Fixation Strength Research Articles

Application of TightRope system combined with Locking-Loop biplane anatomical reconstruction technique for acute acromioclavicular joint dislocation

To investigate the effectiveness of TightRope system combined with Locking-Loop biplane anatomical reconstruction technique in the treatment of acute acromioclavicular joint dislocation. A clinical data of 28 patients with acute acromioclavicular joint dislocation who met the selection criteria and admitted between June 2018 and December 2021 was retrospectively analyzed. There were 18 males and 10 females, with an average age of 47.7 years (range, 22-72 years). The causes of injury included falling (13 cases) and traffic accidents (15 cases). The acromioclavicular joint dislocation was rated as Rockwood type Ⅲ in 7 cases, type Ⅳ in 16 cases, and type Ⅴ in 5 cases. The time from injury to operation was 4-13 days, with an average of 9.5 days. The acromioclavicular joint dislocation was reconstructed with TightRope system and high-strength wire by Locking-Loop methods during operation. The operation time and complications were recorded. Visual analogue scale (VAS) score, Constant-Murley score, and active range of motion of shoulder (forward flexion and upward lift, abduction and upward lift, and external rotation) were recorded before operation and at 12 months after operation to evaluate the functional recovery of shoulder. The loss of acromioclavicular joint reduction was assessed by comparing the coracoclavicular distance (CCD) based on the anteroposterior X-ray films at 3 days and 12 months after operation. The operation time was 58-100 minutes (median, 85 minutes). All incisions healed by first intention. All patients were followed up 12 months. During follow-up, 2 patients developed shoulder adhesion, which recovered after rehabilitation exercise. At 12 months after operation, the VAS score was significantly lower, the Constant-Murley score was significantly higher, and the range of motion of the shoulder joint (forward flexion and upward lift, abduction and upward lift, and external rotation) significantly increased when compared with preoperative ones ( P<0.05). X-ray films showed that the CCD was 8.4 (7.3, 9.4) and 9.2 (8.1, 10.1) mm at 3 days and 12 months after operation, respectively, with a significant difference ( Z=-4.665, P<0.001). During follow-up, there was no complication such as infection, titanium plate entrapment, fracture, internal fixation failure, or redislocation. The treatment of acute acromioclavicular joint dislocation with TightRope system combined with Locking-Loop biplane anatomical reconstruction has the advantages of small incision, joint reduction under direct vision, high fixation strength, and low incidence of postoperative complications, which can effectively relieve the pain of patients' shoulder joint and facilitate the recovery of shoulder joint function.

Separate vertical wiring plus bilateral anchor girdle suturing fixation for the fractures of the inferior pole of the patella

BackgroundThe fixation of inferior pole fractures of the patella (IPFPs) is still a great challenge for surgeons.Materials and methodsWe introduced a new fixation method for IPFP fixation, that is, separate vertical wiring plus bilateral anchor girdle suturing fixation (SVW-BSAG). Three finite element models including the anterior tension band wiring (ATBW) model, separate vertical wiring (SVW) model and SVW-BSAG model, were built to evaluate the fixation strength of different fixation methods. A total of 41 consecutive patients with IPFP injury were enrolled in this retrospective study, including 23 patients in the ATBW group and 18 patients in the SVW-BSAG group. The operation time, radiation exposure, full weight-bearing time, Bostman score, extension lag versus contralateral healthy leg, Insall–Salvati ratio, and radiograph outcomes were employed to assess and compare the ATBW group and SVW-BSAG group.ResultsThe finite element analysis confirmed that the SVW-BSAG fixation method was as reliable as the ATBW fixation method in terms of fixed strength. Through retrospective analysis, we found that there was no significant difference between the SVW-BSAG and ATBW groups in age, sex, BMI, fracture side, fracture type, or follow-up time. There were no significant differences between the two groups in the Insall–Salvati ratio, 6-month Bostman score, and fixation failure. Compared with the ATBW group, the SVW-BSAG group showed advantages in intraoperative radiation exposure, full weight-bearing time, and extension lag versus the contralateral healthy leg.ConclusionThe finite element analysis and clinical results showed that SVW-BSAG fixation methods are a reliable and valuable for IPFP treatment.

