End Of Suture Research Articles

Repair of acute ulnar collateral ligament injuries of the thumb metacarpophalangeal joint with Mitek microsuture anchor

Objective To evaluate the effectiveness of Mitek microsuture anchors in the reconstruction of acute ulnar collateral ligament(UCL) injuries of the thumb metacarpophalangeal joint. Methods From July 2004 to May 2009, 11 patients with acute ulnar collateral ligament injuries of the thumb metacarpophalangeal joint were treated using the Mitek microsuture anchors for one-stage repair. The Mitek microsuture was anchored in the first metacarpal head or the lateral side of proximal phalanx base of the thumb where the ulnar collateral ligament had avulsed. The suture end was sewn through the collateral ligament to reconstruct its attachment. Results Postoperatively the patients were follow-up for 6 months to 4 years, with an average of 2.4 years. According to Saetta functional assessment standard, the results were graded as excellent in 7 cases, good in 3 cases, and fair in 1 case. The overall excellent and good rate was 90.9%. X-rays showed no loosening or displacement of the anchors. Conclusion Suture anchor technique can be recommended as a simple and effective method for repairing ulnar collateral ligament injuries of the thumb metacarpophalangeal joint. Key words: Thumb; Collateral ligaments; Metacarpophalangeal joint; Suture anchors

Influência do butorfanol sobre os períodos de latência e de ação da ropivacaína pela via peridural na ovariossalpingo-histerectomia em cadelas

Avaliaram-se os períodos de latência e de duração do efeito do butorfanol associado à ropivacaína aplicados pela via peridural e a possibilidade de uso dessa associação como protocolo anestésico para realização de ovariossalpingo-histerectomia (OSH) em cadelas. Utilizaram-se 16 cadelas pré-medicadas com acepromazina e midazolam compondo dois grupos: no grupo 1 (n=8) aplicou-se ropivacaína isolada (0,3mL/kg) e no grupo 2 (n=8), butorfanol (0,1mg/kg) e ropivacaína (até o volume de 0,3mL/kg), pela via peridural. Consideraram-se nove momentos (M): M0 - animal sem anestesia, M1 - 15 minutos após medicação pré-anestésica; M2 - 30 minutos após a aplicação peridural; M3, M4 e M5 - correspondentes ao início do procedimento e ao pinçamento dos pedículos esquerdo e direito, respectivamente; M6 - ligadura da cérvix uterina; e M7 e M8 - início da laparorrafia e fim da sutura de pele, respectivamente. Foram avaliados os períodos de latência e ação do bloqueio, além da viabilidade de realização do procedimento cirúrgico por meio do bloqueio efetuado. O que recebeu ropivacaína + butorfanol apresentou sedação pronunciada e permitiu a realização de OSH em 75% dos animais, sem indução anestésica. Não houve diferença entre os grupos quanto aos períodos de latência e duração. A associação do butorfanol à ropivacaína proporcionou bloqueio anestésico compatível com a realização de OSH e período de latência curto, com duração de efeito suficiente para o procedimento cirúrgico.

Rupture traumatique trachéobronchique : gestion des voies aériennes

We report the case of a 25-year-old man who suffered a severe trauma with a complete rupture and separation of the right main bronchus. The patient presented on the scene with respiratory distress and severe hypoxemia. At the admission in the trauma resuscitation unit, the CT scan and fiberoptic examination confirmed the diagnosis of right main bronchus rupture. Selective fiberoptic intubation of the left main bronchus was done and the patient was sent to the operating theater for urgent thoracotomy. During thoracotomy, profound arterial oxygen desaturation requested the right main bronchus being intubated by the surgeon under the control of view and separate lung ventilation, until the end of the bronchus suture. Surgery allowed the patient to survive. He was then discharged alive from the hospital at day 36. Severe tracheobronchial rupture may be rapidly associated with major respiratory distress and severe hypoxemia that necessitate specialised care in referring centre. Initial orientation of these patients appears to be as important that airway and hypoxemia management.

