Fixation In Surgical Treatment Research Articles

COMPLICATIONS OF CONSERVATIVE AND SURGICAL TREATMENT OF FRACTURES OF THE MANDIBULAR CONDYLAR PROCESS (LITERATURE REVIEW)

One of the most pressing problems in modern maxillofacial surgery is the treatment and rehabilitation of patients with fractures of the condylar process of the mandible. According to various statistical data, the incidence of fractures at this site is 19-37%, and these fractures are the most controversial in terms of diagnosis and treatment. In recent years, there has been an increase in severe forms of mandibular condyle fractures: bilateral, combined, intra-articular, leading to serious complications that affect the functioning of the temporomandibular joint. The data obtained indicated the need for a detailed study of this pathology in order to make a qualitative diagnosis and improve the available treatment methods. The aim of the study – to analyse and summarise current data from the scientific literature on possible complications in the treatment of the condylar process fractures of the mandible. Materials and methods. The bibliosemantic method was used to clarify the state of the problem, to study the analysis of the results of previous scientific research based on the literature sources and electronic resources. Results and discussion. The management of patients with mandibular condylar fractures is widely discussed in the literature due to their high prevalence, but there is still no consensus on the optimal management of patients with this pathology. To date, there are many studies that highlight certain complications of conservative and surgical treatment, but they are not generalised or systematised. Conclusions. Summarizing, we can conclude that complications occur during both conservative and surgical treatment of patients with mandibular condyle fractures. Complications are most often associated with incomplete diagnosis, incorrect choice of treatment method, and depend on the method of access and fixation in surgical treatment.

Clinical application of sacral alar screw fixation in surgical treatment of lumbosacral degenerative disease

Objective: To verify the safety and feasibility of sacral alar screw fixation and fusion surgery in lumbosacral area. Methods: The clinical and radiological data of patients receiving L5/S1 single-level cortical bone trajectory screw combined with sacral alar screw decompression fixation and fusion in Beijing Chaoyang Hospital due to lumbar spinal stenosis from January 2019 to January 2020 were retrospectively analyzed. The clinical data included operation duration, intraoperative blood loss, postoperative drainage, pain and function scores during follow-up. The radiological data included preoperative and postoperative follow-up X-rays and three-dimensional reconstruction of lumbar spine CT. The fusion status and complication of internal fixation, such as screw loosening and fixation failure were evaluated by the radiological examination. Results: According to the inclusion and exclusion criteria, a total of 16 patients (7 males and 9 females) were included, with an average age of (69.6±5.2) years. The patients were followed-up for (16.2±1.7) months. The average operation duration was (144±21) min, the intraoperative blood loss was (103±20) ml, and the postoperative drainage was (80±34) ml. The patient's low back pain visual analogue scale (VAS) score was 6.8±1.0 before surgery, and it was improved to 0.9±0.7 at the last follow-up; leg pain VAS score was 6.1±0.9 before the operation and it improved to 0.9±0.7 at the last follow-up; Oswestry disability index (ODI) function score was 66.2%±8.0% before the surgery and it decreased to 26.6%±7.2% at the last follow-up. No neurological complications, surgical site infection, screw loosening, internal fixation failure or cage displacement were observed during the follow-up. The fusion rate was 68.8% (11/16) at 6 months post operation. Conclusion: It is safe, feasible and effective to apply cortical screws combined with sacral alar screws in short-segment decompression, fixation and fusion surgery on the lumbosacral region to treat lumbosacral spinal stenosis.

The role of single odontoid screw fixation in treatment of odontoid fracture type II

BackgroundOdontoid fractures are the most common cervical fractures specially type II. Anterior odontoid screw fixation has many advantages with low incidence of surgical complications.PurposeTo evaluate the role of single odontoid screw fixation in surgical treatment of odontoid fracture type II.Study designA retrospective clinical case series.Patients and methodsTwelve patients with acute traumatic odontoid fracture type II were surgically treated by anterior single odontoid screw fixation. The visual analogue scale (VAS) and neck disability index (NDI) were used to evaluate the functional outcome among our patients. Plain radiography and CT cervical spine were done in all cases preoperatively and during our period of follow-up (6 months). Preoperative MRI cervical spine was done in all cases.ResultsThe study included 12 patients, four of them (33.3%) were females, and 8 (66.7%) were males with a mean age of 41.7 ± 11.4 years. All patients had acute traumatic odontoid fracture type II, oblique fractures in 10 (83.3%) cases, and transverse fractures in 2 (16.7%) cases. All cases operated for anterior single odontoid screw fixation. During our period of follow-up, VAS and neck disability index were improved in all cases. There were 5 cases (41.7%) with transient dysphagia. Solid fusion was achieved in all cases except in one patient (8.3%) (fibrous union).ConclusionSingle odontoid screw fixation is useful and safe procedure in surgical treatment of odontoid fractures type II. Careful attention to the technical aspects of the procedure and selection of patients are essential for good outcome.

