Combined Fixation Research Articles

High-resolution lipidomics coupled with rapid fixation reveals novel ischemia-induced signaling in the rat neurolipidome.

The field of lipidomics has evolved vastly since its creation 15years ago. Advancements in mass spectrometry have allowed for the identification of hundreds of intact lipids and lipid mediators. However, because of the release of fatty acids from the phospholipid membrane in the brain caused by ischemia, identifying the neurolipidome has been challenging. Microwave fixation has been shown to reduce the ischemia-induced release of several lipid mediators. Therefore, this study aimed to develop a method combining high-resolution tandem mass spectrometry (MS/MS), high-energy head-focused microwave fixation and statistical modeling, allowing for the measurement of intact lipids and lipid mediators in order to eliminate the ischemia-induced release of fatty acids and identify the rat neurolipidome. In this study, we demonstrated the ischemia-induced production of bioactive lipid mediators, and the reduction in variability using microwave fixation in combination with liquid chromatography (LC)-MS/MS. We have also illustrated for the first time that microwave fixation eliminates the alterations in intact lipidspecies following ischemia. While many phospholipid species were unchanged by ischemia, other intact lipid classes, such as diacylglycerol, were lower in concentration following microwave fixation compared to ischemia.

Transpedical Interbody Bone Grafting in the Treatment of Senile Osteoporotic Vertebral Fracture.

Objective:To evaluate the clinical effect of transpedical interbody bone grafting in the treatment of senile osteoporotic vertebral fracture.Methods:Eighty-six elders with osteoporotic vertebral fracture were selected and divided into a control group and a test group using random double-blind method. Patients in the control group were treated by short-segment transpedicular screw system internal fixation, while patients in the test group were treated by short-segment transpedicular screw system internal fixation in combination with transpedical interbody bone grafting. Operation related indexes and fracture recovery condition were compared between the two groups.Results:The overall effective rate of the test group was 93.02%, much higher than the control group (76.74%) (P<0.05). The difference of operation duration, intraoperative bleeding volume, length of hospital stay, fracture healing time, preoperative vertebral height loss and preoperative Cobb’s angle between the two groups had no statistical significance (P>0.05). The postoperative pain score of the test group was lower than that of the control group, and the difference was statistically significant (P<0.05). The vertebral height loss and Cobb’s angle of the test group were superior to those of the control group at the last follow up, and the difference had statistical significance (P<0.05). The incidence of internal fixator loosening of the test group was much lower than that of the control group (P<0.05).Conclusion:Short-segment transpedicular screw system internal fixation in combination with transpedical interbody bone grafting shows favorable effects in the treatment senile osteoporotic vertebral fracture, resulting in mild pain and less loss of vertebral height and angle; hence it is worth promotion in clinic.

Combined intramedullary and extramedullary fixation with autogenous bone grafting for the treatment of forearm nonunions with severe bone loss

Introduction Nonunions of diaphyseal forearm fractures are uncommon. They are usually associated with either a complex injury or a complication such as infection. As a result, the majorities of nonunions are atrophic and result in a defined bone defect. Bridge plates and bone grafts were used for the treatment of such cases; however, the presence of poor bone quality especially with disuse can decrease the screw purchase and stability of fixation. Combined intramedullary and extramedullary fixation may add to the stability of fixation and improve the rates of success. Aim The aim of this work was to assess the results of treatment of forearm nonunions with severe bone loss using combined intramedullary and extramedullary fixation with autologous iliac crest bone grafting. Patients and methods This study included six patients with forearm nonunions with severe bone loss treated by combined intramedullary and extramedullary fixation with autologous iliac crest bone grafting. The study included three males and three females. Their age ranged from 14 to 47 years (mean: 36.1±12.4 years). The duration of nonunion ranged from 6 to 180 ms (mean: 78±71.5 ms). A total of four (66.7%) cases had been infected previously. The number of previous surgical procedures ranged from 1 to 8 (mean: 3.5±2.5). The forearm was transformed into a single bone in three (50%) cases. Results All nonunions healed satisfactorily. The final pain scale ranged from 0 to 2 points (mean: 1.3±0.8 points). There was a slight limitation in activities of daily living in all points. The hand grip was normal in one patient, slightly weak in four patients, and moderately weak in one patient. Conclusion Combined intramedullary and extramedullary fixation with autogenous bone grafting is a reliable method of treatment of difficult forearm nonunions with significant bone loss.