Epididymis Ligation: A Minimally Invasive Technique for Preparation of Teaser Rams

To describe a minimally invasive technique for preparation of teaser rams by needle-assisted ligation through the tail of the epididymis. Experimental study. Mature rams (n=6), estrus-induced ewes (2). METHODS; After local anesthesia, epididymis ligation was achieved by restraining the testis distally within the scrotal sac and passing suture through a hypodermic needle inserted between tail of epididymis and distal pole of testis, caudomedial to craniolateral through the scrotum. The needle was removed leaving the suture in place and the testis pushed up dorsally, then the needle was reinserted through the original holes and the suture passed back through the needle, which was withdrawn. This resulted in the suture forming a complete loop around the epididymis. The suture ends were tied ligating the epididymis. Semen was evaluated pre- and postligation. Testes were removed after 30 days for gross and histologic examination. Epididymis ligation was accomplished without postoperative complications. Three weeks after the epididymis ligation, no motile and live spermatozoa were found in ejaculates. From 5 to 28 days after epididymis ligation, attraction to ewes and libido was unchanged and similar to 14 days before ligation. This novel minimally invasive technique is a simple, alternative method for preparation of teaser rams. This method is simply performed, without skin wounds, and minimal postoperative care is needed. The technique should be readily adaptable to other species.

An Ex-Vivo Evaluation of the Application and Strength of a Novel Laparoscopic Knot Substitute Device

Intracorporeal suturing can be challenging, especially in the case of laparoscopic partial nephrectomy. During these procedures, suturing must reapproximate renal tissue to achieve hemostasis but not tear through tissue. We present a new device, the ANPA Suturelock, which can be adjusted to increase or decrease suture tension, optimizing tissue apposition. Two participants (one experienced laparoscopist, one junior resident) completed the protocol. A laparoscopic trainer was used to secure 2-0 polyglactin suture ends in rubber foam using five of each of the following: Traditional laparoscopic suture knots (one surgeon's knot and two square knots), square-to-slip knots, Weston extracorporeal knots, ANPA Suturelock, Lapra-Ty devices, Hem-O-Lock clips, and titanium clips. Tensile strength of each knot and knot substitute was measured using an Instron machine (Instron, Norwood, MA). Time to secure the two suture ends was measured for ANPA Suturelock and laparoscopic surgeon's knot. Statistical analysis was performed using the Student t test. Mean tensile strength of the three knot-tying methods was 53.0 newtons (N) while that of the four knot substitute devices was 8.3 N (P < 0.001). Each of the three individual knot-tying methods had significantly greater tensile strength than any of the knot substitutes (P < 0.001 for all). Of the knot-tying methods, the surgeon's knot was the strongest (mean tensile strength 63.2 N) and was significantly stronger than square-to-slip and Weston extracorporeal knots (39.1 N and 48.4 N, respectively, P < 0.05 for both). Of the knot substitutes, ANPA Suturelock (mean tensile strength 14.7 N) was significantly stronger than Lapra-Ty (6.1 N), Hem-O-Lock (5.4 N), and titanium clip (3.0 N) (P < 0.01 for all). When compared with a laparoscopic surgeon's knot, the time to securing the ANPA Suturelock was significantly quicker for a third year resident (106 sec vs 38 sec, P < 0.001) and an experienced laparoscopist (75 sec vs 23 sec, P = 0.02). The tensile strengths of traditional knot-tying techniques were greater than that of any knot substitute device. The ANPA Suturelock provided the greatest tensile strength of any knot substitute. The time to secure a knot using the ANPA device was also significantly quicker than tying a standard surgeon's knot.

Analgesia in post-thoracotomy patients: Comparison between thoracic epidural and thoracic paravertebral blocks.

Background:Acute postoperative pain can cause detrimental effects on multiple organ systems, leading to chronic pain syndromes.Objective:To compare thoracic epidural block (TEB) and paravertebral block (PVB) for relief of postoperative pain in adult patients undergoing thoracotomy.Materials and Methods:In this randomized, single-blinded, prospective study, 60 adult patients of both sexes, belonging to ASA physical status I and II, were scheduled for elective thoracotomy under general anesthesia. They were randomly divided into two groups, A and B of 30 each, who were comparable in terms of demographic parameters and body weight. Group A received TEB and Group B received PVB. All the patients underwent thoracotomy under general anesthesia using a uniform standard anesthetic technique. Thirty minutes before the anticipated end of skin suture, blocks were activated in both the groups with 7.5 ml for TEB and 15 ml for thoracic PVB of 0.25% bupivacaine, along with 1 ml of fentanyl for postoperative analgesia.Results:Patients receiving PVB for postoperative analgesia experienced better analgesia than those receiving TEB from the immediate postoperative period that lasted longer. Intragroup comparison showed that in the cases receiving TEB, there was a significant statistical difference in preoperative and postoperative values with regard to the mean systolic blood pressure (SBP), mean arterial pressure and mean pulse rate. However, in patients receiving PVB, significant difference in preoperative and postoperative values was seen in mean SBP only.Conclusions:We observed longer duration of analgesia with PVB compared to TEB.