Endoscopic Removal of a Migrated Fragment of Wire used for Intermaxillary Fixation in Surgical Treatment of Mandibular Fracture

Endoscopic Removal of a Migrated Fragment of Wire used for Intermaxillary Fixation in Surgical Treatment of Mandibular Fracture

Comparison of Nitinol and Titanium Nails Effectiveness for Lumbosacral Spine Fixation in Surgical Treatment of Degenerative Spine Diseases

Relevance. Surgical decompression and decompression with stabilization are highly effective for treatment of spinal canal stenosis at the level of lumbar spine. However, complications developing after application of rigid fixation systems resulted in active introduction of dynamic implants into clinical practice.Purpose of the study — to compare effectiveness of nitinol and titanium nails for lumbosacral fixation in surgical treatment of degenerative spine diseases.Materials and methods. 220 patients who underwent surgeries in 4 hospitals were randomized into two groups, each consisting of 110 patients (1:1 ratio): a group of patients who underwent stabilization of the vertebral motor segments with rods of nitinol with the required volume of decompression at the operation level and a group of patients who underwent stabilization of the vertebral motor segments with standard rods of titanium with the required volume of decompression at the intervention level. Patients suffered clinically significant spinal canal stenosis in one or two adjacent segments: from L3 to S1. Outcomes were evaluated during three years postoperatively by VAS scale for spine and lower limbs, and by ODI and SF-36 scales.Results. All scales demonstrated better values in both groups of patients, namely, significant decrease of pain syndrome and improvement in mental and physical health. X-ray examination of all patients during the study period demonstrated restoration of lumbar lordosis. Group of patients with dynamic nails featured less complications rate related to metal implants including adjacent segment disease.Conclusion. Transpedicular fixation of lumbosacral spine by nitinol nails is an effective technique allowing to preserve motion along with stable fixation.

Effects of morphological characteristics of femoral intertrochanteric fractures on internal fixation

Objective To explore the effects of internal fixation in surgical treatment of intertrochanteric fractures by proximal femoral locking compression plate (PFLCP) and proximal femoral nail anti-rotation (PFNA) on fracture morphological features. Methods 43 patients with femoral intertrochanteric fractures were treated with PFLCP or PFNA from January 2013 to December 2015. There were 23 patients treated with PFLCP and 20 cases with PFNA. There were 29 males and 14 females, the average age was 62.6 years old (ranged from 46-85 years). Observed the fracture type (AO/OTA, Evans, the lateral trochanteric wall injury), the direction of key fracture line (lateral superior to medial inferior/medial superior to lateral inferior), preoperative days, preoperative bone mineral density value, operation time, the volume of intraoperative blood loss, the supportive contact rate at the medial cortex of proximal femur after surgery, the surgical intervention rate for medial cortical fracture, postoperative partial load bearing time, full weight bearing time, complications of internal fixation and Harris scores. And analyzed the relationship between the direction of key fracture line and the internal fixation failure. SPSS13.0 software was used for statistical analysis. Results No statistical significance was found in age distribution, fracture types, preoperative days, preoperative bone mineral density value, the internal fixation failure rate (loss of fracture reduction, screw cutting or plate fracture). The operative time of PFLCP group was obviously longer than that of PFNA group and the difference was statistically significant (t=2.216, P=0.032). The intraoperative blood loss was more in PFLCP group than PFNA group and significant difference was found between the two groups (t=4.142, P=0.000) .Though the initial postoperative partial load bearing time is earlier in the PFNA group than PFLCP group, but no statistical difference bewtween the two groups (t=0.833, P=0.902). Full weight bearing time had no statistical difference between the two groups. Harris scores in the PFNA group was slightly lower than in the PFLCP group, but there was no statistical difference (t=0.833, P=0.902). The postoperative medial cortical support rate was higher in the PFLCP group than PFNA group, but no statistical difference between them. The surgical intervention rate for medial cortical fracture was higher in the PFLCP group and difference was statistically significant (χ2=4.768, P=0.029). No correlation had found between invalid support at medial cortex and the direction of key fracture line in all internal fixation failure cases. Distribution of the direction of key fracture line in the two groups had no statistical difference, while the relative risk ratio in terms of internal fixation failure between 2 types of the direction of key fracture line (OR=lateral superior to medial inferior/medial superior to lateral inferior) had statistical difference (χ2=6.081, P=0.014; OR=9.600, P=0.037). Conclusion The direction of key fracture line can foresee the underlying displacement direction of intertrochanteric fractures at postsurgical load bearing, combining with restore the supportive contact at the medial cortex of the proximal femur and timing of load bearing may be determined to avoid internal fixation failure. Key words: Hip fractures; Internal fixators; Fracture fixation, internal

Radiologic Changes by Early Motion in Neck Fractures of the Fifth Metacarpal Treated with Antegrade Intramedullary Fixation.

