm; lateral mass, 40.5±21.4 cNm; P=0.030), although similar trends were observed at the other cervical levels. On the whole, the findings presented herein indicate the level-dependent superior robustness of the Attallah screw as a posterior cervical fixation method compared to the LMS. However, from a biomechanical perspective, the pedicle screw remains the preeminent choice for fixation within the C5-C6 range.

Is Fibular Fixation Necessary with Increasing Proximity in Ankle Fractures: A Survey of OTA and AOFAS Surgeons

Introduction/Purpose: Ankle fractures are one of the most common fractures encountered in orthopedics. The Maisonneuve fracture pattern is described as a pronation, external rotation injury involving the medial ankle structures, the syndesmosis, and the proximal third of the fibula. However, the actual distance from the proximal fibula has not been defined in what distinguishes a Maisonneuve fracture. With Weber C fractures, most surgeons tend to provide fixation to the fibula and reassess the syndesmosis afterwards. When dealing with the proximal fibula “Maisonneuve” fracture pattern, most surgeons would tend to ignore the fibula fracture and focus on syndesmotic reduction. Orthopaedic Trauma Association and American Orthopaedic Foot &amp; Ankle Society provided their opinion via survey in treating increasing proximity of fibula fractures associated with unstable ankle fracture patterns. Methods: A survey was provided to eight OTA and AOFAS orthopedic surgeons. A powerpoint was provided to the surgeons that contained non-weightbearing injury films of eighteen patients. A questionnaire was provided giving two answer choices, address the fibular or syndesmosis primarily. The eighteen ankle fractures were selected based on increasing proximity of the fibula fracture, which ranged from 4.5cm to 32.3cm. The ankle fractures were grouped into four categories to include the Maisonneuve variant based on distance. These fracture radiographs were randomized in order to not influence the surgeon’s opinion during the study. The four groups were as follows: 1. 4.5cm – 7.4cm to include six ankle fracture radiographs 2. 8cm – 10.4cm to include four ankle fracture radiographs 3. 14.6cm to 23.3cm to include five ankle fracture radiographs 4. 30.7cm to 32.3 cm to include three Maisonneuve variant ankle fracture radiographs Results: Regarding section 1, the majority of surgeons responded with open reduction, internal fixation of the fibula as their initial reduction. Section 2, the responses remained consistent with a majority of surgeons choosing to address fibular fixation followed by syndesmotic evaluation. The total number of responses in this section scored 43 answer A selections to 5 answer B selections. Section 3 (14.6-23.3cm) provided the most variability in the responses provided. With 60 possible answer choices, the polled surgeons responded with answer choice A seventeen times and answer choice B 43 times. Section 4 (30.7-32.2cm) or the Maisonneuve produced a steady response of answer choice B. Syndesmotic reduction was performed 34 times compared to only two fibular fixation choices – or answer choice A. Conclusion: The purpose of this study was to evaluate expert opinion on differing treatment as the proximity of the fibular fracture increased in connection with an unstable ankle fracture pattern. General consensus under 10,4cm was to address fibular fixation. However, once the fibular fracture exceeded 14cm, significant variability was noted. These results prove that further biomechanical studies are needed to determine the effect fibular stability in increasing proximity has on the syndesmosis. Chart 1 shows answer selections across the four categories. Chart 2 shows answer selections across the highest variability group 3.

Nonvascularized Bone Grafting for Scaphoid Nonunion

Abstract Background Surgical management of scaphoid nonunions requires not only stable fixation but restoration of carpal alignment and reconstruction of bone defects. The latter can be done with either vascularized or non-vascularized bone grafts, depending largely on surgeon preference. Materials and Methods This article describes the use of non-vascularized bone grafts for scaphoid nonunions and examines reported outcomes. We also describe the senior author's preferred surgical treatment, the hybrid Russe procedure. Description of Technique The hybrid Russe procedure utilizes a corticocancellous strut from the volar aspect of the distal radius to restore anatomy in scaphoid nonunions with flexion deformities. Once the alignment of the scaphoid and associated lunate postural deformities are corrected, fixation then proceeds with a headless compression screw. This combination resulted in healing of 17 scaphoid fracture nonunions at an average time of 15 weeks. Conclusions The literature does not demonstrate a difference in union rates when comparing the use of vascularized and non-vascularized grafts for scaphoid nonunions. When the proximal pole of the scaphoid can be salvaged, the choice of fixation is left to the surgeon's discretion.

