Combined Fixation Research Articles

Cemented or uncemented acetabular fixation in combination with the Exeter Universal cemented stem.

To compare long-term survival of all-cemented and hybrid total hip arthroplasty (THA) using the Exeter Universal stem. Details of 1,086 THAs performed between 1999 and 2005 using the Exeter stem and either a cemented (632) or uncemented acetabular component (454) were collected from local records and the New Zealand Joint Registry. A competing risks regression survival analysis was performed with death as the competing risk with adjustments made for age, sex, approach, and bearing. There were 61 revisions (9.7%; 0.82 revisions/100 observed component years, (OCYs)) in the all-cemented group and 18 (4.0%; 0.30/100 OCYs) in the hybrid group. The cumulative incidence of revision at 18 years was 12.1% for cemented and 5.2% for hybrids. There was a significantly greater risk of revision for all-cemented compared with hybrids (unadjusted sub-hazard ratio (SHR) 2.44; p = 0.001), and of revision for loosening, wear, or osteolysis (unadjusted SHR 3.77; p < 0.001). After adjustment, the increased risk of all-cause revision did not reach significance at age 70 years and above. The advantage for revision for loosening, wear, and osteolysis remained at all ages. This study supports the use of uncemented acetabular fixation when used in combination with the Exeter stem with improved survivorship for revision for aseptic loosening, wear, and osteolysis at all ages and for all-cause revision in patients less than 70 years. Cite this article: Bone Joint J 2020;102-B(4):414-422.

Correction of femoral deformities of inflammatory genesis (osteomyelitis sequalae) in children: an analysis of the treatment results of 76 patients

Backgrоund. In most cases, haematogenic osteomyelitis affects the long bones of the skeleton. Predominantly, the centers of destruction are located in the lower extremities. The orthopedic complications of haematogenic osteomyelitis were observed (according to different data) in 22%71.2% of childhood cases. In 16.2%53.7% of cases, the complications can lead to childhood (nascent) disability.&#x0D; Aim. The purpose of the research is to conduct a retrospective analysis of femoral deformity correction results in children with haematogenic osteomyelitis consequences by applying both an Ortho-SUV Frame (based on passive computer navigation) and following the Ilizarov method.&#x0D; Materials and methods. The study examined 76 patients of both genders aged between 8 and 17 years old who were experiencing the consequences of haematogenic osteomyelitis in the long bones of the lower extremities. A comparative assessment of the parameters reflecting the effectiveness of circular external fixation in combination with an Ortho-SUV Frame and the Ilizarov method was conducted. Reference lines and angles before and after surgery, elongation size, distraction time, deformity correction period, external fixation index, number of complications, and the functional result were all considered.&#x0D; Results. All the children underwent deformity correction surgery, and the length of the afflicted lower extremity segment was reconstructed (restored). The use of the repositioning unit enabled a higher correction accuracy (94.45%) of the femur in comparison with the Ilizarov frame (30%). The frequency of excellent functional results in the first group of patients was more than 1.5 times higher than in the second group, whereas the satisfactory results turned out to be almost twice as low. Fewer complications were observed while using the Ortho-SUV hexapod.&#x0D; Conclusions. The application of the Ortho-SUV Frame at the long-bone-deformity-correction stage facilitates an increase in the efficiency of the circular external fixation method.

Finite element analysis of mini-plate stabilization of human mandible angle fracture – a comparative study