Research status and existing problems of lumbar pedicle double-trajectory screw technique

Lumbar pedicle double-trajectory screw technique refers to the placement of traditional pedicle screw combined with cortical bone trajectory screw in the same pedicle, which has been proved to provide higher fixation strength in osteoporotic vertebral body fixation, and is also a less invasive surgical choice for revision of adjacent segment disease. At present, related basic research and clinical application exploration of double-trajectory screw technique have been carried out, but there are still many problems that need to be further investigated and clarified. The clinical application and existing problems of double screw technique were discussed in this paper for clinical reference.

Rotator Cuff Repair With Bone Grafting of Greater Tuberosity Cyst: A Technique Video

Background: Nearly 500,000 rotator cuff repairs are performed annually in the United States. Cysts within the humeral head have been reported to occur in more than half of patients diagnosed with a rotator cuff tear. They are related to age-related degeneration and rotator cuff dysfunction, and may arise from congenital abnormalities. Indications: Humeral head cysts may pose technical challenges during rotator cuff repair. Cysts located at the footprint of a planned rotator cuff repair can decrease biological healing capacity and reduce the fixation strength of suture anchors. One treatment strategy to address bone loss secondary to humeral head cysts is to incorporate cancellous allograft bone chips, which provide an osteoconductive scaffold for bone formation. Technique Description: Standard arthroscopic portals were established and during arthroscopy, the rotator cuff tear was identified, and tissue was mobilized. The cyst was debrided to healthy, bleeding bone using curettes and an arthroscopic shaver. A 2.5 mL sterile syringe was packed with crushed, cancellous allograft bone chips. The tip of the syringe was removed to allow for a wider aperture to facilitate injection of bone chips. Through an accessory, percutaneous portal just lateral to the acromion, the syringe was inserted into the cyst site, and bone graft contents were injected into the cyst. Pressure was applied to the syringe to impact the bone graft material. The bone chips were impacted with the syringe plunger. Following rotator cuff repair, the patient underwent subacromial decompression, distal clavicle excision, and open sub-pectoral biceps tenodesis with suture anchor fixation. Discussion/Conclusion: Greater tuberosity cysts can impose a technical challenge during arthroscopic rotator cuff repair. Incorporation of impacted cancellous allograft bone chips is an efficient, reproducible method to enhance healing of the RTC tendon enthesis. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

What's New in Sports Medicine.

What's New in Sports Medicine.

Is human bone matrix a sufficient augmentation method revising loosened pedicle screws in osteoporotic bone? – A biomechanical evaluation of primary stability

IntroductionDespite good screw anchorage and safe screw trajectory, screw loosening occurs in several cases, especially in osteoporotic individuals. The aim of this biomechanical analysis was to evaluate the primary stability of revision screw placement in individuals with reduced bone quality. Therefore, revision via enlarged diameter screws was compared to the use of human bone matrix as augmentation to improve the bone stock and screw coverage. Methods11 lumbar vertebral bodies from cadaveric specimens with a mean age of 85.7 years (± 12.0 years) at death were used. 6.5 mm diameter pedicle screws were inserted in both pedicles and hereafter loosened using a fatigue protocol. Screws were revised inserting a larger diameter screw (8.5 mm) in one pedicle and a same diameter screw with human bone matrix augmentation in the other pedicle. The previous loosening protocol was then reapplied, comparing maximum load and cycles to failure between both revision techniques. Insertional torque was continuously measured during insertion of both revision screws. FindingsThe number of cycles and the maximum load until failure were significantly greater in enlarged diameter screws than in augmented screws. The enlarged screws' insertional torque was also significantly higher than of the augmented screws. InterpretationHuman bone matrix augmentation does not reach the same ad-hoc fixation strength as enlarging the screw's diameter by 2 mm and is therefore biomechanically inferior. Regarding the immediate stability, a thicker screw should therefore be prioritised.

Bioreactor analyses of tissue ingrowth, ongrowth and remodelling around implants: An alternative to live animal testing.

