Double Button Research Articles

Similar return to sport between double cortical button and docking techniques for ulnar collateral ligament reconstruction in baseball players

A double cortical button technique for ulnar collateral ligament reconstruction (UCLR) has advantages including significant control over graft tensioning, less concern about graft length and minimized risk of bone tunnel fracture compared to traditional UCLR techniques. This double cortical button technique was recently found to be non-inferior in mechanical performance compared to the traditional docking technique regarding joint strength, joint stiffness, and graft strain. However, clinical outcomes have not been compared between these UCLR techniques. Therefore, the purpose of this study was to determine whether baseball players who underwent UCLR with a double cortical button (double button) technique have similar return to sport (RTS) outcomes compared to baseball players who underwent UCLR with the traditional docking (docking) technique. Baseball players that underwent primary UCLR from 2011-2020 across two institutions were identified. Included patients were contacted to complete a follow-up survey evaluating reoperations, RTS, and functional outcome scores. Functional outcome surveys include the Kerlan-Jobe Orthopaedic Clinic (KJOC) score, Conway-Jobe score, Andrews-Timmerman (AT) elbow score, and the Single Assessment Numeric Evaluation (SANE) score. Overall, 78 male baseball players (age: 18.9±2.4 years) with an average follow-up of 3.1±2.4 years were evaluated, with 73 of the players being baseball pitchers. Players in the double button group more frequently received palmaris longus autografts (78% vs. 30%) and less frequently received gracilis autografts (22% vs. 58%) compared to players in the docking group (p=0.001); however, all other demographic factors were similar between groups. All players in the double button group were able to RTS in 11.1±2.6 months, while 96% of players in the docking group were able to RTS in 13.5±3.4 months (p>0.05). All post-operative outcomes and patient-reported outcomes were statistically similar between groups, and remained similar after isolating pitchers only and after separating partial-thickness from full-thickness UCL tears (all p>0.05). Return to sport and other post-operative outcomes may be similar between baseball players who underwent UCLR with the double button technique and the docking technique. While future research may be necessary to strengthen clinical recommendations, these findings provide the first clinical outcomes in light of a recent cadaveric study finding similar elbow strength, joint stiffness, and graft strain compared to the docking technique.

Paper 20: Similar Clinical Outcomes Between Double Cortical Button and Docking Techniques for Ulnar Collateral Ligament Reconstruction in Baseball Players

Objectives: A double button technique using a cortical button on both the humeral and ulnar sides of the UCLR for fixation has recently been proposed, with advantages including greater control over graft tensioning and decreased risk of bone tunnel fracture. This double cortical button technique was recently evaluated biomechanically and found to be non-inferior to the traditional docking technique regarding strength, joint stiffness, and graft strain. However, clinical outcomes have not been compared between the double cortical button technique and standard UCLR techniques such as the docking technique. Therefore, the purpose of this study was to determine whether baseball players who underwent UCLR with a double cortical button (double button) technique have similar return to sport (RTS) rates, time to RTS, and subjective outcomes compared to baseball players who underwent UCLR with the traditional docking (Docking) technique. Methods: Competitive baseball players that underwent primary UCLR from 2011-2020 at across two institutions were identified using the CPT code 24346. Patients were excluded if they were not baseball players or if they did not undergo UCLR with the double button or docking technique. Included patients were contacted via RedCap to complete a follow-up survey evaluating reoperations, RTS, functional outcome scores, and patient satisfaction. Functional outcome surveys include the Kerlan-Jobe Orthopaedic Clinic (KJOC) score, Conway-Jobe score, Andrews-Timmerman (AT) elbow score, and the Single Assessment Numeric Evaluation (SANE) score. Results: Overall, 78 male baseball players (age: 18.9 ± 2.4 years) with an average follow-up of 3.1±2.4 years were evaluated, with 73 of the players being baseball pitchers and 55 (71%) of players completing the functional outcome surveys. Players in the double button group more frequently received palmaris longus autografts (78% vs. 30%) and less frequently received both gracilis autografts (22% vs. 58%) and allografts (0% vs. 13%) compared to players in the docking group (p=0.001); however, all other demographic factors were similar between groups (Table 1). All post-operative and patient-reported outcomes were also similar between groups. All players in the double button group (100%) were able to RTS in 11.1±2.6 months, while 96% of players in the docking group were able to RTS in 13.5±3.4 months (p>0.05). All other post-operative outcomes and patient-reported outcomes were statistically similar between groups, and remained similar after isolating pitchers only and after separating partial-thickness from full-thickness UCL tears (all p>0.05) (Tables 1-3). Two complications were observed in the docking group, with one player experiencing pain at elbow extension due to nerve neurolysis and another player developing an elbow stress fracture during rehabilitation, while no double button players experienced a complication. Conclusions: Post-operative outcomes were similar between baseball players who underwent UCLR with the double button technique and the docking technique. These findings provide the first clinical outcomes in support of a recent cadaveric study which showed the double button technique to provide similar elbow strength, joint stiffness, and graft strain compared to the docking technique. Larger comparative studies are necessary before a clear clinical recommendation can be made regarding the utilization of double button UCLR for baseball players. [Table: see text][Table: see text][Table: see text][Table: see text]