The purpose of this study was to analyze three patterns of mandible angle fracture treatment by means of the finite element analysis. Investigation has been based on the mandible geometry reconstructed with use of hospitalized patient CT data. The KLS Martin mini-plates with corresponding screws were used to establish proper fracture stabilization. Models were run assuming isotropic and elasto-plastic material properties of connecting devices and cortical bone. The main masticatory muscles and artificial temporomandibular joint have been incorporated to assure mandible physiological movement. The gage loading has been applied in three different locations to cover wider range of possible mastication loading cases during daily routine. A different contact conditions have been applied to the fracture plane to simulate both load bearing and sharing behaviors. Prepared FEM models reflect the most frequently used surgery's approaches to mandible angle fracture treatment. A specific nomenclature has been introduced to describe particular model. The tension plate, with one connecting mini-plate, two-point fixation and combined fixation, both using two mini-plates respectively. Performed analysis allowed for a detailed estimation of the mini-plate connection response under the applied gauge loading. The equivalent stress within the mini-plates and surrounding cortical bone have been compared between all models. Regarding the fracture plane, the contact status and pressure have been considered. The combined fixation model, acting as a biplanar fastener system, presents the highest flexibility and connection efficiency.

Internal fixation of lateral and medial borders for displaced scapular body fractures via minimally invasive approach:results of 23 cases

To evaluate the efficacy of internal fixation of lateral and medial borders for displaced scapular body fractures via the minimally invasive approach. The internal fixation of lateral and medial borders via minimally invasive approach was applied in surgical treatment of 23 patients with scapular body comminuted fractures from January 2014 to June 2018. The lateral approach was made straightly orienting over the lateral border of scapula. The dissection was taken down to the deltoid fascia. The deltoid was retracted cephalically, revealing the external rotators. Blunt dissection was used down to the lateral border between infraspinatus and teres minor, exposing the fracture site. The medial incision was done along the medial border of the scapula over site of the fracture. Dissections were taken down to the fascia and the periosteum. A subperiosteal dissection was then performed to elevate the infraspinatus to the degree necessary to visualize the fracture. The medial and lateral borders of scapula body were fixed with plates and screws in a frame-like way. One patient developed the delayed healing of the incisions due to liquefactive fat necrosis. The other 22 patients showed no complications of the incisions. The glenopolar angle (GPA) of fractured scapula was increased from preoperative (25±12) degrees to postoperative (41±5) degrees (P<0.01). The healing time of fractures healed was 3-8 months, with an average time of (4.4±1.3) months. The lateral-medial combined fixation through minimally invasive surgical approach for the scapula body fractures allows visualization of fracture reduction without extensive muscular or subcutaneous flaps, and is associated with successful fracture healing and high functional scores of the shoulder.

A Technique for 360-Degree Rigid Sternal Fixation with Sternal Plates and Wire Cerclage

Sternal instability after cardiac surgery can lead to poor bony healing, as well as deep sternal wound infections and mediastinitis. Rigid plate fixation is associated with greater stability and fewer complications compared with wire cerclage, however, rigid plate fixation alone lacks posterior stability of the sternum and may be less effective in morbidly obese or osteoporotic patients. This article describes a surgical technique of combined rigid plate fixation and wire cerclage that provides 360-degree stabilization for sternotomies in high-risk patients. We employed this technique in 40 patients with no incidence of deep sternal wound infection.

Congenital pseudarthrosis of the tibia: the outcome of a pathology-oriented classification system and treatment protocol.

Congenital pseudarthrosis of the tibia is defined as a non-union of a tibial fracture that develops in a dysplastic bone segment of the tibial diaphysis. Pathologically, a fibrous hamartoma surrounds the bone at the congenital pseudarthrosis of the tibia site. The cases of 25 children, who have congenital pseudarthrosis of the tibia, were included in this study. Their ages ranged from 15 months to 15 years at the time of treatment. Neurofibromatosis-1 was present in 24 children. They were managed according to our classification system and treatment protocol. The treatment for mobile pseudarthrosis (types 1 and 2) included complete excision of the pathological periosteum, insertion of autogenous iliac crest bone graft, and combined fixation using intramedullary rod and Ilizarov external fixator. For type 3 pseudarthrosis (stiff pseudarthrosis), a pre-constructed Ilizarov fixator was applied for simultaneous distraction of the pseudarthrosis and deformity correction without open surgery. Evaluation of results was mainly radiological and included achievement of union, leg length equalization, deformity correction and prevention of refracture. Consolidation of the pseudarthrosis and osteotomies was achieved in all cases (100%). Refracture occurred in one case (4%) at the site of previous pseudarthrosis. Residual limb length discrepancy more than 2.5 cm occurred in two cases (8%). Valgus deformity of the ankle was present in 12 cases (48%) and was treated by supramalleolar osteotomy. Follow-up ranged from 24 to 48 months (average 36.9 months) after fixator removal. The results of our treatment protocol, based on our classification system, have been consistently good and predictable in all cases of congenital pseudarthrosis of the tibia. Mobility of the pseudarthrosis is an important factor in choosing the type of interference.

