Distal Fixation Research Articles

Improving accuracy of opening-wedge osteotomies of distal radius using a patient-specific ramp-guide technique

BackgroundOpening-wedge osteotomies of the distal radius, performed with three-dimensional printed patient-specific instruments, are a promising technique for accurate correction of malunions. Nevertheless, reports of residual malalignments and discrepancies in the plate and screw position from the planned fixation exist. Consequently, we developed a patient-specific ramp-guide technique, combining navigation of plate positioning, osteotomy cutting, and reduction. The aim of this study is to compare the accuracy of navigation of three-dimensional planned opening-wedge osteotomies, using a ramp-guide, over state-of-the-art guide techniques relying solely on pre-drilled holes.MethodsA retrospective analysis was carried out on opening-wedge osteotomies of the distal radius, performed between May 2016 and April 2017, with patient-specific instruments. Eight patients were identified in which a ramp-guide for the distal plate fixation was used. We compared the reduction accuracy with a control group of seven patients, where the reduction was performed with pre-drilled screw holes placed with the patient-specific instruments. The navigation accuracy was assessed by comparing the preoperative plans with the postoperative segmented, computed tomography scans. The accuracy was expressed using a 3D angle and in measurements of all six degrees of freedom (3 translations, 3 rotations), with respect to an anatomical coordinate system.ResultsThe duration of the surgery of the ramp-guide group was significantly shorter compared to the control group. Significantly less rotational and translational residual malalignment error was observed in the open-wedged osteotomies, where patient-specific instruments with ramp-guides were used. On average, a residual rotational malalignment error of 2.0° (± 2.2°) and a translational malalignment error of 0.6 mm (± 0.2 mm) was observed in the ramp-guide group, as compared to the 4.2° (± 15.0°) and 1.0 mm (± 0.4 mm) error in the control group. The used plate was not significantly positioned more accurately, but significantly fewer screws (15.6%) were misaligned in the distal fragment compared to the control group (51.9%).ConclusionThe use of the presented ramp-guide technique in opening-wedge osteotomies is improving reduction accuracy, screw position, and surgical duration, compared to the existing patient-specific instrument based navigation methods.

Clinical application of uncemented distal stem fixation for revising femoral prosthesis of hip arthroplasty in elderly patients

Objective To evaluate the effectiveness of uncemented distal stem fixation for elderly patients needing revision of femoral prosthesis of hip arthroplasty. Methods From July 2005 to January 2013, 22 patients(12 males and 10 females)aged from 70 to 85 years(average: 76 years old)with aseptic loosening of the femoral stem undergone revision via uncemented distal stem fixation were enrolled into this study.Of all patients, 10 had revision on the right side and 12 on the left side; 11 patients received artificial replacement of the femoral head; 9 had total hip replacements; 2 had femoral fractures.According to the Paprosky classification system, 2 cases were type I, 12 were type Ⅱ, 6 were type ⅢA, and 2 were type ⅢB.Femoral stems for revision included MP(Link)and Solution(Depuy). The Harris score, clinical and radiological results were retrospectively analyzed. Results All patients were followed up for 48 to 78 months(mean: 61 months). The average Harris score increased from 38(25-46)to 87(76-94). All prostheses were initially stable, and no infection, dislocation or complication like deep venous thrombosis was observed after revision.All patients were able to walk without assistance; two of them had minor claudication; radiographs after surgery showed well-positioned implants with increased bone density and thickness around the prosthesis and without loosening or subsidence. Conclusions Reliable axial and anti-rotational stability can be achieved by using uncemented distal stem fixation, with good short-and medium-term clinical results for revision in elderly patients with less severe bone defects than those in Paprosky Ⅳ. Key words: Hip joint; Revision; Femur