A biomechanical analysis of double screw, double button and screw button fixation constructs in PSI guided Latarjet procedure.

The Latarjet coracoid transfer procedure reliably stabilizes the glenohumeral joint for shoulder instability. However, complications such as graft osteolysis, non-union and fracture continue to affect patient clinical outcomes. The double screw (SS) construct is regarded as the gold standard method of fixation. SS constructs are associated with graft osteolysis. More recently, a double button technique (BB) has been suggested to minimize graft related complications. However, BB constructs are associated with fibrous non-union. To mitigate this risk, a single screw combined with a single button (SB) construct has been proposed. It is thought that this technique incorporates the strength of the SS construct and allows micromotion superiorly to mitigate stress shielding related graft osteolysis. The primary aim of this study was to compare the failure load of SS, BB and SB constructs under a standardized biomechanical loading protocol. The secondary aim was to characterize the displacement of each construct throughout testing. Computed tomography scans of twenty matched-pair cadaveric scapulae were performed. Specimens were harvested and dissected free of soft tissue. SS and BB techniques were randomly assigned to specimens for matched-pair comparison with SB trials. A patient specific instrument (PSI) guided Latarjet procedure was performed on each scapula. Specimens were tested using a uniaxial mechanical testing device under cyclic loading (100 cycles, 1Hz, 200N/s) followed by a load-to-failure protocol (0.5mm/s). Construct failure was defined by graft fracture, screw avulsion and/or graft displacement of more than 5mm. Forty scapulae from twenty fresh frozen cadavers with a mean age of 69.3 years underwent testing. On average, SS constructs failed at 537.8N (SD 296.8), while BB constructs failed at 135.1N (SD 71.4). SB constructs required a significantly greater load to fail compared to BB constructs (283.5N, SD 162.8, p=0.039). Additionally, SS (1.9mm, IQR 0.87) had a significantly lower maximum total graft displacement during the cyclical loading protocol compared to SB (3.8mm, IQR 2.4, p=0.007) and BB (7.4mm, IQR 3.1, p<0.001) constructs. These findings support the potential of the SB fixation technique as a viable alternative to SS and BB constructs. Clinically, the SB technique could reduce the incidence of loading-related graft complications seen in the first three months of BB Latarjet cases. The study is limited to time-specific results and does not account for bone union or osteolysis.