Combined Intra-articular K-wire and Coracoclavicular Screw Fixation for Type III Acromioclavicular Joint Dislocations- A Randomized Controlled Study with Minimum of 3 Years Follow-up

Combined Intra-articular K-wire and Coracoclavicular Screw Fixation for Type III Acromioclavicular Joint Dislocations- A Randomized Controlled Study with Minimum of 3 Years Follow-up

Dual fixation of midshaft clavicle fractures in adults: intramedullary Kirschner wire with augmentative plate fixation

Background The clavicle is one of the most commonly fractured bones in the body. In adults, clavicle fractures represent 2.6–5% of all fractures and 44% of all shoulder girdle injuries. Although fracture union usually occurs regardless of the treatment selected, controversy exists regarding optimal management. Although most clavicle fractures can be managed nonoperatively, still there has been debate on how to best treat displaced midshaft clavicular fractures. Without fixation, nonunion rates as high as 15–21% have been reported. Operative fixation for displaced midshaft fractures improve the functional outcomes and decrease nonunion rates. Operative management including open or closed reduction with plate fixation or intramedullary (IM) fixation results in improved outcomes and lower rates of nonunion compared with nonoperative management and is recommended for patients with multiple risk factors for nonunion, especially significant displacement or clavicle shortening. This study was conducted to assess the results and reliability of combined IM and plate fixation of displaced mid-clavicular fractures in adults. Patients and methods Thirty-three adult patients with comparable demographics having displaced mid-clavicular fracture were submitted to surgical fixation by both IM Kirschner wire and short small reconstruction plate. Results were assessed at the end of this period according to Constant and Murley Score (CMS). The CMS is a 100-point functional shoulder-assessment tool in which higher scores reflect increased function. Results At the end of the follow-up period, the mean score was 95.33±9.0. Thirty-two (97%) patients had excellent results, and only one (3%) patient had poor result. The mean final CMS for pain was 14.70±1.74. The mean final CMS for activity of daily living was 19.67±1.91. The mean final CMS for active forward flexion was 9.82±1.04 (145°–174°). The mean final CMS for active abduction was 9.82±1.04 (145°–174°). The mean final CMS for active external rotation was 9.88±0.70. The mean final CMS for active internal rotation was 9.88±0.70. The mean final CMS for strength was 23.88±2.36. Time of union in the studied patients ranged from 8 to 12 weeks, with a mean of 8.25±0.84 weeks. Conclusion Our research data suggest that a relatively new technique using IM Kirschner wire with augmentative anteroinferior short small fragment contoured reconstruction plate fixation is a suitable, reproducible, and effective alternative for surgical fixation of displaced midshaft clavicle fractures in adults and provides reliable functional results.

MISt for patients of infectious spondylitis—PPS fixation to one step combined fixation with LIF approach—

MISt for patients of infectious spondylitis—PPS fixation to one step combined fixation with LIF approach—

Comminuted long bone fractures in children. Could combined fixation improve the results?

Comminuted diaphyseal fractures in the pediatric age group represent a major orthopedic problem. It is associated with a high incidence of complications and poor outcomes because of the instability and difficulty in treatment. The aim of this study was to evaluate the efficacy of combined external skeletal fixation and flexible intramedullary nails in reconstruction of comminuted diaphyseal fracture in skeletally immature patients. Combined external fixator and elastic stable intramedullary nails were used in the management of 27 pediatric patients (15 males and 12 females) with unstable comminuted diaphyseal fractures of the tibia and femur. There were 19 fractures of the femur and eight fractures of the tibia. The average age of the patients was 8.7 years (range 7-14 years) for the femur and 10.8 years (range 6-15 years) for the tibia. Fractures were classified according to the system of Winquist and Hansen as grade II (five cases), grade III (nine cases), and grade IV (13 cases). All cases were operated within 6 days (range 0-6 days) after injury. The mean follow-up period was 2.8 years (range 2-3.5 years). The average duration of the external fixation was 1.6 months for fractures of the tibia, whereas it was 1.4 months for fractures of the femur. The average time for tibia fracture union was 2.8 months for fractures of the tibia, whereas it was 1.9 months for fractures of the femur. Malalignment in varus less than 5° was noted in one patient. One patient had a limb-length discrepancy of 1.5 cms. There were five cases (18.5%) with pin-tract infection. According to the Association for the Study and Application of the Methods of Ilizarov evaluation system, bone results were excellent in 23 cases (85.2%), good in three cases (11.1%), and poor in one case (3.7%). Functional results were excellent in 22 (81.5%) cases and good in five (18.5%) cases. Combined use of external fixators and elastic intramedullary nails is a good method for the treatment of comminuted long bone fractures in children.