Effects of antibiotics on biochemical parameters, leukocytes and Reactive Oxygen Species (ROS) in bitches after ovariectomy

It is well known that following surgical procedures, a variety of patho-physiological alterations occurs in the host, such as changes in haemodynamic, endocrine and immune functions, as well as increase in Reactive Oxygen Species (ROS). Antibiotic administration, a common practice used in surgery, affects immune functions and ROS generation. Our study was aimed to investigate the effect of five different antibiotic regimens: amoxicillin, benzylpenicillin/dihydrostreptomycin, sulfametazine/sulfamerazine/ sulfathiazole, enrofloxacin, lincomycin/spectinomycin, administered twice (2 hours before skin incision and 6 hours after the end of the surgical suture), on biochemical parameters, leukocytes and ROS concentrations, in bitches undergoing open laparotomic ovariectomy. All treated bitches recovered from surgery without developing either systemic dysfunctions, or infections at the surgical site. Mean healing time was 7 ± 3 days. An increase in white blood cell count, in differential leukocyte count and in ROS concentrations occurred 24 hours after the end of surgery, followed by a gradual decrease to basal values within the fourth day after surgery. The biochemical parameters remained quite constant throughout the study. In conclusion, our results show that the above antibiotic regimens, administered only twice, are efficient in inducing an uneventful recovery after laparotomic ovariectomy and preventing the development of infections in the bitch.

A laparoscopic knot-tying device for minimally invasive cardiac surgery☆

Intracorporeal suturing and knot tying can complicate, prolong or preclude minimally invasive surgical procedures, reducing their advantages over conventional approaches. An automated knot-tying device has been developed to speed suture fixation during minimally invasive cardiac surgery while retaining the desirable characteristics of conventional hand-tied surgeon's knots: holding strength and visual and haptic feedback. A rotating slotted disc (at the instrument's distal end) automates overhand throws, thereby eliminating the need to manually pass one suture end through a loop in the opposing end. The electronic actuation of this disc produces left or right overhand knots as desired by the operator. To evaluate the effectiveness of this technology, seven surgeons with varying laparoscopic experience tied knots within a simulated minimally invasive setting, using both the automated knot-tying tool and conventional laparoscopic tools. Suture types were 2/0 braided and 4/0 monofilament. Mean knot-tying times were 246+/-116 s and 102+/-46 s for conventional and automated methods, respectively, showing an average 56% reduction in time per surgeon (p=0.003, paired t-test). The peak holding strength of each knot (the force required to break the suture or loosen the knot) was measured using tensile-testing equipment. These peak holding strengths were normalised by the ultimate tensile strength of each suture type (57.5 N and 22.1N for 2/0 braided and 4/0 monofilament, respectively). Mean normalised holding strengths for all knots were 68.2% and 71.8% of ultimate tensile strength for conventional and automated methods, respectively (p=0.914, paired t-test). Experimental data reveal that the automated suturing device has great potential for advancing minimally invasive surgery: it significantly reduced knot-tying times while providing equivalent or greater holding strength than conventionally tied knots.

Review of geology of the New Siberian Islands between the Laptev and the East Siberian Seas, North East Russia