Introduction: Preclinical assessment of bone remodelling onto, into or around novel implant technologies is underpinned by a large live animal testing burden. The aim of this study was to explore whether a lab-based bioreactor model could provide similar insight. Method: Twelve ex vivo trabecular bone cylinders were extracted from porcine femora and were implanted with additively manufactured stochastic porous titanium implants. Half were cultured dynamically, in a bioreactor with continuous fluid flow and daily cyclic loading, and half in static well plates. Tissue ongrowth, ingrowth and remodelling around the implants were evaluated with imaging and mechanical testing. Results: For both culture conditions, scanning electron microscopy (SEM) revealed bone ongrowth; widefield, backscatter SEM, micro computed tomography scanning, and histology revealed mineralisation inside the implant pores; and histology revealed woven bone formation and bone resorption around the implant. The imaging evidence of this tissue ongrowth, ingrowth and remodelling around the implant was greater for the dynamically cultured samples, and the mechanical testing revealed that the dynamically cultured samples had approximately three times greater push-through fixation strength (p < 0.05). Discussion: Ex vivo bone models enable the analysis of tissue remodelling onto, into and around porous implants in the lab. While static culture conditions exhibited some characteristics of bony adaptation to implantation, simulating physiological conditions with a bioreactor led to an accelerated response.

An Injectable Calcium Phosphate Bone Graft Substitute Improves the Pullout Strength of Various Suture Anchor Designs in an Osteoporotic Bone Model

To compare various suture anchor designs with and without calcium phosphate (CaP) augmentation in an osteoporotic foam block model and decorticated proximal humerus cadaveric model. This was a controlled biomechanical study, consisting of 2 parts: (1) an osteoporotic foam block model (0.12 g/cc; n= 42) and (2) a matched pair cadaveric humeral model (n= 24). Suture anchors selected were an all-suture anchor, PEEK (polyether ether ketone)-threaded anchor, and a biocomposite-threaded anchor. For each study arm, one half the samples were first filled with injectable CaP and the other half were not augmented with CaP. For the cadaveric portion, the PEEK- and biocomposite-threaded anchors were assessed. Biomechanical testing consisted of a stepwise, increasing load protocol for a total of 40 cycles, followed by ramp to failure. For the foam block model, the average load to failure for anchors with CaP was significantly greater when compared with anchor fixation augmented without CaP; the all-suture anchor was 135.2 ± 20.2 N versus 83.3 ± 10.3 N (P= .0006); PEEK was 131 ± 34.3 N versus 58.5 ± 16.8 N (P= .001); and biocomposite was 182.2 ± 64.2 N versus 80.8 ± 17.4 N (P= .004). For the cadaveric model, the average load to failure for anchors augmented with CaP was again greater than anchor fixation without CaP; PEEK anchors went from 41.1 ± 21.1 N to 193.6 ± 63.9 N (P= .0034) and biocomposite anchors went from 70.9 ± 26.6 N to 143.2 ± 28.9 N (P= .004). Augmenting various suture anchors with CaP has shown to significantly increase pull-out strength and stiffness in an osteoporotic foam block and time zero cadaveric bone model. Rotator cuff tears are common in the elderly patients, in whom poor bone quality jeopardizes treatment success. Exploring methods that increase the strength of fixation in osteoporotic bone to improve outcomes in this patient population is important.

Enhanced interaction of dye molecules and fibers via bio-based acids for greener coloration of silk/polyamide fabric

Multi-component fabrics combined with natural silk fibers and man-made polyamide fibers are good choices for high-quality textile owing to the remarkable comfort and excellent resistance. The silk/polyamide fabric colored with reactive dyes generally shows good fastness, but the problems still remain that large dye effluent discharge, high chemical consumption, and long-time dyeing process. To counter these issues, herein we report a greener coloration method without any salt or alkali added for the coloration of silk/polyamide fabrics. Three bio-based acids like acetic acid, citric acid, and tannic acid were introduced into the dye solution to improve the interaction of dye molecules and fibers. Much of the focus has been given to understand the mechanism between the dye molecules, bio-based acids and fibers, which was determined through dynamic surface tension and UV–visible absorption spectrum measurement. Through this, it was found that the citric acid due to its maximum number of carboxyl groups than acetic acid and tannic acid promoted the disaggregation of dyes and enhanced the dye diffusion to fiber surface. As a result, the dye fixation and color strength of silk and polyamide fibers were all significantly improved when using citric acid at pH 6 with the steaming for 5 min. From the SEM analysis, it was seen that the surface morphology of silk/polyamide fibers was not so much affected. Compared with the traditional dyeing method, this method exhibited enhanced color performance with a shorter dyeing process, lower chemical consumption and nice fastness property. This work presented a potential and practical application of natural additives in the dyeing of multi-component fabrics to achieve eco-friendly and high-quality textile products.