OUTCOME OF PERIPROSTHETIC FEMORAL FRACTURES IN HIP ARTHROPLASTY

Periprosthetic fractures are one of the main reasons for revision surgery according to the data of large joint replacement registers. Treatment of patients with periprosthetic fractures is associated with a big number of complications and still keeps its relevance. Purpose of the study is to evaluate treatment outcome of patients with periprosthetic femoral fractures in hip replacement. Material and Methods. The authors performed a retrospective analysis of medical histories of 76 patients who underwent treatment of periprosthetic femoral fractures. The patients were divided into groups by the Unified Classification System (UCS). Follow up period was from 6 to 124 months (mean of 34.90±28.81). Results. 3 cases (3.9%) of periprosthetic femoral fractures were the complications after primary hip arthroplasty and occurred intraoperatively, 75 cases (96.1%) were complications after revision surgery; 56 cases (71.8%) were reported with uncemented and 22 cases (28.2%) with cemented femoral components. In 30 cases (38.5%) fractures had a iatrogenic nature and occurred intraoperatively, in 48 cases (61.5%) — occurred due to high- and low energy trauma. Type B fractures were observed most often — in 53 cases (68%). Conservative treatment, fixation by cerclage or by plate and screws has proven to be the least effective operative options. In the group of patients with extended osteotomy of the greater trochanter the healing was achieved in 90.5% of cases, while in the group without osteotomy — in 75% of cases. Low healing rate of periprosthetic fractures was observed for A and B1 type fractures (65% and 66.7% respectively). Follow up of patients with B2, B3 and C type fractures demonstrated consolidation in more than 80% of cases. Various complications were reported in 17 cases (21.8%). Conclusion. Effective treatment of patients with periprosthetic femoral fractures was associated with extended osteotomy of the greater trochanter (γ = 0.51; p = 0.032), absence of complications in postoperative period (R = 0.55; p = 0.00001), B2, B3 and C fracture types (γ = 0.40; p = 0.02) and use of revision uncemented femoral components with distal fixation (γ = 0.35; p = 0.018). In the authors opinion use of sutures or cerclage wires are not effective in cases of trochanteric fractures and stable femoral components; it would be preferable to perform internal fixation by a plate with hooks such as Dall-Miles. In case of doubts in regard of stem stability the revision should rather stipulate use of uncemented femoral components, in particular long stems with distal fixation.

Embolisation of Type I Endolic after the Endoprosthesis Replacement of the Infrarenal Aorta. Case Report

Introduction. According to the national clinical recommendations, endovascular intervention should be used in the case of infrarenal aneurysm of aorta or common iliac artery in patients with high risk of cardiopulmonary complications during open surgery or serious concurrent conditions. However, despite the reduced risk of minimal invasive intervention, the likelihood of complications remains: the most common of these is endoleak. Type I endoleak is caused by stent graft failure in the area of proximal or distal fixation, leading to an increase of pressure inside the aneurysmal pouch, which can cause it to rupture. In this clinical case, the cause of the endoleak was the short neck of the aneurysm with severe angulation. Leakages of this type must be eliminated by means of a retentive intraluminal cuff or by open surgery. However, the emergency of open surgical intervention in patients with baseline organ dysfunction increases the frequency of complications, often neutralising the advantages of the original endovascular intervention.Materials and methods. The clinical case example demonstrates the effectiveness of embolisation of the endoleak area in a patient with severe cardiac pathology as an alternative to open surgery.Results and discussion. Following elective endovascular implantation of the prosthesis on the control, angiograms are determined by endoleak type I in the area of proximal fixation of endoprosthesis. This is presumably due to incomplete adhesion of endoprosthesis body in the area of the right renal artery. The decision was taken to embolise the zone of leakage. Using a 190.0 cm Abbott Whisper MS 0.014 guide-wire, an Ev3 Rebar-18 2.4F/2.7F. microcatheter was pulled across the area of leakage into the aneurysmatic pouch. An Onyx 18 — 1.5 ml liquid embolic system was pulled through a microcatheter to the area of leakage. Control angiography — embolisation was found to be sufficient. There were no signs of non-target embolisation.Conclusion. If a surgeon is sufficiently experienced and technically capable, type I endoleak embolisation can become a method of choice in the treatment of patients with high-risk open surgery.

Bipolar transfer of the pectoralis major muscle for restoration of elbow flexion in 29 cases

This study evaluated the functional outcomes of bipolar pedicled pectoralis major (PM) transfer to restore elbow flexion. We retrospectively reviewed 29 transfers in 28 patients with a mean age of 31.2 years (range, 5-65 years). The loss of elbow flexion was due to brachial plexus palsy in 24 patients, elbow flexors necrosis in 4, and poliomyelitis in 1. The entire PM muscle was mobilized and fixed proximally to the coracoid process. Intraoperative positioning and postoperative immobilization of the shoulder and the elbow flexed at 60° and 120°, respectively, allowed direct distal fixation of the muscle to the biceps brachii tendon. At the last follow-up (mean, 13 months; range, 4-37 months), 41% of the transfers (n = 12) recovered grade 4 elbow flexion strength and were able to lift 2.2 kg on average (range, 0.5-5 kg), 52% (n = 15) recovered grade 3 strength, and 7% (n = 2) had a poor result (ie, grade 2 elbow flexion). The mean active elbow flexion was 100° (ranging, 30°-150°), and the patients had 0° to 10° elbow flexion contracture. Our results indicate that bipolar PM transfer is a reliable and effective procedure to restore elbow flexion. Flexion of the shoulder and elbow allowed the transfer to reach the elbow fold and avoided an interposition graft between the distal PM and the biceps brachii tendon.