PEEK Cages in Lumbar Fusion: Mid-term Clinical Outcome and Radiologic Fusion.

Historical cohort analysis. Evaluation of mid-term clinical outcome and radiologic fusion in patients treated with a polyetheretherketone (PEEK) cage. Anterior lumbar interbody fusion can be a good alternative in chronic low back pain when conservative treatment fails. Although titanium alloy cages give good fusion rates, disadvantages are the subsidence of the cage in the adjacent vertebrae and problematic radiologic evaluation of fusion. PEEK cages such as the Synfix-LR cage (Synthes, Switzerland) should overcome this. From December 2004 until August 2007, 95 patients (21 double-level and 74 single-level) with degenerative disk disease from L3-S1 were operated by a single surgeon. The number of reoperations was counted. Radiologic fusion on computed tomography scan was scored with a new scoring system by an independent skeletal radiologist and orthopedic surgeon. Intraobserver agreement and specificity were assessed. Clinical improvement was measured by the Oswestry Disability Index score. The median duration of clinical follow-up was 47.7 months (range 29.9-61.6). In total, 26 patients were reoperated after a median period of 17.6 months (range 6.7-46.9) of the initial surgery. Of the 26 patients, 23 patients (18 single-level and 5 double-level) were reoperated for symptomatic pseudarthrosis. A moderate agreement (κ=0.36) and a specificity of 70% and 37% for the radiologist and orthopedic surgeon, respectively, were found for scoring bony bridging. The Oswestry Disability Index score improved after initial surgery; however, reoperated patients reported a significantly lower improvement. A high number of reoperations after an anterior lumbar interbody fusion procedure with the Synfix-LR cage were found, mainly because of symptomatic pseudarthrosis. The absence of posterior fixation in combination with lower stiffness and the hydrophobic characteristics of PEEK probably lead to insufficient initial stability, creating suboptimal conditions for bony bridging, and thus solid fusion. The proposed ease of the evaluation of radiologic fusion could not be supported. Clinicians should be alert on pseudarthrosis when patients treated with the Synfix-LR cage presented with persisted or aggravated complaints.

Solitary bone cyst: a comparison of treatment options with special reference to their long-term outcome

BackgroundSolitary bone cysts (SBC) are benign, tumor-like lesions, which most frequently occur in the proximal metaphyseal-diaphyseal region of the humerus and femur of children and adolescents. The lack of a clear pathoetiology has impeded the development of treatment strategies. Up to date there is no consensus or official guideline for when and how treat SBC. The purpose of this study was to evaluate the effectiveness and the longterm clinical outcome of the treatment of SBC. Different techniques have been used dependant of the site of lesion, dimension, medical history and activity status.Methods135 skeletal immature patients with a solitary bone cyst were included. A follow up of 36 months or more was available for all patients. 22 patients were treated conservatively. All the other patients had at least one surgical intervention. The following four surgical treatment modalities were used: injection of methylprednisolon acetat (steroids), intramedullary nailing (IN), IN + steroids and curettage plus bone grafting.ResultsThere was no significant difference between the treatment groups with respect to secondary fractures, function, pain, or complications. In the individual groups the failure rate after initial treatment was 36,6 % with steroids, 50 % with intramedullary nailing, 21,4 % with intramedullary nailing plus steroids and none in the remaining group.ConclusionSteroid injection remains a reliable method for treating solitary bone cysts owing to its low invasiveness. To prevent fractures and allow a full weight bearing, internal fixation in combination with methylprednisolon acetat injections seems to be the most favorable in weight bearing bones.