Abstract. The New Siberian Islands comprise De Long Islands, Anjou Islands, and Lyakhov Islands. Early Paleozoic, Mesozoic and Cenozoic sediments and igneous rocks are known on the De Long Islands. Cambrian slate, siltstone, mudstone and silicified limestone occur on Bennett Island. Ordovician volcanogenic turbidites, lavas, and small intrusions of andesite-basalt, basalt, dolerite, and porphyritic diorite were mapped on Henrietta Island. The igneous rocks are of calc-alkaline island arc series. The Ordovician age of the sequence was defined radiometrically. Early Paleozoic strata were faulted and folded presumably in the Caledonian time. Early Cretaceous sandstone and mudstone are known on Bennett Island. They are overlain by a 106–124 Ma basalt unit. Cenozoic volcanics are widespread on the De Long Islands. Zhokhov Island is an eroded stratovolcano. The volcanics are mostly of picrite-olivine type and limburgite. Radiometric dating indicates Miocene to Recent ages for Cenozoic volcanism. On the Anjou islands Lower-Middle Paleozoic strata consist of carbonates, siliciclastics, and clay. A Northwest-southeast syn-sedimentary facies zonation has been reconstructed. Upper Paleozoic strata are marine carbonate, clay and siliciclastic facies. Mudstone and clay predominate in the Triassic to Upper Jurassic section. Aptian-Albian coal bearing deposits uconformably overlap lower strata indicating Early Cretaceous tectonism. Upper Cretaceous units are mostly clay and siltstone with brown coal strata resting on Early Cretaceous weathered rhyolite. Cenozoic marine and nonmarine silisiclastics and clay rest upon the older units with a transgressive unconformity including a weathering profile in the older rocks. Manifestations of Paleozoic and Triassic mafic and Cretaceous acidic magmatism are also found on these islands. The pre-Cretaceous structure of the Anjou islands is of a block and fold type Late Cimmerian in age followed by faulting in Cenozoic time. The Lyakhov islands are located at the western end of the Late Cimmerian South Anyui suture. Sequences of variable age, composition, and structural styles are known on the Lyakhov Islands. These include an ancient metamorphic sequence, Late Paleozoic ophiolitic sequence, Late Mesozoic turbidite sequence, Cretaceous granites, and Cenozoic sediments. Fold and thrust imbricate structures have been mapped on southern Bol'shoi Lyakhov Island. North-northwestern vergent thrusts transect the Island and project offshore. Open folds of Jurassic–Early Cretaceous strata are characteristic of Stolbovoi and Malyi Lyakhov islands. Geology of the New Siberian Islands supports the concept of a circum Arctic Phanerozoic fold belt. The belt is comprised of Caledonian, Ellesmerian, Early Cimmerian and Late Cimmerian fold systems, manifested in many places on the mainland and on islands around the Arctic Ocean. Knowledge of the geology of the New Siberian Islands has been used to interpret anomalous gravity and magnetic field maps and Multi Channel Seismic (MCS) lines. Two distinguishing structural stages are universally recognized within the offshore sedimentary cover which correlate with the onshore geology of the New Siberian Islands. Dating of the upper structural stage and constituent seismic units is based on structural and stratigraphic relationships between Late Mesozoic and Cenozoic units in the archipelago. The Laptev Sea–western East Siberian Sea seismostratigraphic model for the upper structural stage has much in common with the seismostratigraphic model in the American Chukchi Sea.

Suture End Length as a Function of Knot Integrity

To evaluate tension at the failure of 3 commonly used sutures when suture ends were cut to 3 lengths. Knots were tied using U.S. Pharmacopeia Size 0-0 polyglactin 910, silk, or polydioxanone sutures. The knots were tied randomly on a jig by the same surgeon. End lengths were then cut to random lengths of 0, 3, and 10 mm. We compared the individual knot strength when subjected to tensile forces via tensiometer with the point of knot failure, which was defined as untying and/or breaking of the knot. Three types of suture were divided into 3 groups based on end lengths for a total of 178 knots. A logistic regression analysis showed the odds of knots coming untied were highest for polyglactin 910 (odds ratio [OR] = 33.7; 95% confidence interval [CI] = 4.1-277.1). End length also had a significant effect on knots untying, with the 0-mm knots being more likely to come untied (OR, 21.2; 95% CI, 2.9-153.0). Post hoc tests for a 3 x 3 analysis of variance found that silk knots failed at significantly lower tension than polydioxanone (p < 0.001) and polyglactin 910 (p < 0.001) knots. The knots with an end length of 0 mm were significantly more likely to come untied than either 3- or 10-mm knots. Among all the materials, polyglactin 910 was the most prone to untying; however, it resulted in untying at a mean tension greater than the breaking point of silk.