Хирургическое лечение пациентов с разрывом дистального сухожилия двуглавой мышцы плеча: методы фиксации и реабилитации. Опыт лечения 20 пациентов

Distal biceps brachii tendon ruptures are relatively uncommon injuries with numerous surgical exposures and methods of fixation offered for repair. The goal of surgical management is to restore the anatomic footprint of the biceps tendon on the radial tuberosity. Distal biceps fixation techniques include the use of bone tunnels in the bicipital tuberosity, tendon fixation with interference screws and cortical button that are competitive with alternative methods of suture anchors and transosseous sutures. Amplification of technical surgical aspects allows for a safer procedure, more aggressive postoperative rehabilitation and reduced recovery period for the elbow joint. Objective The purpose was to present the clinical experience and compare methods of fixation of tendon ruptures in terms of their advantages and disadvantages, implants’ effect on postoperative function recovery in a group of patients followed for three years. Material and methods A retrospective review included 20 patients with distal biceps brachii tendon ruptures that required surgical treatment. Results Positive outcomes were achieved in 19 cases (95 %). Disability period was 33.5 ± 0.5 days in a group of intellectual workers and 45.5 ± 0.71 days in physically active patients or sportsmen. Conclusion The findings showed advantages of combined tendon fixation with cortical button and biodegradable interference screw. The results of treatment were shown to rank more than twice over those achieved with suture anchors and transosseous sutures.

Clinical outcomes and survival rate of cementless modular distal fixation femoral stem for revision hip arthroplasty: A minimum 6-year follow-up.

Revision hip arthroplasty is a very challenging procedure. Use of a modular distal fixation stem is one of the available options for revision arthroplasty in patients with proximal femoral bone deficiency. The purpose of this study was to evaluate mid- to long-term outcomes of cementless modular distal fixation femoral stem implantation in revision hip surgery. Clinical and radiological findings, complications, and stem survival rate were analyzed for 46 patients (48 hips) who underwent revision hip arthroplasty using a cementless modular distal fixation femoral stem. The mean patient age was 58.8 years (range 31-82 years) and the mean follow-up period was 95 months (72-122 months). The preoperative diagnoses were aseptic loosening (36 hips), infection (4 hips), ceramic fracture (4 hips), and femoral periprosthetic fracture (4 hips). The mean Harris hip score improved from 56.6 preoperatively to 88.2 postoperatively at the last follow-up. All hips showed stable osteointegration and firm fixation. Complications involved four hips (8.3%); there was one case each of periprosthetic fracture, delayed union of osteotomy site, femoral perforation, and infection. One stem re-revision was performed for deep infection of the femoral side. The Kaplan-Meier survival rate was 97.6% at the final follow-up. Revision hip arthroplasty using a cementless modular distal fixation femoral stem showed satisfactory initial firm fixation and mid- to long-term survival rate. Complications can be minimized by careful surgical planning and meticulous procedure.

In Displaced Distal Tibial Fractures, Intramedullary Nail and Locking Plate Fixation Did Not Differ in Terms of 6-Month Disability.

In Displaced Distal Tibial Fractures, Intramedullary Nail and Locking Plate Fixation Did Not Differ in Terms of 6-Month Disability.