Long-term results and physiotherapeutic determination in operative treatment of intra-articular calcaneal fractures

The authors present their own observations of the surgical treatment of articular calcaneal fractures using a minimally invasive percutaneous fixation in combination with the unifi ed self-developed physiotherapy program. The analyzed techniques include the Westhues’ technique and its modifi cation with additional stabilization of the bone fragments with Kirschner wires, as well as transdermal stabilization by Rąpała. The research material comprises 82 patients with intraarticular fractures - 68 men (83%) and 14 women (17%) treated surgically between 1990 and 2012. The analyzed calcaneus fractures were divided by Essex–Lopresti scale and evaluation of functional outcome at follow-up was based on the Creighton–Nebraska criteria. Men with the “tongue type” fracture treated using the Westhues’ technique had good functional outcomes in 12 cases (17.6%) and acceptable in 7 cases (10.3%). Women with the “tongue type” fracture treated using the Westhues’ technique had good functional outcomes in 2 cases (14.3%) and in one case, poor (7.1%). After analysis of the material, the authors claim that minimally invasive techniques are not really minimally invasive, taking the observed complications into consideration in most of the patients, which lead to the poor functional outcome at long term follow-ups.

Combined approach to treatment of Tile type B and C old pelvis fracture

Objective To investigate the operative methods in treatment of Tile type B and C old pelvis fracture. Methods The study enrolled 19 cases (13 males and 6 females) with a mean age of 53.4 years (range, 25-66 years) treated from July 2009 to July 2014. Injury resulted from traffic accidents in 14 cases, high falls in 3 cases and hit by heavy objects in 2 cases. Time from injury to operation was 1.5-10.3 months. According to the Tile classification, the type of fracture was 5 B2, 5 B3, 3 C1, 4 C2 and 2 C3. Four cases of type B and two cases of type C were combined with acetabulum fracture. Type B fracture deformity was operated through the anterior letournel approach, during which the malunion had osteotomy and reconstruction plate fixation. When posterior wall or column acetabular fracture existed, additional posterior Kocher-Langenbeck incision was used to achieve fracture reduction and stabilization through bilateral fenestration in the floating position. Type C fracture undergone osteotomy through anterior letournel approach and posterior sacral osteotomy or ilio-lumbar fixation following sacroiliac osteotomy. With regard to the combined posterior wall or column acetabular fracture in type C fracture, the surgical method was the same as type B. Radiological and functional results were respectively evaluated using the Mears-Velyvis system and Majeed criteria. Results Mean duration of follow-up was 11.4 months (range, 3-24 months). All fracture united in the one-stage, with mean union time of 5.2 months (range, 3-7 months). According to the Mears and Velyvis system, 10 cases obtained anatomical reduction, 6 were satisfied, and 3 were unsatisfied. According to the Majeed criteria, the results were excellent in 6 cases, good in 10 and fair in 3. After operation, 2 cases sustained poor control of urination caused by sacral nerve injury; 1 case still had hip pain caused by old acetabular fracture, but the symptom could be controlled by non-steroidal anti-inflammatory drugs; 2 cases had sacroiliac joint pain. There was no fixation failure. Conclusion Through the combined approach, osteotomy and fixation of malunion in anterior and posterior rings of pelvis that restores the pelvic ring is an effective method to improve the quality of fracture reduction and rectify limb shortening. Key words: Pelvis; Acetabulum; Fracture fixation, internal; Lumbosacral fixation

Experimental substantiation of combined fixation of tumor endoprothesis for the replacement of diaphyseal defects of rat long bones

Goal: to compare the durability of fixation of endoprothesis for replacement of postresection femur defects in experimental animals under bending and strain loading. Methods: investigation was performed on 20 non-linear white rats at the age of 6 months. Partial resection of femur middle 1/3 and defect replacement with modular endoprothesis was performed. Average diameter and lenght of intramedullary canal of rat femur were defined using radiographic and osteometrtic investigation of the rats of analogous age, gender and body-weight. The sizes of intramedullary stems for fixation of endoprothesis in bone canals were claculated using obtained data. Plate was fixed with screws to the body of endoprothesis and after implantation it adjoined tightly to distal femur fragment. Intramedullary stems and plate were covered with a layer of corundum ceramics. The animals were devided on 2 groups: experimental group — using of modular endoprtohesis with plate; control group — using of modular endoprtohesis without plate. 3 months after operation the durability of endoprothesis fixation to bone diaphysis were studied under bending and strain loading. Results: control group — just in 3 rats of 10 the stable fixation of endoprothesis was observed. According to index of bending moment the best results were revealed for intact femurs — (1,89 ± 0,81) N•m. Conclusion: use of endoprothesis with additional plate fixation allowed to obtain more durable fixation «implant-bone» and significantly decreased the quantity of postoperative complictions.