Sheathed fixation improves BASHTI technique in an anterior cruciate ligament reconstruction.

Bone and Site Hold Tendon Inside (BASHTI) technique is an implant-less surgical methodology used for anterior cruciate ligament (ACL) reconstruction. It has some clinical advantages, such as speeding up the healing process. Since the force required to insert the core bone inside the tunnel may damage the core bone and affect the fixation process, the study aims to investigate the strength of fixation of BASHTI technique using proposed sheathed core bones. Experimental tests were performed to evaluate the biomechanical strength of the fixation. Synthetic bone combined with bovine tendons as a graft was used. Polymers were used to create the sheath for mechanical testing. The results showed that fixation strength and stiffness in PTFE sheath with 0.1 mm were 343.86 N and 114.62 N/mm and in PVC sheath with similar thickness, 235.95 N, and 93.36 N/mm. Subsequently, 0.2 mm PTFE sheaths were tested in two different sections: incomplete fixation and complete fixation. The strength and stiffness of the first section were 221.6 N and 66.99 N/mm and for the second section 420.02 N and 126.16 N/mm. Using sheath facilitates the fixation process in BASHTI technique. The 0.1 mm PTFE sheath and 0.2 mm PTFE sheath with complete fixation provide higher fixation strength than other groups. The outcome showed that engaged length has a direct effect on the fixation strength. The BASHTI technique offers an implant-less organic ACL reconstruction method that can improve the fixation method and speed up the healing process.

Clinical Trial for the Safety and Feasibility of Pedicle Screws Coated with a Fibroblast Growth Factor-2-Apatite Composite Layer for Posterior Cervical Fusion Surgery.

To solve the instrument loosening problem, we developed a fibroblast growth factor-2-calcium phosphate composite layer as a novel coating material to improve screw fixation strength. The primary aim of the present study was to demonstrate the safety and feasibility of screws coated with the FGF-2-calcium phosphate composite layer for posterior instrumented surgery of the cervical spine. The trial design was a single-arm, open-label, safety and feasibility study. Patients receiving fusion of the cervical spine from C2 (or C3) to C7 (or T1) were recruited. The primary endpoint to confirm safety was any screw-related adverse events. Seven patients who underwent posterior fusion surgery of the cervical spine were enrolled in the present study. The coated pedicle screws were inserted bilaterally into the lowest instrumented vertebrae. There was only one severe adverse event unrelated with the coated screw. Three out of the fourteen coated screws showed loosening. The present results prove the safety and feasibility of pedicle screws coated with the FGF-2-calcium phosphate composite layer for fusion surgery in the cervical spine. This is the first step to apply this novel surface coating in the field of spine surgery.

Comparison of patellar anchor fixation graft and graft through patellar tunnel reconstruction of medial patellofemoral ligament in the treatment of recurrent patellar dislocation: A protocol for a meta-analysis of comparative studies.

Recurrent patellar dislocation (RPD) occurs in people who have their own patellofemoral dysplasia and who have not been properly treated after their first patellar dislocation. For RPD where conservative treatment is ineffective, medial patellofemoral ligament (MPFL) reconstruction is the first choice for surgical treatment, but there are various and controversial ways of MPFL reconstruction and fixation. Initially, more scholars adopted the patellar lateral tunneling (PT) approach to contain and stabilize the graft, but with the newer materials and techniques, some experts adopted the lateral patellar anchor fixation (AF) of the graft, which can avoid the collateral damage caused by the patellar lateral tunneling and can obtain the same definite efficacy. Therefore, a meta-analysis must be performed to provide evidence whether there is a difference between AF and PT reconstruction of the MPFL in the treatment of RPD. We will search, with no time restriction, without any restriction of language and status, the time from the establishment of the database to October 2022, on the following databases: PubMed (MEDLINE), Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, Chinese National Knowledge Infrastructure (CNKI), Wanfang Data (WF), Chinese Scientific Journals Database (VIP), and Chinese databases SinoMed (CBM) electronic databases. The electronic database search will be supplemented by a manual search of the reference lists of included articles. We will apply the risk-of-bias tool of the Cochrane Collaboration for randomized controlled trials to assess the methodological quality. Risk-of-Bias Assessment Tool for Non-randomized Studies was used to evaluate the quality of comparative studies. Statistical analysis will be conducted using RevMan 5.4 software. This systematic review and meta-analysis will evaluate the functional outcomes of the two fixation modalities, AF and PT, in reconstructing MPFL for RPD. The findings of this study will provide a basis for clinical judgment of whether there is a difference between the two forms of AF and PT reconstructed MPFL for RPD.