Screw Distraction Technique For Gaining Fibular Length

Category: Trauma Introduction/Purpose: A shortened fibula may be caused by several conditions like tumors, premature closure of the growth plate and most frequently, malunion. Biomechanically a shortened fibula causes a lateral shift of the talus, widening of the ankle mortise, decreased tibiotalar contact area and eventually could lead to osteoarthritis. Even in a posttraumatic scenario, with moderate or severe osteoarthritis, fibular lengthening has shown to be beneficial in terms of pain reduction and improved function.Several osteotomies have been described with their advantages and disadvantages in terms of technical difficulty, need for bone graft and the ability to correct length and rotation.We present an easy and reproducible surgical technique on a case, that allow restoring length and rotation independently and it does not require complex distractor devices. Methods: Case report: A 34 year old female patient who presented 8 months status post initial open reduction internal fixation (ORIF). She developed a fibular nonunion, broken distal fixation with a shortened fibula and non-anatomic mortise and presented for revision surgery.Surgical technique: The fibula is exposed in standard fashion. A fully-threaded cortical screw is placed across the tibia, distal to the fibula fracture and parallel to the plafond. Next, a second screw is placed into the fibula bicortically from anterior to posterior and approximately 12 mm distal to the tibial screw. A toothed laminar spreader is then placed in-between the screws and distracted resulting in a lengthening of the fibula. A 2 mm Kirschner wire is placed to hold reduction once fibular length is restored and ORIF continues in standard fashion. Results: The technique we present has several advantages. The technique is straightforward, easy to reproduce, and cost effective. Since the anchoring points used for distraction are not both in the fibula, rotation is not implicitly locked in as in the case when both anchoring points are in the fibula, allowing for independent and progressive adjustment of both length and rotation. There is also less risk of proximal migration of the fibular head as no force is applied directly to the proximal fibula. There is also less risk of proximal migration of the fibular head as no force is applied directly to the proximal fibula. Conclusion: Fibular lengthening can achieve improved function, pain relief and decrease the risk of osteoarthritis in selected patients. Several techniques with different degrees of difficulty have been described to treat this condition, but most are not versatile enough in correcting the length and rotation independently. The technique that we present has the advantage of correcting the length and rotation as needed, without requiring complex devices.

RS01. Planned Exclusion of the Celiac Artery During Complex Thoracic Endovascular Aortic Repair Procedures: Is It Safe?

Achieving adequate proximal and distal fixation and maintaining visceral branch flow make thoracic endovascular aortic repair (TEVAR) procedures for thoracoabdominal aneurysm (TAAA) complex. Whereas superior mesenteric artery (SMA) and renal vessels must be preserved, there may be selected cases in which patent celiac arteries may be intentionally excluded. We sought to define the incidence of ischemic complications of celiac exclusion during complex TEVAR procedures and to define specific conditions in which the celiac can be safely covered. We performed a retrospective 12-year audit in two tertiary care institutions of patients with a suprarenal aneurysm or TAAA treated by standard TEVAR involving the distal thoracic aorta with intentional celiac fabric coverage or bare distal stent across the celiac (preserved), custom or modified aortic endografts (complex TEVAR/fenestrated EVAR [FEVAR]) involving multiple visceral branch endoprostheses with and without planned celiac exclusion, or a transabdominal hybrid approach with visceral debranching bypasses (with or without celiac revascularization) from distal inflow sites and staged or simultaneous long length thoracoabdominal endografting. The decision to exclude celiac arteries was made from preoperative computed tomography findings of a small diameter, stenotic origin, presence of replaced right hepatic artery, or existing large SMA celiac collaterals. Cases with a chronically occluded celiac were excluded. Primary end points were 30-day mortality, spinal cord ischemia, and any foregut ischemia occurring early or during late follow-up (ischemic acalculous cholecystitis or splenic infarction). There were 223 patients who met inclusion criteria (Table I). In the standard/complex TEVAR/FEVAR group, 26 patients (15%) had celiac coverage with 144 cases of celiac preservation. In the hybrid group, 11 cases (21%) had celiac exclusion, whereas 42 patients had a separate celiac bypass. In the standard/complex TEVAR/FEVAR group, celiac coverage did not result in significant increase in foregut ischemic events (3.8% vs 2.1%; P = .6; Table II). However, exclusion of the celiac artery during hybrid cases resulted in an increase in foregut ischemia (two early and one case presenting 1 year later) compared with patients having celiac bypass revascularization (27% vs 7%; P = .06). The incidence of spinal cord ischemia and 30-day all-cause mortality was not different with regard to celiac exclusion or between treatment groups. Selected celiac exclusion appears safe during standard/complex TEVAR/FEVAR procedures as long as SMA patency is ensured. A hybrid approach to complex TAAA requires separate bypass to all patent visceral branches including the celiac to minimize foregut ischemia.Table IDemographicsVariableTEVAR with celiac coverageTEVAR with celiac revascularizationHybrid without celiac revascularizationHybrid with celiac revascularizationNo.261441142M/F69/3174/2655/4568/32Urgent/emergent35131810History of aortic surgery27515536Dissection present12102710TEVAR, Thoracic endovascular aortic repair.Values are reported as percentage. Open table in a new tab Table IIPostoperative outcomesVariableTEVAR with celiac coverageTEVAR with celiac revascularizationTEVAR covered celiac vs TEVAR revascularized celiac, χ2 comparison P valueHybrid without celiac revascularizationHybrid with celiac revascularizationHybrid with and without revascularization, χ2 comparison P valueNo.26144114230-Day mortality7.7 (2)3.5 (5).319.1 (1)11.9 (5).79SCI3.8 (1)15.3 (22).120 (0)11.9 (5).57Foregut ischemia3.8 (1)2.1 (3).5927.2 (3)7.1 (3).06SCI, Spinal cord ischemia; TEVAR, thoracic endovascular aortic repair.Values are reported as % (No.). Open table in a new tab