Complications after use of extracortical clamp device in combined and consecutive external and internal fixation of femoral bone

Introduction. Extracortical Clamp Device (ECD) is a tool that, unlike conventional wires and pins, does not perforate long bone cortex. Therefore, its use simplifies methods of combined and consequtive use of internal and external fixation, osteosynthesis in periprosthetic fractures and deformities. Purpose of the study - to compare the rate of complications and their structure depending on extracortical clamp device application and conventional transosseous elements in combined external fixation of femur. Materials and methods. We analyzed the complications arising in treatment of 66 patients with frames where ECD were used (group «ECD»). The results were compared with the results of treatment 29 patients, when utilizing combination of external and internal fixation, external fixation device included conventional transosseous elements only (group «W-P»). Results. In the group «ECD» inflammation of the soft tissues around fixing elements was identified in 14.8% of cases. In these patients complication arisen at 45.5% of the all used fixing elements; of them - 18.2% around ECD. In the group «W-P» pin-tract infection occurred in 29.2% cases. ECD breaking was in one case (3.7%) breaking of wires or pins in «W-P» group was diagnosed in 3 cases (13.6%). In the treatment of periprosthetic fractures and deformities with ECD soft tissues around fixing elements was in 16.7% of cases. In the treatment of similar fractures and deformities without prosthesis pin-tract infection were diagnosed in 21.5% cases. All of these complications did not affect the outcome. Other complications (neuropathy, contracture of the knee) were not depending on the application of ECD.

Early clinical results of channel-assisted combined fixation and interbody fusion for treating lumbar vertebra diseases by muscle-splitting approach

Objective To explore the feasibility and effectiveness of channel-assisted spatium intermusculare approach interbody fusion for treating lumbar vertebra diseases. Methods A total of 81 patients with lumbar vertebra diseases were treated from June 2012 to December 2013, including 35 males and 46 females between 29 and 76 years old with an average age of 54.6. There were 36 cases of lumbar disc degeneration, 10 cases of recurrence in situ after lumbar disc herniation surgery, 6 cases of huge lumbar disc herniation, 11 cases of lumbar disc herniation with spinal canal stenosis, 5 cases of extreme lateral lumbar disc herniation and 13 cases of lumbar degenerative spondylolisthesis. There were 67 cases of single segment lesion and 14 cases of two segment lesions. Lesion sites contained L1, 2 in 1 case, L3, 4 in 4 cases, L4, 5 in 50 cases, L5S1 in 12 cases, L3, 4 and L4, 5 in 8 cases, and L4, 5 and L5S1 in 6 cases. Results The length of incision was 2.42±0.45 cm in cases of single segment lesion and 4.28±0.38 cm in cases of two segment lesions. The operation time was 96.00±21.53 minutes and intraoperative blood loss was 347.50±241.62 ml. During the operation, one case suffered from dural laceration, cerebrospinal fluid leakage and ipsilateral nerve root injury. Two cases suffered from pedicle fractures. Eight cases experienced epidermal necrosis of the incision. One case had poor wound healing. Three cases suffered from nerve injury. A total of 76 patients were followed up for 12-30 months, averagely 20.5 months. Intervertebral height of lesion segments was apparently recovered after surgery, and maintained in good condition during the final follow-up. No significant difference in the changes of area and grade of multifidus was detected 12 months after surgery and before surgery. Except 4 cases, the remaining had interbody fusion with a fusion rate of 94.7%. The balance between the coronal plane and sagittal plane of the lumbar spine was evidently improved. Average Japanese Orthopaedic Association score increased from 12.66±1.88 points preoperatively to 26.4±1.92 points during the final follow-up, which showed significant differences. Conclusion The method of channel-assisted spatium intermusculare approach interbody fusion has some advantages for treating lumbar vertebra such as small incision, fewer traumas, less bleeding, fast recovery, and high fusion rate. However, there is a long time of operation in the early stage and high occurrence rate of complications. Key words: Lumbar vertebrae; Bone screws; Zygapophyseal joint; Spinal fusion

Double Prosthetic Repair for Complex Incisional Hernia Repair: Long-term Results and Evolution of the Technique