249. Traumatic subaxial cervical facet joint dislocation: predictors of spinal cord injury and surgical failure

BACKGROUND CONTEXT Approximately two thirds of cervical spine injuries affect the subaxial cervical spine, with fractures occurring most often at C6 and C7 and dislocations at C5-C6 and C6-C7. In the spectrum of these injuries, facet joint dislocation represents a severe injury, frequently associated with spinal cord injury (SCI). PURPOSE The purpose of this study was to analyze a cohort of surgically treated subaxial cervical spine dislocations and to identify factors associated with higher risk of SCI and predictors of surgical failure. METHODS All patients operated in a single institution during a 10-year period (2007-2016) for traumatic single-level cervical facet joint dislocation were retrospectively reviewed. Age, gender, injury characteristics (dislocation or subluxation, uni- or bilateral, level of injury and presence of associated facet fracture), mechanism of trauma, presence of SCI (determined by the American Spinal Injury Association Impairment Scale [ASIA]), surgical data and follow-up records were reviewed. All patients had a minimum follow-up of 2 years. RESULTS A total of 71 patients, 53 men and 18 women, with mean age of 57 ± 18 years (18-90) were identified. Motor-vehicle accidents were the most frequent trauma mechanism, followed by fall from height. Young adults were mostly represented among motor-vehicle accidents, whereas falls contributed to a majority of facet joint dislocations sustained by the elderly. The C6-C7 level was the most affected (37/71 cases). Forty-seven patients had unilateral and 24 bilateral dislocation, with 47 of these cases (66%) having associated facet fractures. Spinal cord injury was present in 37% of the cases. Rigid columns (p = 0.009) and bilateral dislocations (p = 0.004) were associated with the presence of spinal cord injury. Patients with bilateral dislocation were 4.7 times more likely to have a spinal cord injury (OR: 4.7, 95% CI = 1.6-13.8). The closed reduction with cranial traction was attempted in 51 cases, with a success rate of 86%. 59 cases were submitted to isolated anterior cervical arthrodesis and 7 to anterior cervical corpectomy. Five were submitted to combined anterior and posterior fixation (360°). There were 3 failures after the previous isolated fixation, which required revision surgery with 360 ° fusion. All cases of failure occurred after an isolated anterior fusion in the C7-T1 transition (p CONCLUSIONS Patients with rigid spines or with bilateral facet dislocations are at higher risk for SCI. After successful reduction, anterior discectomy and fusion, as a single procedure, offers an excellent surgical option in the management of many cervical facet fracture dislocations, has showed in this analysis. Failure occurred always at the C7-T1 level, suggesting that here; a 360 degree fusion may be needed. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Treatment of open tibial diaphyseal fractures by external fixation combined with limited internal fixation versus simple external fixation: a retrospective cohort study