Restoration of the shape, location and skin of the severe burn-damaged breast

Thermal injuries to the anterior chest in pre-pubescent girls result in breast contracture. During puberty, the breast parenchyma develops and grows underneath the scars, resulting in being flattened and disfigured. The breast mound, as well as the nipple–areolar complex, is partially or completely levelled out and displaced. The contours are unclear and the inframammary fold is effaced. This feature of the most severe breast contracture still poses a challenge for most surgeons. This type of breast contracture can be successfully eliminated with the author-suggested, improved free-skin grafting technique. The scars are excised and the shifted area of parenchyma is mobilised symmetrically to the border of the undamaged breast. Then, the shape and positioning of the breast as well as the nipple–areolar complex are reconstructed with the help of circular suturing through the fat layer on two to three breast levels. The suture ends are led beyond the wound area and are affixed with certain tension contralateral to the breast displacement. The suture ends, being in state of tension, are tied into untied knots around bolsters and are retained in place for about 3 months. During this time, the form and the positioning of the breast can be corrected using the traction of the untied sutures; the skin transplants are stabilised, under which the scar tissue is formed. Skin transplant and the scar tissue hold the shape and positioning of the breast and the sutures can be removed at this stage. In this series, 11 patients were operated upon and 13 breasts were reconstructed. Good results were achieved in all cases: the breast's shape and skin was restored and the positioning was corrected.

A simplified laparoscopic ventral hernia repair: the scroll technique

Dear Sir, We read with great interest the article entitled A Simplified Laparoscopic Ventral Hernia Repair: The Scroll Technique published in Surgical Endoscopy [1]. We congratulate authors for their excellent results and their description of a new technique for mesh insertion in the laparoscopic repair of ventral hernia. With our technique, published in the JSLS [2], we introduce the mesh through a trocar placed in the center of the hernia defect itself. This provides two benefits. It prevents trocar-site incisional hernia, reported in other series [3], and avoids inducing weakness in other sites of the abdomen and a difficult closure, especially in obese patients. The orientation and placement of the mesh is ensured by putting a long suture in the center of the mesh and two stitches in the mesh at the 6 and 12 o’clock positions before insertion. The end of the long suture remains outside the abdomen through the trocar when the mesh is fully inside the abdomen. Pulling on that long suture helps to centralize the mesh in relation to the hernia defect. The two sutures in the 6 and 12 o’clock positions help to orient the mesh in longitudinal or transverse position according to the shape and size of the hernia defect. The authors reported one case of mesh infection, and we are interested in the way this problem has been managed. Also, they reported no case of incisional hernia at the 12-mm trocar site, and we are interested in knowing whether this issue was investigated during the follow-up period. Another point is seroma formation associated with polytetrafluoroethylene (PTFE). The authors explained this as due either to the tight weaving of the mesh or to the mesh material. They also recommend abdominal binder postoperatively to reduce the seroma formation. In our practice, we did not find a significant association between the type of mesh and seroma formation, which we believe is entirely related to the size of the hernia, the thickness of subcutaneous fat, extent of dissection and the hemo-static technique and not to the type of mesh. Having said that, we also advise abdominal binder postoperatively for 2 weeks because we believe this will reduce the seroma formation.

A Simple Suture-Retrieval Device for the Placement of U-Stitches During Laparoscopic Gastrostomy

During minimally invasive operations, it is sometimes necessary to retrieve the end of a suture or a suture needle and bring it out through the abdominal wall. Using a standard needle and a length of suture, we have developed a simple device that allows the retrieval of a suture end during minimally invasive operations that require the placement of U-or stay stitches. The author has used the device described during more than 100 laparoscopic gastrostomy placement procedures and other operations involving the placement of U- or stay stitches with excellent results and no complications. Using a beveled hollow-bore needle and a loop of polypropylene suture, one can construct a simple device that allows the retrieval of a suture from within a body cavity during minimally invasive surgery, making the placement of U- and stay stitches easier and more precise.

Prevention of suture exposure in transscleral intraocular lens fixation: an original technique

Background: In this retrospective study, we evaluated our surgical outcomes of transscleral intraocular lens (IOL) fixation and introduced a simple, quick, and effective method to fixate and bury the sutures in the sclera to avoid suture exposure. Methods: Eyes were divided into 3 groups according to surgical technique. Half-thickness scleral flaps were prepared, and polypropylene suture ends were cut short in group 1 (12 eyes). Suture ends were left long without flaps in group 2 (47 eyes) and were buried into the scleral tunnel in group 3 (21 eyes). Results: The suture exposure rate was significantly lower in group 3 (0%) compared with group 2 ( p = 0.006) and group 1 ( p = 0.040). There was no significant difference in group 1 (25%) compared with group 2 (27.6%) ( p = 1.000). Interpretation: Burying the suture ends into the scleral tunnel is a simple, safe, and effective technique for avoiding suture exposure in scleral-fixated IOL implantation.