No single approach has emerged as the best way to close complex incisional hernias. The aim of this report is to present the long-term results with a double prosthetic repair. In this prospective observational study over 12 years (Group 1, 8 years; Group 2, 4 years), the following data were collected: age, gender, previous surgery, comorbidities, situation and size of defect, hospital stay, postoperative complications, and recurrence. There were 53 lateral cases and 31 midline cases. About 88.6 per cent of the lateral defects were repaired without needing to approach the intra-abdominal cavity (Type I), whereas in the patients with large medial defects this was only achieved in 6.5 per cent of the cases (93.5% required a Type II). The average length of the defects was 18 cm. Global morbidity was 18 per cent early, and 7 per cent late. The statistical analysis over time shows significant differences in the operative time, hospital stay, and consumption of analgesics (P < 0.001). The recurrence rate has not varied despite the modifications to the technique (use of lighter meshes and fixation with tacks and glue). Complex abdominal wall defects can be corrected using the double prosthetic repair technique with low morbidity rates and with practically no long-term recurrence. The combination of two meshes reduces their density and the use of combined fixation (tacks + glue) improves postoperative recovery.

Sensitive western blotting for detection of endogenous Ser129-phosphorylated α-synuclein in intracellular and extracellular spaces.

α-Synuclein deposited in Lewy bodies, a pathological hallmark of Parkinson’s disease (PD), is highly phosphorylated at serine 129 (Ser129). In contrast, there is very little Ser129-phosphorylated α-synuclein in the normal brains. This difference suggests that Ser129-phosphorylation is involved in neurodegenerative processes of PD. However, the role of this modification remains unclear. One limiting factor for relevant biochemical analyses is that it is difficult to detect endogenous Ser129-phosphoryated α-synuclein by western blotting, because α-synuclein monomers detached from the transferred membrane during incubation. Here, we reported that combination fixation of the transferred membrane with 4% paraformaldehyde and 0.01 ~ 0.1% glutaraldehyde produced an approximately 10-fold increase in the sensitivity for Ser129-phosphorylated α-synuclein monomers, allowing detection of endogenous proteins even in conditioned medium, human cerebrospinal fluid, and extracts from cell lines and human brain. This method may enable more detailed biochemical analyses for α-synuclein transmission between intra and extracellular spaces under physiological and pathological conditions.

Primary stability of three different iliosacral screw fixation techniques in osteoporotic cadaver specimens—a biomechanical investigation

BackgroundThe incidence of osteoporotic and insufficiency fractures of the pelvic ring is increasing. Closed reduction and percutaneous fixation with cannulated sacroiliac screws is well-established in the operative treatment of osteoporotic posterior pelvic ring fractures. However, osteoporotic bone quality might lead to the risk of screw loosening. For this reason, cement augmentation of the iliosacral screws is more frequently performed and recommended. PurposeThe aim of the present biomechanical study was to evaluate the primary stability of three methods of iliosacral screw fixation in human osteoporotic sacrum specimens. Study Design/SettingThis study used methodical cadaver study. MethodsA total of 15 fresh frozen human cadaveric specimens with osteoporosis were used (os sacrum). After matched pair randomization regarding bone quality (T-score), three operation technique groups were generated: screw fixation (cannulated screws) without cement augmentation (Group A); screw fixation with cement augmentation before screw placement (cannulated screws) (Group B); and screw fixation with perforated screws and cement augmentation after screw placement (Group C). In all specimens both sides of the os sacrum were used for operative treatment, resulting in a group size of 10 specimens per group. One operation technique was used on each side of the sacral bone to compare biomechanical properties in the same bone quality. Pull-out tests were performed with a rate of 6 mm/min. A load versus displacement curve was generated. ResultsSubgroup 1 (Group A vs. Group B): Screw fixation without cement augmentation: 594.4 N±463.7 and screw fixation with cement augmentation before screw placement: 1,020.8 N±333.3; values were significantly different (p=.025). Subgroup 2 (Group A vs. Group C): Screw fixation without cement augmentation: 641.8 N±242.0 and perforated screw fixation with cement augmentation after screw placement: 1,029.6 N±326.5; values were significantly different (p=.048). Subgroup 3 (Group B vs. Group C): Screw fixation with cement augmentation before screw placement: 804.0 N±515.3 and perforated screw fixation with cement augmentation after screw placement: 889.8 N±503.3; values were not significantly different (p=.472). ConclusionsRegarding iliosacral screw fixation in osteoporotic bone, the primary stability of techniques involving cement augmentation is significantly higher compared with screw fixation without cement augmentation. Perforated screws with the same primary stability as that of conventional screw fixation in combination with cement augmentation might be a promising alternative in reducing complications of cement leakage. These biomechanical results have to be transferred into clinical practice and prove their clinical value.