Evolution of degradation mechanism and fixation strength of biodegradable Zn–Cu wire as sternum closure suture: An in vitro study

This work reports the first in vitro study on the in-situ biodegradation behaviour and the evolution of fixation strength of Zn–Cu alloy wires in a simulated sternum closure environment. Zn–Cu wires were used to reapproximate the partial bisected sternum models, and their fixation effect was compared with traditional surgical grade 316 L stainless steel (SS) wires in terms of fixation rigidity, critical load, first/ultimate failure characteristics. The metal sutures were then immersed in Hank's balanced salt solution for 12 weeks immersion period, and their corrosion behaviours assessed.Zn–Cu wires showed similar fixation rigidity at 70.89 ± 6.97 N/mm as SS, but the critical load, first failure and ultimate failure characteristics were inferior to SS. The key challenges that limited the fixation effect of the Zn–Cu wires were poor mechanical strength, short elastic region, and strain softening behaviours, which resulted in poor load-bearing capabilities and reduced the knot security of the sutures. The in-situ biodegradation of the Zn–Cu suture was accompanied by the early onset of localised corrosion within the twisted knot and the section located next to the incision line. Crevice corrosion and strain-induced corrosion were the dominant mechanisms in the observed localised corrosion. The localised corrosion on the Zn–Cu sutures did not lead to a significant shift in fixation rigidity, critical load and the first failure characteristics. The findings suggest that the Zn-based biodegradable metallic wires could be a promising sternum closure suture material once the limitations in mechanical characteristics are addressed.

Prophylactic Femoral Neck Fixation in an Osteoporosis Femur Model: A Novel Surgical Technique with Biomechanical Study.

Intramedullary nailing (IMN) is a popular treatment for elderly patients with femoral shaft fractures. Recently, prophylactic neck fixation has been increasingly used to prevent proximal femoral fractures during IMN. Therefore, this study aimed to investigate the biomechanical strength of prophylactic neck fixation in osteoporotic femoral fractures. An osteoporotic femur model was created to simulate the union of femoral shaft fractures with IMN. Two study groups comprising six specimens each were created for IMN with two standard proximal locking screws (SN group) and IMN with two reconstruction proximal locking screws (RN group). Axial loading was conducted to measure the stiffness, load-to-failure, and failure modes. There were no statistically significant differences in stiffness between the two groups. However, the load-to-failure in the RN group was significantly higher than that in the SN group (p < 0.05). Femoral neck fractures occurred in all specimens in the SN group. Five constructs in the RN group showed subtrochanteric fractures without femoral neck fractures. However, one construct was observed in both subtrochanteric and femoral neck fractures. Therefore, prophylactic neck fixation may be considered an alternative biomechanical solution to prevent proximal femoral fractures when performing IMN for osteoporotic femoral fractures.

High flex femoral component with slanted pegs improves fixation strength of total knee arthroplasty

High incidences of early aseptic loosening cases have led to numerous analyses on fixation strength of femoral component (FC). This study consists of two objectives: (1) to analyze the correlation between articulating contact area shape conformities and fixation strength, and (2) to analyze the relationship between slanting box patterns of the FC and fixation strength. Two design analyses were constructed: first, using three different types of contact congruence with radius ratios of 0.50, 0.89 and flat. Second, box patterns of the FC were anteriorly slanted at 2, 4 and 6°. The fixation strength of the FC is significantly improved (38.59%) by slanting the box pattern anteriorly as compared to the non-slanted FC design.