Where does the South Anyui suture go in the New Siberian islands and Laptev Sea?: Implications for the Amerasia basin origin

The South Anyui suture is a major tectonic boundary in NE Asia, believed to represent the remains of an ocean basin which separated Siberia from North America in Jurassic time. Its history also figures prominently in the Mesozoic reconstruction of the Arctic and the origin and evolution of the Amerasia basin. Three types of proposed trends of the South Anyui suture are evaluated. 1) The suture ends near the Kolyma River mouth where it meets the rotational transform. The paper, however, proves that the suture continues further westward up to Big Lyakhov Is. Consequently, a simple geometric rotational model for Amerasia basin origin must be rejected. 2) The suture trends from Big Lyakhov to the Anjou islands. The Anjou islands geology is examined, and it is concluded that the suture could not go through them. Hence, all proposed versions of the rotational hypothesis of the Amerasia basin opening are claimed to be invalid. 3) A proposed Taimyrian connection of the suture is examined, and it is concluded that this model must be rejected as well. The failure of all previously suggested models for the suture extent through the New Siberian islands and Laptev Sea means that in Early Mesozoic there was no oceanic basin that separated the New Siberian–Chukotka terrane from Siberia. Thus Siberia and North America formed a continuous continent in Jurassic time. This paper presents evidence that the South Anyui suture has instead turned back from Big Lyakhov island and followed a sinuous path designated as the Chroma Loop before connecting with the Kolyma Loop suture. On this model the South Anyui suture can be interpreted as a small segment of extensive boundary which separated the Amerasia Jurassic margin and terranes accreted to it from the Pacific. The modern boundary around the North Pacific is also quite sinuous. It was suggested that in Jurassic time it was straighter and the Amerasia ocean was originated as a common back-arc basin. Finally a new two-pole parallelogram hypothesis for the Amerasia basin opening is suggested and the approaches to its verification are outlined.

A New Technique for Intracorporeal Knot Tying in Laparoscopic Surgery

Laparoscopic intracorporeal knot tying in minimally invasive surgery is an advanced skill. Mastering this skill is a difficult process with a long learning curve. Intracorporeal suturing is essential to advanced laparoscopy and is a rate-limiting step in many procedures. Many different instruments and methods have been described for laparoscopic suturing and knot tying. We have developed a new technique for laparoscopic knot tying. The long end of the suture is held with a left-hand instrument, and the instrument is rotated for 360 degrees in a clockwise direction to make a forward-direction loop. The end of the loop is grasped with the right-hand instrument, and the other end of the suture is grasped with the left-hand instrument. The suture end, held by the left hand, is pulled though the loop and tied, thus making a half-knot of a square knot. The second half-knot is made by using the right-hand instrument with the same technique. Laparoscopic suturing and knotting is difficult to perform, especially when the angle between the working instruments is narrow and working space is limited. In all these situations, knot tying using this technique makes knotting more simple and easy to perform, especially for those who have limited experience in intracorporeal suturing and knot tying. No special instrument is required to perform knot tying with this technique.

Long-Term Results of a Suture Burial Technique

To report the long-term (minimum 24 months of follow-up) results of a scleral suture fixation technique. Surgical databases from one surgeon were reviewed for consecutive cases from March 2003 to August 2005 in which the scleral suture fixation technique was used and a minimum follow-up of 24 months was completed. In this study, by knotting the suture onto itself, the author has buried the end and the knot of the suture into the sclera for scleral fixation, to stay put within the sclera. Intraoperative technical complications, postoperative visual outcomes, intraocular pressures, and suture-related complications were evaluated for each patient. A total of 150 scleral-sutured free suture ends were evaluated after a minimum 24 months of follow-up in 75 eyes of 75 patients. No technical or suture-related complications (suture exposure, irritation, granulomas, giant papillary conjunctivitis, suture abscess) were recorded throughout the follow-up period. Long-term follow-up of the suture burial technique - which allows avoidance of scleral incision, flap, or tunnel formation, as well as patch grafts for scleral fixation of intraocular lenses - showed it to be safe and effective.