Biomechanical Comparison of Distal Biceps Tendon Repair Techniques: Extracortical Single-Button Inlay Fixation Versus Intracortical Double-Button Onlay Anatomic Footprint Fixation

Background: Extracortical single-button (SB) inlay repair is a commonly used distal biceps tendon technique. However, complications (eg, neurovascular injury) and nonanatomic repairs have led to the development of intracortical fixation techniques. Purpose: To compare the biomechanical stability of extracortical SB repair with an anatomic intracortical double-button (DB) repair technique. Study Design: Controlled laboratory study. Methods: The distal biceps tendon was transected in 18 cadaveric elbows from 9 donors. One elbow of each donor was randomly assigned to the extracortical SB or anatomic DB group. Both groups were cyclically loaded with 60 N over 1000 cycles between 90° of flexion and full extension. The elbow was then fixed in 90° of flexion and the repair construct loaded to failure. Gap formation and construct stiffness during cyclic loading and ultimate load to failure were analyzed. Results: When compared with the extracortical SB technique after 1000 cycles, the anatomic DB technique showed significantly less gap formation (mean ± SD, 2.7 ± 0.8 vs 1.5 ± 0.9 mm; P = .017) and significantly more construct stiffness (87.4 ± 32.7 vs 119.9 ± 31.6 N/mm; P = .023). Ultimate load to failure was not significantly different between the groups (277 ± 93 vs 285 ± 135 N; P = .859). The failure mode in the anatomic DB group was significantly different from that of the extracortical SB technique (P = .002) and was due to fracture avulsion of the cortical button in 7 of 9 specimens (vs none in the SB group). Conclusion: Our study shows that the intracortical DB technique produces equivalent or superior biomechanical performance to that of the SB technique. The DB technique may offer a clinically viable alternative to the SB repair technique. Clinical Relevance: This study suggests, at worst, an equivalent and, at best, a superior biomechanical performance of intracortical anatomic DB footprint repair at the time of surgery. However, the mode of failure suggests that this technique should not be used in patients with poor bone quality.

Functional outcomes after arthroscopic double button fixation of distal clavicular fractures in athletes

Distal third clavicle fractures are a frequent pathology in young, active patients, accounting for 30% of all clavicle fractures. There are several treatments available, which range from orthopedic management to surgical treatment with various options including: locking plates, tension bands and button fixation. The aim of this study was to evaluate the clinical and radiologic results of a group of patients treated with the arthroscopic double button fixation technique and, secondly, to analyze the complications and the rate of return to sports. MethodsNineteen patients (15 male and 4 Female) with a mean age of 38.2 years (21–64) were included. In all cases, an arthroscopic surgery with double button fixation of the distal third of the clavicle was performed. Functional Outcomes were evaluated with the visual analog scale (VAS) for pain, the American Shoulder and Elbow Surgeons scale (ASES) for functional outcomes. Range of Motion (ROM) was also assessed. ResultsThe mean follow up was 27.3 months (12 to 54 months). The mean VAS was 0.63 and the mean ASES score was 94.1. The ROM was fully recovered in 17 patients (89,4%). All patients returned to regular sports practice at 3.5 months. Finally, a total of 2 complications were registered (11,6%). ConclusionThe arthroscopic double button fixation of distal clavicular fractures is a safety and reliable procedure, and it is associated with favorable functional and radiological outcomes in most patients.

DOUBLE BUTTON FIXATION SYSTEM FOR THE TREATMENT OF ACUTE HIGH-GRADE ACROMIOCLAVICULAR JOINT DISLOCATION

Background: Acromioclavicular joint injuries represent the spectrum of soft tissue disruptions. These injuries usually occur in young males associated with athletic activities in which a direct blow to the lateral aspect of the shoulder occurs. Athletes belonging to the population at risk individuals, especially those who play football, rugby, or hockey. Conservative management is still considered a better modality for type 1, type 2, and some type 3 injuries. This prospective interven Materials and methods: tional study was conducted on patients who underwent surgery for AC joint dislocation. Mini-open surgery with a double-button xation technique was performed. Rockwood classication types 4-6 were included in the study. Proper pre-operative radiographs were obtained for better planning and management. Follow-up was taken at 2 weeks, 4 weeks, 3 months, 6 months, and 12 months. A total of 24 patients were included in the Results: study, with a mean age of 32.54 years. Among them 19(79.16%) were male and 5(20.83%) were females. According to Rockwood classication, 18(75%) patients belonged to type 4 injuries and 6(25%) patients to type 5 injuries. The mean VAS score at the nal follow-up was 0.16±0.38 which was signicantly improved from the pre-operative value of 6.87±1.15. The improvement in DASH score was from 19.6±2.66 preoperatively to 0.35±1.42 at 12 months postoperatively. There were no complications associated with the procedure. Acute traumatic Conclusion: high-grade acromioclavicular joint dislocations should be treated with operative methods. Double button xation device using a mini-open technique provides adequate exposure, better anatomical xation, and excellent functional outcomes.