A scoring system to evaluate stability of percutaneous osseointegrated implants for transfemoral amputation with validation in the ITAP clinical trial.

Percutaneous osseointegrated implants for individuals with lower limb amputation can increase mobility, reduce socket related pain, and improve quality of life. It would be useful to have an evaluation method to assess the interface between bone and implant. We assessed outpatient radiographs from the Intraosseous Transcutaneous Amputation Prosthesis clinical trial using an interface scoring system which summed and weighted equally measures of implant collar cortical ongrowth and radiolucency along the implant stem/bone interface. Radiographs from 12 participants with unilateral transfemoral amputations (10 males, 2 females, mean age = 43.2, SD = 7.4 years) in the clinical trial from cohort I (implanted in 2008/09) or cohort II (implanted in 2013/14) were collated (mean image span = 7.2, SD = 2.4 years), scale normalised, zoned, and measured in a repeatable way. Interface scores were calculated and then compared to clinical outcomes. Explanted participants received the lowest interface scores. A higher ratio of stem to residuum and shorter residuum's produced better interface scores and there was an association (weak correlation) between participants with thin cortices and the lowest interface scores. A tapered, cemented, non curved stem may provide advantageous fixation while stem alignment did not appear critical. In summary, the interface score successfully demonstrated a non-invasive evaluation of percutaneous osseointegrated implants interfaces when applied to the Intraosseous Transcutaneous Amputation Prosthesis clinical trial. The clinical significance of this work is to identify events leading to aseptic or septic implant removal and contribute to clinical guidelines for monitoring rehabilitation, design and surgical fixation choices.

What is the best fixation method in medial patellofemoral ligament reconstruction? A biomechanical comparison of common methods for femoral graft attachment

Introduction: A variety of techniques have been described for femoral fixation in medial patellofemoral ligament reconstruction (MPFLr). The aim of this study was to compare the biomechanical performance of the most used methods for graft fixation in the femur using human cadaveric tissue. We wondered what is the best fixation method for femoral fixation in MPFL reconstruction? Hypothesis: A suspensory fixation device provides the best femoral fixation. Material and method: Twenty cadaveric knees were tested. Four femoral fixation methods were compared (5 knees per group): interference fixation with a Biosure© RG 5 mm and a 7 mm, suture anchor (Healicoil Regenesorb 4.75 mm ©) and suspensory fixation with the Ultrabutton©. The testing was divided in preconditioning, cyclic loading and load to failure. Load to failure, elongation, stiffness and mode of failure were recorded and compared. Results: The Ultrabutton© had the highest mean ultimate load (427 ± 215 N (p = 0.5)), followed by Healicoil anchor © (308 ± 44 N (p &gt; 0.05)) and the interference screw of 7 mm (255 ± 170 N (p &gt; 0.05)). Mean stiffness was similar in the Ultrabutton© and 4.75 mm. Healicoil anchor © groups (111 ± 21 N/mm and 119 ± 20 N/mm respectively), and lowest in 7 mm Biosure© screw fixation group (90 ± 5 N/mm). The Biosure© 5 mm RG screw presented 100% of premature rupture because of tendon slippage. The Ultrabutton© presented the lowest premature rupture (40%). Discussion: A suspensory fixation for the femur had the lowest number of graft failures and highest load to failure. This study has implications for surgeons’ choice of graft fixation in MPFLr. It is the first study to test the most commonly femoral used fixation methods, allowing direct comparisons between each method.