Coolwater culmination: Sensitive high‐resolution ion microprobe (SHRIMP) U‐Pb and isotopic evidence for continental delamination in the Syringa Embayment, Salmon River suture, Idaho

During dextral oblique translation along Laurentia in western Idaho, the Blue Mountains superterrane underwent clockwise rotation and impinged into the Syringa embayment at the northern end of the Salmon River suture. Along the suture, the superterrane is juxtaposed directly against western Laurentia, making this central Cordilleran accretionary‐margin segment unusually attenuated. In the embayment, limited orthogonal contraction produced a crustal wedge of oceanic rocks that delaminated Laurentian crust. The wedge is exposed through Laurentian crust in the Coolwater culmination as documented by mapping and by sensitive high‐resolution ion microprobe U‐Pb, Sri, and ɛNd data for gneisses that lie inboard of the suture. The predominant country rock is Mesoproterozoic paragneiss overlying Laurentian basement. An overlying Neoproterozoic (or younger) paragneiss belt in the Syringa embayment establishes the form of the Cordilleran miogeocline and that the embayment is a relict of Rodinia rifting. An underlying Cretaceous paragneiss was derived from arc terranes and suture‐zone orogenic welt but also from Laurentia. The Cretaceous paragneiss and an 86‐Ma orthogneiss that intruded it formed the wedge of oceanic rocks that were inserted into the Laurentian margin between 98 and 73 Ma, splitting supracrustal Laurentian rocks from their basement. Crustal thickening, melting and intrusion within the wedge, and folding to form the Coolwater culmination continued until 61 Ma. The embayment formed a restraining bend at the end of the dextral transpressional suture. Clockwise rotation of the impinging superterrane and overthrusting of Laurentia that produced the crustal wedge in the Coolwater culmination are predicted by oblique collision into the Syringa embayment.

Arthroscopic Reduction and Fixation With Suture-Bridge Technique for Displaced or Comminuted Greater Tuberosity Fractures

Abstract The arthroscopic suture-bridge technique (transosseous equivalent technique) was initially described for increasing the footprint size during arthroscopic rotator cuff repair. We describe a method in which the same principles are used to fix a displaced or comminuted greater tuberosity fracture. The technique involves reducing the displaced fragment with two medially placed, trans-tendinous anchors and compressing the greater tuberosity using the sutures from these medial anchors in two laterally placed anchors. The two medial anchors are inserted through the junction of the cuff and fragment. The anchor driver can be used as a joystick to reduce the fragment into position. One suture limb of each anchor is passed back through the tendon 5 mm from the original anchor insertion point in the tendon. With the scope in the subacromial space, the sutures from the medial anchors are tied in a mattress configuration. The four suture ends are passed distally over the greater tuberosity and incorporated into two PushLock anchors (4.5 mm; Arthrex, Naples, FL) using the suture-bridge technique. The postoperative rehabilitation protocol is similar to that for rotator cuff repairs.

A Biomechanical Comparison of 2 Technical Variations of Double-Row Rotator Cuff Fixation

Background Previous studies have shown comparable biomechanical properties of double-row fixation versus double-row fixation with a knotless lateral row. SutureBridge is a construct that secures the cuff with medial row mattress suture anchors and knotless lateral row fixation of the medial suture ends. Recent completely knotless constructs may lead to lesser clinical outcomes if the construct properties are compromised from lack of suture knots. Hypothesis A completely knotless construct without medial row knots will compromise the biomechanical properties in both cyclic and failure-testing parameters. Study Design Controlled laboratory study. Methods Six matched pairs of cadaveric shoulders were randomized to 2 groups of double row fixation with SutureBridge: group 1 with medial row knots, and group 2 without medial row knots. The specimens were placed in a materials test system at 30° of abduction. Cyclic testing to 180 N at 1 mm/sec for 30 cycles was performed, followed by tensile testing to failure at 1 mm/sec. Results Data included cyclic and failure data from the materials test system and gap data using a video digitizing system. All data from paired specimens were compared using paired Student t tests. Group 1 had a statistically significant difference (P < .05) for gap formation for the 1st (3.47 vs 5.05 mm) and 30th cycle (4.22 vs 8.10 mm) and at yield load (5.2 vs 9.1 mm). In addition, there was a greater energy absorbed (2805 vs 1648 N-mm), yield load (233 vs 183.1 N), and ultimate load (352.9 vs 253.9 N) for group 1. The mode of failure for the majority (4/6) of group 2 was lateral row failure, whereas all group 1 specimens failed at the clamp. Conclusion Although lateral row knotless fixation has been shown not to sacrifice structural integrity of this construct, the addition of a knotless medial row compromises the construct leading to greater gapping and failure at lower loads. Clinical Relevance This may raise concerns regarding recently marketed completely knotless double row constructs.