BIOMECHANICAL COMPARISON OF DISTAL BICEPS REPAIR TECHNIQUES: SINGLE EXTRACORTICAL BUTTON INLAY FIXATION VERSUS DOUBLE INTRACORTICAL BUTTON ONLAY ANATOMICAL FOOTPRINT FIXATION

The extracortical single-button (SB) inlay repair is one of the most preferred distal biceps tendon repair techniques. However, specific complications such as neurovascular injury and non-anatomic repairs have led to the development of techniques that utilize intracortical double-button (DB) fixation.To compare the biomechanical stability of the extracortical SB repair with the anatomical DB repair technique.Controlled laboratory study.The distal biceps tendon was transected in 18 cadaveric elbows from 9 donors. One elbow of each donor was randomly assigned to the extracortical SBor anatomical DB group. Both groups were cyclically loaded with 60N over 1000 cycles between 90° of flexion and full extension. The elbow was then fixed in 90° of flexion and the repair construct loaded to failure. Gap-formation and construct stiffness during cyclic loading, and ultimate load to failure was analysed.After 1000 cycles, the anatomical DB technique compared with the extracortical SB technique showed significantly less gap-formation (mean difference 1.2 mm; p=0.017) and significantly more construct stiffness (mean difference 31 N/mm; p=0.023). Ultimate load to failure was not significantly different comparing both groups (SB, 277 N ±92 vs. DB, 285 N ±135; p=0.859). The failure mode in the anatomical DB group was significantly different compared with the extracortical SB technique (p=0.002) and was due to fracture avulsion of the BicepsButton in 7 out of 9 specimens (vs. none in SB group).Our study shows that the intracortical DB technique produces equivalent or superior biomechanical performance to the SB technique. The DB repair technique reduces the risk of nerve injury and better restores the anatomical footprint of biceps tendon. The DB technique may offer a clinically viable alternative to the SB repair technique.

Study of double button plate and cannulated screw fixation for posterior cruciate ligament avulsion fracture.

The posterior cruciate ligament (PCL) plays an important role in maintaining the stability of the knee joint. To date, researchers have not reached agreement on which type of fixation material should be used to treat PCL tibial avulsion fractures. The aim of this study was to investigate the effects of double button plate and cannulated screw fixation in the treatment of PCL avulsion fractures. We retrospectively reviewed our database, which was collected prospectively. From January 2019 to January 2020, 46 patients with posterior cruciate ligament avulsion fractures who were treated with double button plate and cannulated screw fixation. The primary outcomes of this study were surgical complications (fixation failure/displacement, implant breakage, nonunion, infection), radiological parameters, and knee function and secondary outcomes included reoperation rates for the fixation methods and the prevalence of symptomatic hardware causing soft tissue irritation outcomes were included. Values were analysed using multiple comparisons, where P-values of 0.05 or less were considered significant. Double button plate fixation had significantly higher values than cannulated screw fixation. The results showed that double button plate fixation was related to greater decreases in the length of surgery, intraoperative blood loss, hospital days, full weight bearing time, and incidence of complications, as well as greater increases in postoperative range of motion and Knee Society Score function and Lysholm scores. Compared with cannulated screw fixation, the use of double button plate fixation technology has the following advantages: less trauma, shorter operation time, convenient use of instruments and fixtures, and it does not need to be removed, thus avoiding secondary trauma. Moreover, double button plate fixation under direct vision is safe and reliable without the need for additional equipment.