As intramedullary (IM) fixation is one of the fixation methods used in neck fractures of the fifth metacarpal, an early motion of injured finger can be allowed. The purpose of this study is to evaluate whether immediate active motion affects the stability of antegrade IM fixation in surgical treatment of neck fractures of the fifth metacarpal bone and to assess related factors. Thirty one patients treated by closed reduction and antegrade IM fixation were consecutively enrolled. All patients started active motion of the little finger since 7 postoperative days and only daily activities including writing, typing or washing were allowed until the union of fracture. All fractures were healed within four to eight weeks. The changes of angulation, fifth metacarpal length and tip to head distance of K-wire were compared between immediate postoperative radiographs and radiographs at eight weeks. In addition, the effects by age, gender, initial angulation and comminution of the metacarpal neck were assessed. The average change of angulation was 0.12°, 5th metacarpal length was 1.49mm and tip to head distance of K-wire was 1.31mm. There was no significant difference in the change of angulation (p = 0.137). But, there were significant differences in the change of 5th metacarpal length and tip to head distance of K-wire ([Formula: see text]). The change of angulation was related to a comminution of the metacarpal neck and that of 5th metacarpal length was related to age and sex. The change of 5th metacarpal length and tip to head distance of K-wire can occur by an early mobilization in the antegrade IM fixation for neck fractures of the fifth metacarpal. However, we thought that an early active motion after surgery is important to increase the patients' satisfaction, even though careful selection of candidates is necessary.

The Role of Combined Anterior Retropharyngeal Approach and Posterior Fixation in Surgical Treatment of Upper Cervical Lesions

The Role of Combined Anterior Retropharyngeal Approach and Posterior Fixation in Surgical Treatment of Upper Cervical Lesions

National Trends of Surgical Treatment for Intertrochanteric Fractures in Korea

Intramedullary nailing has been reported to have better outcome compared with traditional plate fixation in surgical treatment of intertrochanteric fractures. We evaluated the trends of surgical treatment of intertrochanteric fracture in Korea. Data of patients with intertrochanteric fractures, who were operated between the years of 2006 and 2011, was obtained from the Health Insurance Review and Assessment Service. The ratio of intramedullary nailing increased from 27.9% in 2006 to 64.3% in 2011 (P < 0.001), while the ratio of plate fixation decreased. During recent 5 yr, the utilization of intramedullary nailing doubled in clinical practice of intertrochanteric fractures in Korea.

Puncture Transpedicular Fixation in Surgical Treatment of Thoracic and Lumbar Vertebrae Injuries

Results of transpedicular fixation (TPF) performed to 113 patients with injuries of thoracic and lumbar vertebrae are presented. In 26 patients original puncture TPF was performed, in 14 cases the reposition system was used. Analysis of treatment results showed high efficacy of puncture TPF. Duration of surgical intervention and volume of blood loss decreased reliably, cosmetic defect was less marked.

P33. Result of Intermittent Pedicle Screw Fixation in Surgical Treatment of Flexible Idiopathic Scoliosis

BACKGROUND CONTEXT: Segmental pedicle screw fixation is recognized as a very effective method in surgical treatment of idiopathic scoliosis. However, many authors report that they insert pedicle screws in all segments of the corrective side without prior sufficient study of its efficacy.

Postero-medio-anterior approach of the ankle for the pilon fracture

A good view of the operative field is important for better reduction and fixation in surgical treatment of fractures. The exposure of the ankle joint for the pilon fracture is commonly through the anterior approach, or combined with the medial approach. But sometimes it is still difficult to have complete viewing of the articular surface and to apply internal fixation by that approach. In recent years, we developed a “postero-medio-anterior” approach of the ankle joint by one incision. This approach provides an excellent exposure of the anterior, medial and posterior aspects of the ankle joint with a clear view of the articular surface. In our 45 cases of pilon fracture during 1991 to 1995, there was no incisional injury to the neurovascular bundle. Superficial wound edge necrosis was noted in two cases which healed later without further procedure. Therefore, we recommend this approach as a simple and reliable incision for open reduction of pilon fractures.

Comparative Analysis of Trans-syndesmotic Versus Non-syndesmotic Screw Fixation in Surgical Treatment of Ankle Fracture with Diastasis

Comparative Analysis of Trans-syndesmotic Versus Non-syndesmotic Screw Fixation in Surgical Treatment of Ankle Fracture with Diastasis