Biodegradable metallic suture anchors: A review

Suture anchors are widely used for attaching soft tissue to bone due to their ease of insertion, fixation strength, and small size. The past few decades have seen great advances in the materials and designs of suture anchors. They were originally constructed of non-biodegradable metals and polymers, but in recent years there has been a considerable move toward biodegradable polymers. The biodegradable polymer anchors offer advantages such as gradual degradation over time, minimized risk of migration, less complex revision surgery, no need for a removal operation, and improved postsurgical imaging. However, these anchors have lower fixation strength than metal anchors and suffer from adverse local tissue reactions, inflammatory responses, and rapid degradation. Biodegradable metals appear to be ideal candidates for the future of suture anchors. They have high fixation strength and low elastic modulus close to that of bone, which promote osseointegration and allow the design of thinner and lower volume implants. The current article gives an overview of the application and manufacturing of biodegradable metallic suture anchors and summarizes their current concepts and properties in this area of continual development. • Biodegradable metal anchor has high fixation strength and promotes osseointegration. • Mg, Fe, Zn, and their alloys are used for fabricating biodegradable metal anchors. • AM, machining, and metal injection molding are used in manufacturing metal anchors.

Plating for Intra-articular Fractures of the Distal Femur: Functional and Radiological Outcomes.

Background and objective Intra-articular fractures of the distal femur pose a significant surgical difficulty. These fractures are challenging to repair, and surgery is frequently advised for a successful outcome. The distal femoral fractures make up between 4-6% of all femoral fractures and account for less than 1% of all fractures. When compared to the single screw's axial stiffness or pullout resistance, as is the case with unlocked plates, the locking compression plate (LCP) is a single beam construct whose strength of fixation is equal to the sum of all screw-bone contacts. Against this backdrop, the current study was conducted for evaluating the functional outcomes of distal femoral fractures treated with LCP fixation. Methodology We conducted an observational study at a tertiary care facility in Kolar spanning a period of three years, from January 2019 to January 2022. We included all patients aged more than 18 years, who were diagnosed with distal femoral fractures [only those classified as type C according to theAOFoundation/Orthopedic Trauma Association (AO/OTA) classification]. Patients with terminal illnesses, revision of previous surgery, fractures with neurovascular injuries, and those diagnosed with pathological fractures were excluded from the study. The included patients were treated by LCP and discharged on postoperative day 10 after suture removal. The first follow-up was at the first month and subsequent follow-ups were done at threeand six months, and the functional outcomes were assessed by using Neer's score for straight leg raises. Radiographs with fading fracture lines and callus formation onthree-fourthsof the cortices were regarded as indicators of fracture healing. Results Among the 30 study participants,80% were males. The mean time for the radiological union was 15 weeks. In this study, there were no instances of infection or angular deformity greater than 5 degrees. About 80% of the study participants had ranges of motion (ROM) above 120 degrees at the end of the six-month follow-up period; 12 cases had an excellent score (40%), 15 cases (50%) had a satisfactory score, two cases (6.7%) had an unsatisfactory score, and only one case had poor score. Common complications observed were excessive bleeding, difficulty in reduction, superficial infections, and knee stiffness. Conclusion For patients with distal femoral fractures, the LCP treatment can result in good functional and radiological outcomes with fewer complications.

Implications of navigation in thoracolumbar pedicle screw placement on screw accuracy and screw diameter/pedicle width ratio

IntroductionThere is ample evidence that higher accuracy can be achieved in thoracolumbar pedicle screw placement by using spinal navigation. Still, to date, the evidence regarding the influence of the use of navigation on the screw diameter to pedicle width ratio remains limited. Research questionThe aim of this study was to investigate the implications of navigation in thoracolumbar pedicle screw placement not only on screw accuracy, but on the screw diameter to pedicle width ratio as well. Material and methodsIn this single-center single-surgeon study, 45 Patients undergoing navigated thoracolumbar pedicle screw placement were prospectively included. The results were compared with a matched comparison group of patients in which screw placement was performed under fluoroscopic guidance. The screw accuracy and the screw diameter to pedicle width ratio of every screw were compared between the groups. ResultsScrew accuracy was significantly higher in the navigation group compared to the fluoroscopic guidance group, alongside with a significant increase of the screw diameter to pedicle width ratio by approximately 10%. In addition, both the intraoperative radiation dose and the operating time tended to be lower in the study group. ConclusionThis study was able to show that navigated thoracolumbar pedicle screw placement not only increases the accuracy of screw placement but also facilitates the selection of the adequate screw sizes, which according to the literature has positive effects on fixation strength. Meanwhile, the use of navigation did not negatively affect the time needed for surgery or the patient's intraoperative exposure to radiation.