Implant-dependent behavior of tunnel widening and clavicular button migration after arthroscopic-assisted treatment of acromioclavicular joint instabilities.

Despite ongoing discussions for the previous few decades, there is still no consensus regarding the optimal surgical technique for acromioclavicular joint instabilities. The purpose of this study was to determine the impact of various implant materials following arthroscopically assisted stabilization of acromioclavicular joint instabilities on tunnel widening and implant migration. We hypothesized an implant-dependent behavior for tunnel widening and implant migration with differences when comparing acute and chronic acromioclavicular joint instabilities. This study compared 105 patients with acromioclavicular joint instabilities that were managed operatively with coracoclavicular double button constructs. Two of the groups containing acute cases were treated with either a double button construct with a wire (TR) or a tape (D) as a central pillar. The two groups with chronic cases were either treated with a wire (T+) or tape D+ as a central pillar and additional hamstring tendon augmentation (+). One central transclavicular-transcoracoidal drill channel was made in the acute cases, while additional medial and lateral drill channels to augment the central pillar with the hamstring tendon were made. The central drill channel in all cases and the medial/lateral drill channels in chronic cases were subsequently radiologically analyzed immediately postoperatively and at follow-up. Following this, additional radiological analysis of the implant migration of the clavicular button took place. All groups showed significant tunnel widening of the central drill channel at follow-up (p ≤ 0.001). The TR+ technique demonstrated significant widening in both the medial (p ≤ 0.001) and lateral (p ≤ 0.001) drill channels. The D and D+ group displayed significant higher rates of clavicular button migration to a cortical and intraosseous level (p ≤ 0.002). Tunnel widening and implant migration following arthroscopically assisted management of acromioclavicular joint instabilities are dependent on the chosen implant. The stable tape showed a significantly increased degree of tunnel widening with respect to the central drill channel in comparison with the wire. In contrast, a higher degree of load capacity of the tape ultimately favors a protected intraosseous graft healing for chronic cases, which leads to less tunnel widening of the medial and lateral drill channel. Finally, the D/D+ implant groups showed higher rates of implant migration due to lower contact surface area of the implant at the upper clavicular cortex.

Pectoralis Major Repair with Double Button Sliding Tension Technique

Background: Pectoralis major rupture is often is weightlifters, commonly during benchpressing, eccentric phase of contraction and external rotation under maximum contraction. Preoperative imaging is use to differentiate between complete, partial, or intermuscular tear. In athelete patient, operative treatment has shown better result in return of strength and overall satisfaction over nonoperative treatment. Objectives: We described a surgical technique in 6 patients with acute pectoralis major rupture, with double button sliding technique. Methods: A deltopectoral approach is performed, and identify pectoralis major tendon and each tendon is secured with No.2 non absorbable braided suture using a modified krackow configuration. A 3.2 mm drill is used to make a unicortical hole at footprint. Two button were inserted and tensioned follow by knot-tying. Results: After six months evaluation, all patients underwent surgery with double button sliding tension technique returned to their pre-injury level. Conclusion: Double button tension sliding technique in pectoralis major rupture had excellent result, patients have returned to sport without complication.

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

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

Clinical and Radiological Outcomes of Closed-Loop, Double Button, Coracoclavicular Fixation for Extralateral (Neer Type IIC) Fractures of the Distal Clavicle.