BackgroundThe treatment of open tibial shaft fractures is challenging. External fixation (EF) is comparatively safe in treating these open injuries, meanwhile it has the advantages of easy application, minimal additional disruption, and convenient subsequent soft tissue repair. Nevertheless, its application is accompanied by a series of problems in alignment and bone healing. Therefore, limited internal fixation (LIF), such as cortical screws, has been used based on the external fixator for better therapeutic effect. The aim of this study is to compare the outcomes of EF combined with LIF and simple EF in the management of open tibial shaft fractures, evaluating the efficacy and safety of using the combined technique in treating such fractures.MethodsFrom January 2012 to December 2016, patients with open tibial shaft fractures treated with EF with or without LIF augmentation were identified. A total of 152 patients were included in the analysis, and there were 85 patients in the simple external fixation group and 67 patients in the EF-LIF group. General assessment indicators included the direct cost of hospitalization and the times of first surgery, full weight bearing, and complete union. Infections and complications in union or limb alignment were compared as primary outcomes. Additionally, the number of patients who changed the fixation system for various reasons were analysed.ResultsEffective follow-up of all participants for statistical analysis was obtained. The follow-up time averaged 17.15 months (range: 12.00 to 24.00 months) in the EF group and 16.20 months (range: 12.00 to 19.00 months) in the EF-LIF group. Combined fixation provided shortened time to bear full weight and achieve complete bone union, while requiring additional first surgery time. No significant difference was found in infection rates or direct cost of hospitalization. Delayed union and non-union in the EF-LIF group were significantly decreased (20.9% versus 40.0, 1.5% versus 14.1%, p < 0.05). In limb alignment, patients with combined fixation exhibited reduced malreduction, loss of reduction, and malunion. In terms of secondary fixation, the EF-LIF group showed a markedly lower incidence (5.8% versus 34.1%, p < 0.001).ConclusionCompared with simple EF, combined fixation is an effective and safe alternative for management of open tibial diaphyseal fractures. It provides superior initial reduction, better stability and decreases the risk of inferior alignment and delayed union without increasing the risk of infection.

Treatment of Femoral Traumatic Fractures with a Custom Bridge Combined Fixation System

Background: With the development of transportation in modern China, the incidence of traumatic fracture and the global degree of fracture complexity are increasing. This study explored the use and curative effect of a novel custom-manufactured bridge combined fixation system for traumatic fractures of the femur. The bridge combined fixation system can be tailored to the specific patient's requirements by bending the rods and sliding the attachment modules. Methods: From May 2013 to August 2017, 14 patients with traumatic femur fractures were managed with the bridge combined fixation system. The operation was conducted according to the routine incision approach of femur fracture. The patients were given early postoperative functional rehabilitation exercise. The curative effect was evaluated according to clinical manifestations, postoperative imaging, and a self-developed standard for bone healing. Results: All patients were followed for 12–24 (median: 12.5) months. Fracture healing was assessed based on clinical symptoms and postoperative X-ray. After 3 months, complete weight-bearing on the affected leg was painless. X-ray showed that the fracture line had disappeared by 6–9 months postoperatively and showed bone healing. According to the self-developed standard for bone healing, 13/14 (92.8%) patients achieved excellent/good clinical outcomes. Bone union was achieved in all patients within 2 years. Conclusion: The custommanufactured bridge combined fixation system is simple and can effectively achieve tailored reduction of the fracture. The fixation was stable, with few complications after surgery and with good treatment effect for traumatic fractures.

Double-plate fixation together with bridging bone grafting in nonunion of femoral supracondylar, subtrochanteric, and shaft fractures is an effective technique.

The aims of the present study were to evaluate and report the therapeutic outcomes of double-plate fixation in combination with autogenous bridging bone grafting in treatment of nonunion fractures of femur. In this retrospective case series study, 41 patients with nonunion fracture of femur who underwent surgery by double-plate fixation and autogenous bridging bone grafting in academic referral center from July 2010 to July 2015 were enrolled. Totally, 32 males and 9 females with mean age of 35years were evaluated. They were evaluated for related risk factors, previous therapeutic methods, time interval between injury to nonunion surgery and surgery to full clinical and radiological union, duration of follow-up, levels of postoperative limb shortening, and movement limitations. Ten patients had open fractures and eight patients had infected nonunion in the femoral supracondylar, subtrochanteric, and shaft fractures. Nailing was the most common used method as the primary treatment of femoral shaft fractures. In addition, the mean follow-up time was 37months. Full union was obtained even in infected cases. Deep vein thrombosis was found in one patient and pulmonary thromboembolism in another patient, and both patients were treated successfully. Moreover, limitations of articular movements were seen in seven patients. Double-plate fixation in combination with bridging bone grafting is an effective method in the treatment of nonunion of femoral supracondylar, subtrochanteric, and shaft fractures even in the infected cases.