Internal fixation of cruciate ligament avulsion fractures with metallic implants

Abstract Background: Tibial spine anterior cruciate ligament (ACL) avulsion injuries are uncommon injuries and are less accompanied with tear or rupture of ligaments. Posterior cruciate ligament (PCL) avulsions are significantly associated with concomitant injuries. Methods: Thirteen patients with tibial avulsion fractures were studied (7 with anterior cruciate and 6 with posterior cruciate ligament avulsion fractures). All patients were operated with open reduction and internal fixation with metallic stainless steel or titanium implants and were followed up for 12-24 months. Functional and clinical outcomes were observed with Lysholm knee score and GH SF36 score at 6 months, 1 year and at final visit. Results: Mean radiological union was 11.6 weeks in both cruciate avulsion fractures. Of the 13 cases, 11 were treated with cannulated screws and 2 were treated with 3.5 mm stainless steel plate. We had observed mean motion of knee to be 131.42° in ACL avulsion fractures and 143.33° in PCL avulsion fractures. Mean Lysholm score at final visit was 87.38 and mean SF36 general health score was 85.41. Conclusion: In regards of cruciate ligaments tibial avulsion fractures, metallic implants are coveted choice of fixation with charismatic experience of learning and expertise. Metallic implants impose a definite functional outcome with sure and reliable union rate and secure activity of daily living without any implant related adverse issues.

Self locking zip ties temporary displaced mandibular fracture reduction

The article addresses mandibular fractures, which are common today, often resulting from traffic accidents, violence and falls. Surgical management is crucial to avoid future complications. The work describes a specific case in which Nylon tape (clip) was used to reduce a mandibular fracture in a male patient who was a victim of physical aggression. The patient, a homeless individual involved with narcotic substances, was treated by neurosurgery and trauma surgery teams. The fracture was initially reduced with nylon tape during primary care. The patient was subsequently transferred to the oral and maxillofacial surgery (BMF) team for definitive treatment. The treatment involved several steps, including nasotracheal intubation, antisepsis, local anesthesia, submandibular surgical access, removal of nylon tape, tooth extraction, cleaning of the fracture, manual reduction, plate fixation and occlusion review. The patient received conventional clinical support and was released on the second postoperative day for outpatient follow-up. The choice of fixation with replaced load of the 2.4 mm system (load bearing) stands out due to the need for high rigidity in contaminated fractures. The extraction of teeth 43 and 44 was carried out to avoid risks of contamination. The article concludes by highlighting the effectiveness and accessibility of using nylon tape for the temporary stabilization of mandibular fractures, providing local pain relief and reducing the distress associated with bone movement.

Comparison of Different Laparoscopic Sacrocolpopexy Procedures: A Retrospective Dual Center Analysis.

Introduction: Pelvic organ prolapse (POP) affects up to 50% of women and has a significant impact on quality of life. Abdominal sacrocolpopexy is the gold standard treatment for vault prolapse and laparoscopic sacrocolpopexy has many advantages. This study aimed to compare the results of two laparoscopic sacrocolpopexy procedures performed at two different surgical centers. Materials and Methods: The primary objective of this retrospective study was to assess surgical feasibility and complication rates associated with sacrocolpopexy procedures performed at Center A (using self-fixating mesh) and Center B (using sutured mesh). Secondary objectives included assessment of length of hospital stay, readmission rates, and surgical outcomes. The study included patients treated between January 2019 and October 2023. Results: Thirteen patients, six from Center A and seven from Center B, were included. Patient characteristics, such as age and body mass index, were similar between the two groups. Operative time and length of stay were not significantly different. Center A reported one postoperative complication (mesh erosion), which occurred two years after surgery and required laparoscopic intervention. Center B also reported one conversion to laparotomy because of metabolic acidosis and hypercapnia. Conclusion: The two laparoscopic sacrocolpopexy techniques were safe and effective for treating POP and our study confirmed the importance of mesh and fixation choices. Further research is needed to improve understanding of these surgical techniques.