Background: The distal end of the clavicle accounts for 10-28% of all clavicle fractures of which 52.8% are considered displaced and require internal fixation due to their high percentage of non-union. Numerous surgical techniques have been described for the well-known Neer types IIA, IIB, and V. Still, the literature is scarce for the rare “extralateral” (type IIC) fracture where the fracture line is located lateral to the completely torn coracoclavicular (CC) ligaments; such small fractures are sometimes not amenable for standard locking plate fixation.Methods: We present a series of seven patients treated surgically with closed-looped double button CC stabilization via an open approach. There were four males and three females with a mean age of 31 years (range: 19-46 years). The mechanism of injury was a motor vehicle accident in four cases and a fall from height in three cases. The average time from injury to surgery was 2.7 ± 1.3 days and the average follow-up period was 25.7 months (range: 16-48 months). A custom-made, closed-looped, double button device was made using the ProCinch Adjustable Cortical Fixation for anterior cruciate ligament (ACL) (Stryker, Kalamazoo, Michigan) and another standard or slotted button. The fracture was reduced anatomically and the device was tightened and secured with five to six knots. In two cases, additional interfragmentary sutures were used for extra stability. Postoperatively, the arm was immobilized in a simple sling for four weeks; passive assisted elevation up to 90 degrees was allowed from the second postoperative week, followed by active elevation after the sixth postoperative week. Radiological outcomes (bony union, loss of reduction, implant mispositioning, or subsidence of buttons) were assessed using serial plain radiographs. The Constant score (CS) and the Acromioclavicular Joint Instability Score (AJIS) were used for the final clinical evaluation, at least one year postoperatively.Results: Bony union was achieved in all patients at a mean time of 2.7 months (range: 2.5-3.6 months). No cases of delayed union, loss of reduction, button migration, or subsidence were noted. The mean CS was 96.6 ± 3.4 and the mean AJIS score was 94.1 ± 4.7 in a mean follow-up period of 25.7 months (range: 16-48 months). One patient developed a hypertrophic scar and another had mild skin irritation by the suture knots; no other complications were noted except for one patient who developed an early superficial skin infection managed with antibiotics and debridement under local anesthesia. Four patients who participated in sports before injury were able to regain almost full activity seven to nine months after the operation. All were satisfied with the final result. Two patients showed ossification of the CC ligaments with no significant clinical implications.Conclusions: Although we retrospectively reviewed a small series of patients, we were able to demonstrate a complete rate of fracture union and excellent clinical outcomes with no major complications. Type IIC distal clavicle fractures are rare and require special attention in terms of reduction and optimal fixation. Open CC fixation with closed-looped double buttons is a relatively easy and reproducible technique. We advocate the readjustment of Neer’s classification, including “extralateral” fractures as a IIC subtype.

The humeral suspension technique: a novel operation for deltoid paralysis.

Isolated deltoid paralysis is a rare pathology that can occur after axillary nerve injury due to shoulder trauma or infection. This condition leads to loss of deltoid function that can cause glenohumeral instability and inferior subluxation, resulting in rotator cuff muscle fatigue and pain. To establish dynamic glenohumeral stability, a novel technique was invented. Humeral suspension is achieved using a double button implant with non-resorbable high strength cords between the acromion and humeral head. This novel technique was used in two patients with isolated deltoid paralysis due to axillary nerve injury. The results indicate that the humeral suspension technique is a method that supports centralizing the humeral head and simultaneously dynamically stabilizes the glenohumeral joint. This approach yielded high patient satisfaction and reduced pain. Glenohumeral alignment was improved and remained intact 5 years postoperative. The humeral suspension technique is a promising surgical method for subluxated glenohumeral joint instability due to isolated deltoid paralysis.

Analysis of the effect of double button plate combined with strengthened anchor in the treatment of acromioclavicular dislocation