Evaluation of iliac screw, S2 alar-iliac screw and laterally placed triangular titanium implants for sacropelvic fixation in combination with posterior lumbar instrumentation: a finite element study

This study aimed to implement laterally placed triangular titanium implants as a technique of sacropelvic fixation in long posterior lumbar instrumentation and to characterize the effects of iliac screws, S2 alar-iliac screws and of triangular implants on rod and S1 pedicle screw stresses. Four female models of the lumbopelvic spine were created. For each of them, five finite element models replicating the following configurations were generated: intact, posterior fixation with pedicle screws to S1 (PED), with PED and iliac screws (IL), with PED and S2 alar-iliac (S2AI) screws, and with PED and bilateral triangular titanium implants (SI). Simulations were conducted in compression, flexion-extension, lateral bending and axial rotation. Rod stresses in the L5-S1 segment as well as in the S1 pedicle screws were compared. One anatomical model was not simulated due to dysmorphia of the sacroiliac joints. PED resulted in the highest implant stresses. Values up to 337MPa in lateral bending were noted, which were more than double than the other configurations. When compared with IL, S2AI and SI resulted in lower stresses in both screws and rods (on average 33% and 41% for S2AI and 17% and 50% for SI). Implant stresses after S2AI and SI fixations were lower than those attributable to IL. Therefore, pedicle screws and rods may have a lower risk of mechanical failure when coupled with sacropelvic fixation via S2AI or triangular titanium implants, although the risk of clinical loosening remains an area of further investigation. These slides can be retrieved under Electronic Supplementary Material.

Proximal, Distal, and Combined Fixation Within the Tibial Tunnel in Transtibial Posterior Cruciate Ligament Reconstruction: A Time-Zero Biomechanical Study In Vitro

To compare the time-zero biomechanical properties of 3 graft fixation techniques (proximal, distal, and combined fixation) within the tibial tunnel in transtibial posterior cruciate ligament (PCL) reconstruction. Porcine tibias and bovine extensor tendons were used to simulate a transtibial PCL reconstruction invitro. Load-to-failure testing was carried out in 3 groups: distal fixation alone (group I, n= 10), proximal fixation alone (group II, n= 10), and combined fixation (group III, n= 10). The load-elongation curve, tensile stiffness (in newtons per millimeter), ultimate load (in newtons), yield load (in newtons), energy absorbed to failure (in joules), and failure mode were recorded. All graft-tibia complexes failed because the grafts slipped past the interference screws. The tensile stiffness, yield load, and energy absorption in group I were significantly lower than those in group II and group III (tensile stiffness, 19.25 ± 9.68N/mm in group I vs 34.92 ± 16.48N/mm in group II [P= .016] and 32.31 ± 13.79N/mm in group III [P= .041]; yield load, 265.36 ± 144.52N in group I vs 398.23 ± 57.04N in group II [P= .006] and 424.94 ± 74.00N in group III [P= .001]; and energy absorption, 5.16 ± 2.35J in group I vs 19.95 ± 3.48J in group II [P < .001] and 21.09 ± 4.29J in group III [P < .001]). No statistically significant differences in biomechanical properties were found between group II and group III (P > .05). Compared with distal fixation in transtibial PCL reconstruction, proximal fixation and combined fixation showed superior time-zero biomechanical properties. Proximal fixation and combined fixation produced superior biomechanical properties to distal fixation in transtibial PCL reconstruction.