A prospective study to evaluate the functional and clinical outcome of anterior cruciate ligament reconstruction with standard hamstring autograft

Background: The anterior cruciate ligament (ACL) is the primary stabilizer of the knee and prevents the knee against anterior translation. It is also important in counteracting rotational and valgus stress. The arthroscopically aided approach has the advantages of smaller skin and capsular incisions, improved viewing of the intercondylar notch for placement of the tunnel and attachment sites, less postoperative pain, fewer adhesions, earlier motion, and easier rehabilitation. The advantages with semitendinosus grafts are the availability of a greater sectional area and the unaffected integrity of the extensor mechanism. Moreover, the tensile strength of quadrupled hamstring is found to be even better than a normal ACL. The rate of complications such as extension loss, anterior knee pain, and surgical site infections was also lower than in other procedures such as in BPTB grafts. Cortical suspension devices have the necessary biomechanical properties with regard to ultimate failure strength, displacement, and stiffness for the initial fixation of soft tissue in the femoral tunnel for ACL reconstruction. The aperture fixation methods such as the interference screws allow for early firm fixation and heal with a tight bone–tendon interface.Objective: A prospective study to evaluate the functional and clinical outcome of ACL reconstruction with standard hamstring autograft.Materials and Methods: The study results included 30 patients admitted with clinical and radiological deficiency of ACL from September 2019 to March 2021 using endobutton and bioabsorbable interference screw in terms of range of motion, postoperative knee stability, subjective knee functions, and prospective assessment of functional outcome using Tegner Lysholm knee scoring system.Results: Sports injuries were the most common mode of injury (n = 17, 56.7%). The mean size of graft used was 8.2 ± 0.39 mm. Postoperatively at 2-year follow-up, 30 cases (100%) had 0 grade pivot-shift test, 0 grade Lachman test, and anterior drawer test. The mean postoperative Lysholm score improved from preoperative score of 62.83 ± 5.2–91.0 ± 5.54. The overall satisfactory result (excellent + good) at 6-month follow-up was (excellent – 30 and good – 70) 100%. Out of this, 27 (90%) patients had returned to preinjury level of activity in 1 year. In this study, one patient had superficial infection and two patients had knee pain.Conclusion: Arthroscopy-assisted ACL reconstruction using hamstring tendon autograft provides a stable knee, reduces postoperative morbidity, and enables early rehabilitation.

Biplane double supported screw fixation in femoral neck fractures using percutaneous approach

Introduction: Fracture neck of femur has always presented a great challenge to the Orthopaedic surgeons. Results depend upon adequacy of reduction and stable fixation. Fixation with cannulated cancellous screws is usually adequate for femoral neck fractures. The aim of the study was to analyze the results of treatment of fracture neck of femur with cannulated cancellous screw fixation using BDSF method.Materials and Methods: This prospective study was carried out in the postgraduate Department of Orthopaedics, Govt. Bone and Joint Hospital, an associated hospital of Govt. Medical College Srinagar from 2019-2021. A total of 25 patients who presented in the department with femoral neck fractures and qualified the inclusion criteria were included in the study.Results: Among 25 patients 12 (48%) patients achieved excellent results, 8 (32%) patients achieved good results, 3 (12%) patients achieved fair results and 2 (8%) patients achieved poor results. 80% of the patients achieved either excellent or good result.Conclusion: BDSF is a novel method of fixation of femoral neck fractures, associated with higher axial fixation strength and union rate compared to conventional fixation methods. It employs bi-plane positioning of three cannulated screws placed at steeper angles to the diaphyseal axis.