To evaluate the efficacy and prognosis of double button plate combined with strengthened anchor technique and clavicular hook plate internal fixation for complete acromioclavicular joint dislocation. From July 2017 to September 2020, a total of 42 patients with acromioclavicular joint dislocation treated by surgery were choosen as study objects and divided into observation group (21 cases) and control group (21 cases). In the observation group, there were 14 males and 7 females, aged 21 to 63 years old, with an average of (45.05±8.70) years old. In the control group, there were 16 males and 5 females, aged 25 to 68 years old, with an average of(45.00±9.44) years old. The patients in the observation group were treated with double button plate combined with strengthened anchor technique, whereas those in the control group received clavicular hook plate internal fixation. The two groups were compared in terms of operating time, intraoperative blood loss, postoperative hospital stay, shoulder pain(visual analogue scale, VAS) score, shoulder function Constant-Murley score and postoperative complications. There was no significant difference between the two groups in intraoperative blood loss or postoperative hospital stay(P>0.05). The operating time of double button plate combined with strengthened anchor technique group (65.24±5.36) min was significantly longer than that of the clavicular hook plate group (48.81±4.72) min, and the difference was statistically significant (P<0.05). There was no significant difference in shoulder function or pain degree between the two groups before operation (P>0.05). After 1 month, 3 months and 6 months, the Constant-Murley score of the observation group was 73.29±2.15, 85.43±1.47, 93.86±1.24 separately, which were significantly higher than those of the control group;and the VAS score was 2.76±0.62, 1.71±0.64, 0.57±0.51 separately, which were significantly lower than those of the control group (P<0.05). One instance of shoulder discomfort was found in the observation group, while 5 cases of shoulder pain, 2 cases of restricted shoulder mobility, and 1 case of subacromial bone absorption were found in the control group. In both group, there was no loss of reduction. In the treatment of complete acromioclavicular joint dislocation double button plate combined with strengthened anchor technique achieves favorable clinical result. Internal fixation does not need to be removed. The recovery of shoulder joint function and pain relief are superior than clavicular hook plate internal fixation, which is more worthy of clinical promotion.

A Failure Case of Double Button Plate Fixation for Treatment of Nonunion of Patella Fracture

The rate of nonunion of patella fracture was 2.4%-4.8% [1]. For the patella nonunion with no symptom or slight symptom, because the knee joint function is acceptable, non-surgical treatment is often used clinically. However, in some patients with nonunion, there are steps on the articular surface of patella, often have obvious symptoms such as knee joint pain, limited flexion and extension activities, etc., which can often cause serious complications such as traumatic patellofemoral arthritis, joint degeneration, joint stiffness, etc [2,3].

Open Double-Button Technique is Superior to Hook Plate in the Treatment of Acute Rockwood Type III/V Acromioclavicular Dislocations.

The aim of this study is to compare open double-button (DB) and hook plate (HP) techniques in the treatment of acromioclavicular joint dislocation (ACJD) in terms of clinical and radiological outcomes and to determine which method is superior. This retrospective comparative study included patients with ACJDs (Rockwood Type III/V) who were treated with one of these implants (22 patients with HP, 21 patients with DB) between June 2014 and February 2018. A total of 43 patients (39 men and 4 women) with a mean age of 41.8±17.4 years have participated in this study. The mean follow-up time was 20.6±7.5 months. Mean times of fluoroscopy, operation, and return to work were shorter in the DB group. Compli-cation rates were 23.8% and 54.6%, reoperation rates (including mandatory implant removals [IR]) were 4.8% and 77.3%, mean constant scores were 92.1±3.4 and 88.3±4.2, and mean Visual Analog Scale scores were 0.8±1.0 and 1.5±1.0 for the DB and HP groups, respec-tively. IR was the main reason for reoperations in the HP group, whereas the DB group's only reoperation was caused by a coracoid cutout (due to coracoid tunnel malposition) leading to redislocation. AC joint arthritis (36.4%) and subacromial osteolysis (31.9%) were com-monly encountered in the HP group. The most frequent complication of the DB group was malreduction (initial undercorrection) (9.6%). DB was superior to HP in functional outcome, post-operative pain, complication and reoperation rates, operation and fluoroscopy times, and time to return to work. Besides, reoperation (for IR) was needed in most of the HP patients. Therefore, the open DB technique should be preferential to the HP procedure.