Volar Locking Plate Fixation for Distal Radius Fractures Distal to the Watershed Line with an Intact Lunate Volar Rim.

Background: We treated distal radius fractures (DRFs) beyond the watershed line without fracture of the lunate volar rim using a volar locking plate (VLP) and report the radiological and clinical outcomes at least 3 years after surgery. Methods: In 41 consecutive patients between January 2012 and August 2017, the fragment was composed of the radial styloid process (distal to the watershed line) and the lunate volar rim was intact. We evaluated demographic factors, radiological features and radiological/clinical outcomes at the final follow-up. Results: Twenty-nine patients were followed and evaluated. The mean follow-up period was 5.7 years. The mean patient age was 52.7 years and 24 patients had intracapsular intra-articular fractures. The fracture line was present in the lunate fossa in all patients. Twenty patients were classified as Soong grade 2, and five and four patients were grades 1 and 0, respectively. No radiological parameter (volar tilt, radial inclination, step-off and ulnar variance) was significantly different between the affected and contralateral normal sides. The mean visual analogue scale pain score and Disabilities of the Arm, Shoulder and Hand score, as well as the range of movement of the wrist, were not different between the affected and contralateral normal wrists. Finally, the grip strength on the affected side was 92% of the contralateral value. Major complications, such as nonunion, malunion and tendon rupture, were absent. Conclusions: DRFs distal to the watershed line with an intact lunate volar rim are rare and easy to miss. Careful inspection of 3D-CT images is necessary to determine these injuries, and the optimal choice for proper fixation of the fragment amongst the commercial VLPs would result in satisfactory radiological and clinical outcomes. Level of Evidence: Level IV (Therapeutic).

Comparison of the operation safety and biomechanical stability of sacral alar-iliac vs. sacroiliac screws in the fixation of sacroiliac joint in simulated models of low bone density

BackgroundSacral alar-iliac screws (SAISs) have been used for sacroiliac joint and are superiority to traditional sacroiliac screws (SISs) in patients with low bone density. The aim of this study was to investigate the operation safety and biomechanical stability of the SIS, transsacral-transiliac screw (TSTIS), S1AIS and S2AIS in the treatment of sacroiliac joint in simulated models of low bone density. MethodsCT data from 80 normal pelvic structures were employed to measure the anatomical parameters, including the safety zones of the S1AIS and S2AIS at the insertion point and the trajectory lengths of the SIS, TSTIS, S1AIS and S2AIS. Sixteen synthetic pelvises with simulated osteoporotic bone structure were used to simulate type C Tile lesions and divided into 4 groups with an anterior plate and posterior fixation using one of the following: 1) one SIS on each side, 2) one TSTIS fixing both sides, 3) one S1AIS on each side, or 4) one S2AIS on each side. The stiffness and maximum load of the specimens were analyzed using a biomechanical machine under vertical loading. ResultsThe safety zone of S1AIS was larger than that of S2AIS (p < 0.05). The TSTIS had the largest trajectory length, followed by the S1AIS and S2AIS, and the SIS had the smallest trajectory length (p < 0.05). However, the lengths of the TSTIS (26.1 ± 1.7 mm) and SIS (27.8 ± 1.8 mm) trajectories on the short side (the iliac side) were smaller than those of S1AIS (40.4 ± 3.8 mm) and S2AIS (39.1 ± 3.8 mm), thus indicating significant differences (p < 0.05). The stiffness and maximum load of S1AIS and S2AIS were similar and the greatest, followed by TSTIS and SIS (p < 0.05). ConclusionThe stability of S1AIS and S2AIS is similar, both stronger than that of SIS and TSTIS, which have shorter lengths of the screw trajectories on the ilium side. However, the safety zone of S2AIS at the insertion point is smaller than that of S1AIS. Therefore, considering both safety and stability, S1AIS is the preferred choice for fixation of sacroiliac joint dislocation in simulated models of low bone density.