Optimal plate fixation of distal femoral fractures in the presence of a well fixed cemented hip arthroplasty femoral stem.

The requirement for lateral plate fixation in the presence of a hip arthroplasty stem is increasing, yet the optimal plate construct necessary to reduce inter-prosthetic strain and prevent subsequent fractures is unknown. Therefore, the purpose of this study was to determine the optimal position of a lateral femoral plate in relation to a femoral stem. We used 4th Generation Composite Sawbones®, a collarless polished cemented femoral stem and a broad Peri-loc™ plate with varying overlap of the stem. Each construct was subjected to torsion, axial compression and 3-point lateral bending, with the strain measured at the tip of the femoral stem and the force-to-failure recorded. In all three loading directions a plate, which extended at least two shaft diameters proximal to the tip of the stem, experienced the lowest strain ( p < 0.001). Constructs with no overlap, and particularly those with a small gap between the tip of the stem and the proximal extent of the plate experienced the highest strain ( p < 0.001). This high strain resulted in lower forces required to cause fracture in the clinically significant scenarios of femoral torsion and lateral bending. Optimal plate fixation is achieved by extending a lateral femoral plate at least two shaft diameters proximal to the tip of the stem and using a spread of proximal screws. Distal fixation increases the strain experienced at the tip of the stem and higher strains are noted the smaller the gap between the proximal extent of the femoral plate and the tip of stem.

A clinical study on analysis in mid shaft femur fractures with the application of intramedullary nail

Background: Femoral shaft fractures are usually the result of high‐energy trauma, such as road traffic accidents. Kuntscher was the first to introduce the concept of intramedullary nailing, later there were modifications in intramedullary nailing and for the first time Klemm and Schelmann, Grosse and Kempt and Russel Taylor developed proximal and distal fixation called intramedullary interlocking nail. Intramedullary nailing provide predictable restoration of femoral shaft alignment along with load sharing. Aim and Objective: To evaluate an analysis in mid shaft femur fractures with the application of intramedullary nail. Methodology: 37 cases of fracture shaft femur were studied in our study, admitted to A tertiary care teaching hospital in North India. All patients sustained a road traffic accident. Patient were analysed for short term outcome. Results: The poor result in open interlocking nailing attributed to disturbance of fracture haematoma and periosteal stripping in open interlocking nailing. 3 patients had ipsilateral tibial shaft fracture 1 patient had degloving injury over his right calf region, 1 patient had ipsilateral patella and proximal third tibial fracture. All patients were investigated according to the protocol and surgery performed between day 3 to day 7 after trauma, average duration was 6 days. Blood loss ranged from 150-300ml with a mean of 200ml.

Open Treatment of Olecranon Fractures with Plate Fixation.

Fractures of the olecranon are sometimes difficult to treat. The steps for operative plate fixation of olecranon fractures consist of (1) a dorsal incision, (2) exposure using full-thickness flaps, (3) removal of hematoma from the fracture site, (4) fracture reduction, (5) provisional fixation, (6) plate application, (7) proximal fixation, (8) distal fixation, and (9) layered wound closure. Although this is generally a straightforward procedure, several specific steps may make fixation easier and improve outcomes. Outcomes following olecranon fracture fixation are generally good. Patients should expect some loss of terminal extension and a potential for symptoms related to implant prominence, especially in slender patients. Ulnar nerve symptoms are unusual but possible.