A Case Report of Revision Surgery with a Double Button Implant After a Rare Tuber Kalkanei Fracture Non-Union

Tuber kalkanei kopma kırıkları, genellikle indirekt travma sonrası oluşan ve nadir görülen kırıklardır. Osteoporoz ve diyabet, kırık gelişiminde risk faktörleridir. Bunlar, olası yara sorunları nedeniyle erken cerrahi girişim ile tedavi edilmesi gereken kırıklardır. Bu yazıda, kopma kırığı nedeni ile cerrahi tedavi uygulanan ve vida ile tespiti yapılan, takiplerinde osteoporoz, hasta uyumsuzluğu (erken yük verme), yara yeri problemleri nedeniyle sirküler alçı uygulanamaması gibi problemler nedeniyle erken dönemde implant yetmezliği ve kırık fragmanda redüksiyon kaybı gelişmesi üzerine çift düğme implantı ile revizyon cerrahisi yapılan bir olgu sunuldu.

Biologic and synthetic ligament reconstructions achieve better functional scores compared to osteosynthesis in the treatment of acute acromioclavicular joint dislocation.

To systematically review the outcomes of surgical treatments of acute acromioclavicular joint dislocation. Studies were identified by electronic databases (Ovid, PubMed). All studies reporting functional and radiological outcomes of surgical treatments of acute acromioclavicular joint dislocations were included. Following data were extracted: authors and year, study design, level of evidence, number of patients, age, classification of acromioclavicular joint dislocation, time to surgery, surgical technique, follow-up, clinical and imaging outcomes, complications, and failures. Descriptive statistics was used, when a data pooling was not possible. Comparable outcomes were pooled to generate summary outcomes reported as frequency-weighted values. Quality appraisal was assessed through the MINORS checklist. One hundred and thirty-three studies were included for a total of 4473 shoulders. Mean age of participants was 36.9years. Mean follow-up was 42.06months. Arthroscopy showed better ASES (p < 0.0001) and lower VAS pain score (p = 0.0249) compared to an open approach. Biologic and synthetic reconstructions demonstrated better results over osteosynthesis techniques. Biologic techniques showed overall better Constant (p = 0.0001) and DASH (p = 0.0215) scores, while synthetic reconstruction showed better UCLA score (p = 0.0001). Among suture buttons, triple button showed overall better results in Constant (p = 0.0001) and VAS (p = 0.0001) scores, while better results in DASH score (p = 0.0003) were achieved by 2 double button techniques. Overall, the level of evidence was low. Biological and synthetic reconstructions achieved better functional scores compared to osteosynthesis. Among suture buttons, the triple button showed better functional performance. IV.

Metabolismo en los edificios. Estudio de medidas para el ahorro del consumo de agua en tres centros docentes en Madrid

Estudios previos han investigado sobre el desempeño energético de centros docentes. Sin embargo, no parece haberse explorado suficientemente la relación entre consumo de energía y consumo de agua en este tipo de edificios. Este artículo presenta los resultados de un estudio empírico, basado en la metodología de la auditoría energética operativa, realizado en tres centros docentes ubicados en la Comunidad de Madrid. Los resultados sugieren que las medidas de ahorro en el consumo de agua, como implantar perlizadores, temporizadores o doble pulsadores, son relevantes en cuanto a la mejora de la eficiencia energética, suponen inversiones moderadas y obtienen unos periodos de retorno simple de la inversión atractivos para los gestores de los edificios. Se abren nuevas vías de investigación que apuntan a realizar el análisis de otros flujos de materia e información, de manera que se establezca la relación entre dichos flujos y el consumo de energía que llevan aparejados.

Study of double button plate fixation in treatment of inferior pole of patella fracture

ObjectiveTo investigate effect of double button plate fixation in the treatment of inferior patella fracture MethodsPatients with inferior pole of patella fracture were treated with double button plate fixation. The perioperative and postoperative outcomes of MPIF with those of KWIF patients with metacarpal and phalangeal fractures were included. ResultsThe average operation and hospital stay time was 55 min and 8 days respectively. Range of motion (ROM) and knee society scores(KSS) was related to a greater increase. No patients have nonunion, infection and revision. ConclusionIn this study, double button plate fixation technology for the treatment of comminuted fracture of the inferior patellar pole has the advantages of simple operation, rapid recovery, early full weight bearing, better ROM and KSS, without incidence of nonunion, infection and revisions or reoperation.