Малоинвазивные методы комбинированного остеосинтеза спицами Киршнера при лечении оскольчатых переломов плечевой и бедренной кости у кошек

The article describes clinical cases of surgical treatment of comminuted diaphyseal fractures of three humerus and four femur bones in cats. Three animals (two tomcats, one cat) have the open complex comminuted, not reconstructed fractures of the humerus ― 12-C3, according to AO classification. Two animals (cat and tomcat) were diagnosed with comminuted, non ― reconstructed femoral fractures-32-C3, according to AO classification. One animal (cat) was diagnosed with wedge-shaped fractures of both femur bones-32-v3, according to AO classification. The diagnosis was made on the basis of clinical examination and radiography of bones in the lateral and direct projection. From the moment of injury to the examination and the treatment from 3 to 5 days passed in all patients, the age of patients ranged from 6 months to 4 years. For the treatment of patients, a minimally invasive combined method of osteosynthesis with a monolateral external fixator in combination with an intramedullary spoke (Tie-in method) and a hybrid of I...II type of external fixators in combination with intramedullary fixation were used. Minimally invasive osteosynthesis with Kirschner spokes provided adequate fixation of fractures with maximum preservation of biological factors of bone healing. Consolidation of fractures occurred with the formation of corn, limb function restored in a short time in the absence of contractures of adjacent joints.

Clinical application of bridge-link combined fixation system for adult mid-shaft clavicle fractures

To explore clinical efficacy of bridge-link combined fixation system for adult mid-shaft clavicle fractures. From January 2016 to August 2016, 28 patients with mid-shaft clavicle fractures were treated by bridge-link combined fixation system, including 15 males and 13 females, aged from 27 to 82 years old with an average of(48.50±15.34) years old; the courses of disease was for 13 to 15 months with an average of (14.17±0.77) months. Fracture healing time and complication were observed, postoperative and postoperative Constant function score of shoulder joint at 1, 3 and 13 months and were compared. All patients were followed up for 13 to 15 months with an average of (14.17±0.77) months. Twenty-eight patients achieved clinical fracture healing without infection, bone un-union, delayed union, breakage of internal fixation and re-fracture after removing of the internal fixation occurred. Fracture healing time ranged from 2.5 to 4 months with (3.05±0.44) months. Postoperative Constant score at 1, 3 and 13 months were 76.57±4.70, 90.75±3.62, 96.07±2.40 respectively, and had significant difference compared with before operation(58.36±4.98). Bridge-link combined fixation system could be used as a new internal fixation for adult mid-shaft clavicle fractures, which has advantages of rapid recovery, less complications, and could reduce incidence of breakage of internal fixation, osteoporosis, re-fractures after removing the internal fixation.

Experimental Study on the Prevention of Posttraumatic Osteoarthritis in the Rabbit Knee Using a Hinged External Fixator in Combination with Exercises

Objective: To report the design and effect of our proprietary hinged external fixator, used in combination with treadmill exercise for rabbits with intra-articular inflammation and cartilage degeneration. Methods: Thirty-two white rabbits were randomly allocated into four groups: No treatment (NT), Distraction only (D), Exercise only (Ex), and Distraction plus exercise (D + Ex). Each rabbit underwent an anterior cruciate ligament transection on the right knee, with the contralateral knee used as a sham control (C). Results: In the D + Ex group, the levels of Interleukin (IL)-1β and Tumor necrosis factor (TNF)-α in synovium and TNF-α in joint effusion were significantly lower, while the expression of IL-10 in joint effusion and blood was significantly higher. The ratio of IL-10/TNF-alpha in blood was also the highest in the D + Ex group. The condition of collagen loss was examined: the D + Ex group had the lowest level of type II collagen in effusion and C-telopeptides of type II collagen (CTX-II) in blood. On the other hand, the D + Ex group had the highest expression of cartilage regeneration genes, including type II collagen, Aggrecan (AGN), and SRY-box 9 (SOX9). Finally, the histology showed an attenuation of cartilage degeneration with a lower OA score in the D + Ex group. Conclusion: Our hinged external fixator combined with treadmill exercise up-regulated cartilage regeneration genes, reduced synovial and intra-articular inflammation, and reduced type II collagen and proteoglycan loss, indicating the use of the fixator in combination with treadmill exercise could prevent progression of posttraumatic osteoarthritis of knee joint in rabbits.