Distal Biceps Rupture—Achilles Augmentation Technique

The treatment of chronic distal biceps ruptures is challenging. Direct anatomical reinsertion is often difficult as a consequence of tendon retraction, muscle atrophy, and scar tissue. Nonanatomical repair is a controversial option. Repair and reinforcement with autografts or allografts is a reliable option. Achilles allograft has several advantages over other grafts. Indications to this procedure are discussed as well as surgical tips and tricks; in addition, outcomes and complications from the available literature are reported. The literature is lacking on this specific field. Only few case series describe surgical tips and report clinical outcomes. Good results are generally reported in terms of function and strength recovery bot in flexion and supination. Complications, mainly involving neurological problem, are similar to those observed in acute cases. Achilles tendon allograft is a reliable option to reinforce the anatomical repair of chronic distal biceps tendon ruptures. Proximal tendinous portion wraps biceps muscle to ensure solid interface. Distal calcaneus bone plug allows for bone-to-bone fixation. The choice of which is the best option for distal fixation and postoperative protocol are still debated issues.

Minimally Invasive Surgery for Neuromuscular Scoliosis: Results and Complications in a Series of One Hundred Patients.

Study Design.A retrospective review.Objective.To report the results of an alternative technique using a minimally invasive fusionless surgery. The originality is based on the progressive correction of the deformities with proximal and distal fixation and on the reliability of the pelvic fixation using iliosacral screws on osteoporotic bones.Summary of Background Data.Spinal deformities are common in neuromuscular diseases. Conventional treatment involves bracing, followed by spinal instrumented fusion. Growing rod techniques are increasingly advocated but have a high rate of complications.Methods.The technique relies on a bilateral double rod sliding construct anchored proximally by four hooks claws and distally to the pelvis by iliosacral screws through a minimally invasive approach. Hundred patients with neuromuscular scoliosis underwent the same fusionless surgery extended from T1 to the pelvis. The average age at initial surgery was 11 + 6 years. Diagnoses included cerebral palsy (61), spinal muscular atrophy (22), muscular dystrophy (10), and other neurological etiologies (7). Cobb angle and pelvic obliquity were measured before and after initial surgery, and at final follow-up. Complications were reviewed.Results.At latest follow-up 3 + 9 years (range 2 yr–6 + 3 yr), the mean Cobb angle improved from 89° to 35° which corresponds to 61% correction. Mean pelvic obliquity improved from 29° to 5°, which corresponds to 83% correction. Mean T1-S1 length increased from 30.02 to 37.28 cm. Mean preoperative hyper kyphosis was reduced from 68.44° to 33.29°. Complications occurred in 26 patients including mechanical complications (12) and wound infections (16). No arthrodesis was required at last follow-up.Conclusion.This original fusionless technique is safe and effective, preserving spinal and thoracic growth. It provides a significant correction of spinal deformities and pelvic obliquity with a reduced complications rate. The strength and stability of this modular construct over time allow the avoidance of final arthrodesis.Level of Evidence: 4

A Prospective Observational Assessment of Unicortical Distal Screw Placement During Volar Plate Fixation of Distal Radius Fractures.

Although volar plating of the distal radius is performed frequently, the necessity of distal bicortical fixation in the metaphyseal and epiphyseal areas of the distal radius has not been proven. This study aimed primarily to quantify the ability of unicortical distal screws to maintain operative reduction of adult distal radius fractures and secondarily to determine if unicortical screw lengths could be predicted based on anatomical measurements. This prospective trial enrolled 75 adult patients undergoing volar locking plate fixation of a unilateral distal radius fracture at a tertiary center. Study inclusion required screw fixation in the distal rows of the plate performed with unicortical screw placement. The primary outcome was maintenance of operative reduction, according to predefined parameters, quantified by comparing initial operative reduction to final reduction after fracture healing. Repeated measures analysis of variance analyzed for systematic change in radiographic parameters between injury, operative, and healed images. Correlation coefficients quantified the relationship of screw lengths with lunate width and other anatomical measurements. Seventy-five patients (mean age, 54 years ± 15 years; 79% women) were enrolled and followed to fracture union. Fracture severity varied and included AO type A (40%), B (12%), and C (48%) fractures. There was no significant change in mean lateral translation, intra-articular gap, intra-articular stepoff, radial inclination, or lateral tilt of the radius between the time of fixation and union for the cohort. Two patients lost reduction (increased dorsal tilt, 10°, 20°, respectively), potentially attributable to provision of unicortical fixation (3%; 95% confidence interval [95% CI], 0%-9%). No extensor tenosynovitis or extensor tendon ruptures occurred. Eighty percent of screws were 18 mm or less and screw lengths were not correlated with lunate width or any other anatomical measurements. Unicortical distal fixation during volar locking plate fixation effectively maintains operative reductions of distal radius fractures while potentially minimizing the incidence of extensor tendon ruptures. Therapeutic IV.