The use of Brainsuite iCT for frame-based stereotactic procedures.

Frame-based stereotactic procedures are the gold standard because of their superior stereotactic accuracy. The procedure used to be in multiple steps and was especially cumbersome and hazardous in intubated patients. A single-step procedure using intraoperative CT was created to optimize the procedures. A combined fixation and low profile frame holder was designed for the operating table, allowing positioning for the scanning procedure immediately followed by the surgical biopsy procedure with the same positioning and head fixation. For placement of depth electrodes immediate CT control of positioning was feasible. In the first 8 months the procedure was successfully used 65 times including 8 times in pediatric cases. The procedure duration in awake patients was on average 81 min (range 33 to 202) and in intubated patients (children) on average 89 min (median 89, 78-100). This study demonstrates that frame-based stereotactic procedures in all brain locations are a feasible and practical technique with improved workflow and added patient safety and comfort.

Combined Use of Percutaneous Canulated Screws and External or Internal Fixation for Less Invasive Treatment of Tibial Plateaux Fractures

The classic way of treatment of tibial plateau fractures with an extensive approach, opening of the knee and compressive internal fixation can lead to major complications such as infection, skin necrosis and knee stiffness. Here we present a less invasive and thus safer surgical technique, and its indications and results. Twenty patients with various types of fractures according to Schatzker’s classification (mainly V and VI) were treated during a time period of seven years. Surgical treatment usually consisted of a combination of percutaneous canulated screws with a hybrid external fixator. In three cases canulated screws were combined with a laterally applied anatomic locking plate. Patients were followed up for six months to three years postoperatively. Indications as well as intra and postoperative parameters such as surgical time, stability of fixation, blood loss, wound healing, infection, fracture healing and final result were studied. No major complications were recorded either early or later. The use of external οr less invasive internal fixation in combination with percutaneous canulated screws appears to be an adequate method for the treatment of most types of these fractures.

Shaft Fractures of Both Forearm Bones: The Outcomes of Surgical Treatment with Plating Only and Combined Plating and Intramedullary Nailing.

BackgroundPlate fixation is the most commonly used technique for the treatment of shaft fractures of both forearm bones (SFBFBs). However, all fractures are difficult to treat with plate fixation because of soft tissue injuries, fracture patterns, or the patient's condition. The purpose of this study is to compare the functional results of plate fixation only and combined plate and intramedullary (IM) nail fixation in SFBFBs.MethodsFifty-nine cases of SFBFBs that were surgically treated from June 2007 to July 2012 were retrospectively reviewed. In this study, 47 cases that were followed up for more than 12 months were included. All SFBFBs were divided into two groups according to the methods used for internal fixation: plate fixation only (group A) and combined plate and IM nail fixation (group B). The fixation methods were determined intraoperatively. Plate fixation was considered as the first option in all cases, but combined plate and IM nail fixation was selected as the second option if it was difficult to be fixed with plate only. Groups A and B comprised of 31 and 16 cases, respectively. The functional results were evaluated by the Grace and Eversmann rating system and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire.ResultsIn groups A and B, a radiologic union was achieved in 30/31 and 14/16 cases and average union time was 11.1 and 17.8 weeks, respectively. According to the Grace and Eversmann rating system, group A had excellent results in 15 cases, good in 14, acceptable in one, and unacceptable in one. Group B had excellent results in three cases, good in nine, acceptable in two, and unacceptable in two. The average DASH score was 7.1 points (range, 0 to 19.2 points) in group A and 15.1 points (range, 0 to 29.6 points) in group B. Three cases of nonunion with unacceptable results achieved a bony union by additional procedures and the functional results of these cases improved to good or excellent.Conclusions The functional results and the average union time were superior in group A than in group B. However, we think that combined fixation is a useful method for SFBFBs that cannot be treated with plate fixation only.