Modification of the air conditioner with acrylic and maleic acid copolymer as a way to increase the adhesion strength of glass ionomer cements in combination with hard tooth tissues

Improving the operational and technological characteristics of glass ionomer cements for fixing plays an important role in the reliability increase of orthopedic treatment. The purpose of study was to find way to increase the adhesion index of glass ionomer cements for fixation in combination with hard tooth tissues. The study revealed an increase in the adhesion strength of glass ionomer cements in conjunction with hard tooth tissues by adding acrylic and maleic acids to the conditioner of the copolymer.

Effects of Ocular Parameters on Medial Rectus Faden Operation with Recession for Esotropia

Background: In the treatment of infantile and accommodative esotopia medial rectus (MR) recession combined posterior fixation suture (Faden operation) can be used. But, there is very limited literature on effect of ocular parameters (axial length, medial rectus width and the distance of medial rectus insertion to limbus) to this operation. Objective: To evaluate effects of ocular parameters on medial rectus Faden operations with recession for esotropia. Material and Methods: In this retrospective study, 38 patients (57 eyes) who underwent Faden operation with unilateral or bilateral recession (4 - 4.5 mm) on medial rectus were divided into three groups according to axial length, medial rectus width and the distance of medial rectus insertion to limbus. Preoperative and postoperative deviations compared. Results: 11 cases were infantile esotropia, 46 cases were acquired esotropia. Female/male rate was 19/19. The mean preoperative amount of esotropia at near was 49.95 ± 17.36 prism diopters (PD) and postoperative 1 week 11.77 ± 11.14 PD, 1 month 12.02 ± 11.52 PD and 6 months 9.46 ± 10.19 PD. The mean preoperative amount of esotropia at distance was 38.84 ± 19.03 PD and postoperative 1 week 7.25 ± 11.29 PD, 1 month 6.54 ± 10.52 PD and 6 months 4.40 ± 9.08 PD. Due to axial length, in shorter eyes, the decrease in mean post-operative deviation was statistically significant. Due to medial rectus width and the distance of medial rectus insertion, there was no statistically significant difference. Conclusions: Axial length has an effect on medial rectus Faden operations with recession but medial rectus width and medial rectus insertion distance from limbus do not.

Optimization of Surgical Care and Anesthesia in the Treatment of Multilevel Degenerative Diseases of the Lumbar Spine in Patients with Overweight and Obesity