Staged humerus lengthening with monolateral fixation followed by a circular frame: Technique of fixator change

Monolateral external fixator (MEF) has been commonly used for limb lengthening in both upper and lower extremities. Since MEF can only lengthen or shorten the bone, sagittal, coronal, and torsional deformities need to be corrected acutely at the time of MEF application. Acute correction, particularly torsional correction, may endanger the radial or peroneal nerves. Gradual correction of torsion may be safely achieved using a circular external fixator (CEF) frame. We present a case study of humeral lengthening with derotation to describe a technique, whereby it is possible to first lengthen with MEF and then derotate with CEF. This is a case report of a 14-year-old boy with a history of neonatal sepsis and growth arrest of the proximal humerus that led to a short right humerus and loss of external rotation. Humerus lengthening was achieved (6.6 cm) using MEF. Conversion to CEF was done after the distraction phase and prior to regenerate bone consolidation. Two 2/3 rings were connected to the proximal and distal fixation half-pins, and then the six connecting struts were added. The rotation deformity correction was then performed gradually to achieve 60° of external rotation. The described technique to convert the MEF into CEF is versatile and can be employed in the clinic safely and without sedation.

Non-Spanning Syringe Distractor: An Alternative Technique for Fracture Distal End Radius Fixation for Rural Areas of Developing Countries with Limited Resources

Non-Spanning Syringe Distractor: An Alternative Technique for Fracture Distal End Radius Fixation for Rural Areas of Developing Countries with Limited Resources

Mid-term results of revision total hip arthroplasty with an uncemented modular femoral component.

Introduction:During revision total hip arthroplasty (THA), the surgeon commonly faces deficient proximal femoral bone. In this situation, distal fixation of the prosthesis is required. The aim of the current retrospective study is to assess the clinical and radiographic mid-term outcome of revision total hip arthroplasty using a modular uncemented, tapered, grit-blasted, distal straight stem system.Methods:This retrospective study included 70 femoral revisions that were performed in 67 patients using the device of interest. All patients were operated on via an extended trochanteric osteotomy. 60 revisions were performed as 1-stage (12 infected) and 10 as 2-stage (all infected) revisions. At 3 months postoperatively and at final follow-up, patients were assessed radiographically for the presence of osteolysis and for distal integration.Results:The mean follow-up time was 4.3 (2.0-7.6) years. 4 patients had a removal of at least 1 prosthetic component. Stem survival for any reason was 92% after 5 years (95% confidence interval [CI], 83%-100%). With aseptic loosening of the stem as the endpoint of interest, survival after 5 years was 96% (95% CI, 88%-100%). A postoperative subsidence rate of 14.7% was found. No perioperative femoral fractures were found in the current patient series.Conclusions:This study showed excellent mid-term survival and good clinical and radiographic outcomes in patients who had undergone revision THA with a modular uncemented, tapered, straight design.

The technique of S2-alar-iliac screw fixation: a literature review

The distal fixation in thoracolumbar deformity surgery can be challenging for spine surgeons. When isolated S1-pedicle screws are utilized as the sole distal fixation in long thoracolumbar posterior constructs, there is a high rate of failure, due to loosening, breakage, and pseudarthrosis. Unfortunately, with iliac screw fixation the entry point at the posterior superior iliac spine requires considerable soft tissue dissection and may potentially increase the likelihood of wound complications. S2-alar-iliac (S2AI) screw fixation technique was developed recently to provide increased fixation with a lower profile screw and rod construct. These screws can be inserted with percutaneous or free hand techniques. This fixation also has comparable biomechanical properties to the S1 iliac screw. This technique may provide advantages such as decreased rates of reoperation, surgical site infection, wound dehiscence and symptomatic screw prominence as compared to traditional iliac screw fixation. The purpose of this manuscript is to review the S2AI screw fixation literature including anatomy, technique, biomechanics, and clinical outcomes.