Background: The provision of surgical care in the treatment of degenerative diseases of the lumbar spine in patients with obesity and obesity is associated with significant risks of anesthesia and the development of perioperative complications. Aims: to analyze the results of the introduction of a combination of surgical procedures and anesthesia in the treatment of multilevel degenerative diseases of the lumbar spine in patients with excessive body weight and obesity.Materials and methods: The results of surgical treatment of 86 patients were studied, 2 groups were identified. In the study group (SG, n=37), minimally invasive surgical techniques and original surgical approach, paravertebral musculature infiltration with bupivacaine with epinephrine, and multimodal anesthesia with dexmedetomidine were used. The comparison group (CG, n=49) consisted of patients who used the technique of traditional open transpedicular fixation in combination with the posterior interbody fusion without the above combination of surgical procedures and anesthesia. Observation and clinical evaluation was performed in the early (during hospitalization) and in the distant (on average 36 months) postoperative periods.Results: In SG there were no changes in hemodynamics and better results were obtained on the speed of recovery of psychomotor functions. The use of local anesthetics significantly reduced the local pain syndrome (p0.05) and the need for analgesics (p=0.002). Comparative analysis in the main group revealed significantly better results in indices of the duration of the operation [SG 145 (105; 155) min, CG 185 (100; 205) min; p=0.02], the volume of blood loss [SG 110 (90; 140) ml, CG 510 (390; 640) ml; p0.001], the activation time [SG 1 (1; 2) days, CG 3 (3; 4) days; p=0.01], the length of hospitalization [SG 10 (9; 11) days, CG 13 (12; 15) days; p=0,03], remote clinical parameters of the pain syndrome level from the visual analogue scale in the lower extremities [SG 3 (1; 4) mm, CG 9 (6; 14) mm; p=0.006] and the lumbar spine [SG 6 (4; 9) mm, CG 16 (11; 21) mm; p=0.001], functional state according to ODI [SG 8 (6; 10) points, CG 16 (12; 24) points; p=0.008], subjective satisfaction with the operation performed on the Macnab scale (p=0.01). The number of postoperative complications in SG was 8%, in CG ― 18% (p=0.006).Conclusions: Analysis of the results of the introduction of a combination of surgical and anesthetic support methods in the treatment of multilevel degenerative diseases of the lumbar spine in patients with overweight and obesity, including minimally invasive surgical techniques, infiltration of paravertebral muscles with bupivacaine and epinephrine, multimodal anesthesia with dexmedetomidine showed its high perioperative safety, low number of complications, as well as better and clinical outcomes in the early and late postoperative periods.

Current treatment of congenital pseudarthrosis of the tibia: a systematic review and meta-analysis.

To compare the current treatments for congenital pseudarthrosis of tibia, a total of 33 studies were reviewed. Vascularized fibular graft with external fixation or combined fixation had the fastest time till initial union (P<0.05). Bone morphogenetic protein had no advantage in terms of initial union, time till union, and refracture rates. This meta-analysis supports that fixation methods with corticocancellous bone autograft utilizing the combined technique of Ilizarov external fixation and intramedullary rod stabilization ensure a statistically significant reduction in the number of refractures compared with standalone fixation methods and would be the preferred method for preventing long-term complications in patients with congenital pseudarthrosis of tibia.

Evaluation of Posterior Stabilization Reinforced with Intravertebral Titanium Mesh Cages in Treating Acute Thoracolumbar Burst Fractures

Background Data: Burst fractures are commonly provoked by axial compression which disrupts the anterior column. In this setting, posterior stabilization using pedicle screws alone may lead to delayed kyphosis and instrumentation failure due to inadequate support of the anterior column.Purpose: To evaluate the efficacy of pedicle screw instrumentation combined with transpedicular titanium mesh cage augmentation for treatment of burst fractures.Study Design: Prospective descriptive cohort clinical case study.Patients and Methods: Fourteen neurologically intact patients with acute incomplete thoracolumbar burst fracture (AO type A 3.1), and operated upon through period from January 2016 to June 2017 were included. Patients were treated using a three vertebrae pedicle screw fixation construct combined with bilateral transpedicular titanium mesh cage augmentation of the fracture. Patients were followed for at least one year. Data about pain (VAS), function (ODI) and vertebral body deformity (Beck index and local kyphotic angle) were recorded prospectively.Results: Patients were operated within 5 days after trauma. The mean VAS score improved after surgeryfrom 8.2±1.3 to 3.7±1.1 postoperatively and to 1.8±0.7 at final follow up (P<0.05). The mean ODI score improved from 69.4±5.2 preoperatively to 17.2±2.4 at final follow up. The mean Beck index improved from 0.63 preoperatively to 0.81 postoperatively and to 0.79 at final follow up. The mean local kyphotic angle improved from 20.4o preoperatively to 11.5o postoperatively and declined to 13.7o at final visit. No patient had neurological deterioration or hardware failure during the follow up.The mean follow up was 13.4±1.8 months.Conclusion: Posterior stabilization using pedicle screw fixation in combination with titanium mesh cage augmentation can maintain vertebral restoration, prevent hardware failure and lead to better clinical outcome. (2018ESJ162)