Screw Fracture Research Articles

Internal Fixation With Cannulated Screws for Stable Femoral Neck Fractures in High-Risk Patients: Good Clinical Outcomes and Evaluation of Postoperative Complications

Internal Fixation With Cannulated Screws for Stable Femoral Neck Fractures in High-Risk Patients: Good Clinical Outcomes and Evaluation of Postoperative Complications

Maintenance Costs, Time, and Efforts Following Implant Therapy With Fixed Restorations Over an Observation Period of 10 Years: A Randomized Controlled Clinical Trial.

To assess the costs and efforts of maintenance therapy following implant treatment with fixed restoration over an observation period of 10 years. This randomized controlled clinical trial included 64 patients who were randomly assigned to receive one of two implant systems (AST or STM) and fixed restoration. Patients were included in a regular maintenance program and were examined at loading, 1, 3, 5, 8, and 10 years. Outcome measures included technical and biological complications, time, efforts, and costs to resolve them. A total of 97 implants were placed in 64 patients (AST: 54, STM: 43). Patient recall rates at 5 and 10 years were 89% and 67%. In general, technical complications were resolved within one to two appointments (mean = 1.5), and biological complications required a mean of 1.3 appointments. The overall regular maintenance time for the period of 10 years amounted to 77 min per year. Technical complications occurred in 39.5% of the patients, with screw-loosening being the most common one (43.4% of all complications). The most time-consuming technical complication was abutment fracture (94 min ± 68), followed by screw fracture (84 min ± 38). The prevalence of peri-implant mucositis on the patient level was 30.2%, and it was 9.3% for peri-implantitis. The average annual maintenance costs amounted to 9% of the initial cost of the implant treatment over the period of 10 years. Additional regular maintenance costs and costs due to the treatment of potential complications have to be taken into consideration when placing dental implants. The majority of technical complications could be resolved within one appointment, whereas the time needed to treat biological complications varied between one and three appointments for peri-implantitis.

Comparison of surgical outcomes between bioabsorbable and metal screw fixation for distal tibial physeal fracture in children and adolescent.

This study aimed to compare the surgical outcomes between bioabsorbable and metal screw fixation for distal tibial physeal fracture in children and adolescents, radiographically and clinically. This study included consecutive 67 children and adolescents who underwent open reduction and internal fixation using metal or bioabsorbable screws for the distal tibia physeal fracture. All patients underwent preoperative radiographs, three-dimensional computed tomography scans, and postoperative follow-up teleradiogram. Patients were divided into metal (N = 40) and bioabsorbable groups (N = 27). We compared the surgical outcomes between the two groups in terms of clinical and radiographic outcomes, length of hospital stays, and medical cost. Follow-up duration were significantly longer in the metal group than that in the bioabsorbable group. There was no significant difference in the incidence of growth arrest after surgery and the scores of the Oxford Ankle and Foot Questionnaire between the two groups. However, the total hospital stay was significantly longer in the metal group (5.2 ± 4.8 days) compared to the bioabsorbable group (2.6 ± 0.5 days). Medical costs were significantly higher in the bioabsorbable group than in the metal group with a difference of 397 US dollars. The use of bioabsorbable screws exhibited therapeutic effects equivalent to that of metal screws for pediatric distal tibia physeal fractures regarding clinical and radiological outcomes. Moreover, it had the advantage of avoiding the need for repeated general anesthesia and secondary operation for implant removal. Therefore, the use of bioabsorbable screws may be a favourable surgical option for treating pediatric fractures.

Implant abutment screw fracture: Two case reports

Implant abutment screw fracture: Two case reports

Fasciocutaneous bridge flap to cover defects on the lower leg after compartment syndrome with acomplication-prone course : An "almost" forgotten safe flap procedure

This article reports on acomplicated case of asoft tissue defect with challenging soft tissue coverage on the lower leg. After alower leg fracture and treatment with atibial nail, a29-year-old man developed compartment syndrome due to massive secondary bleeding with alesion of the common peroneal nerve and muscle necrosis around the fibular muscles. The initial coverage with split skin showed no tendency to heal, so the patient was admitted to this hospital with asoft tissue defect of approximately 25 cm × 10 cm on the lateral lower leg with an exposed tibia over a length of 15 cm. The primary attempt was coverage with a split-thickness skin graft after secondary granulation; however, due to the previously damaged vascular supply, the wound demonstrated adelayed incomplete healing over 8 months. In addition, X‑ray imaging revealed anonunion and aresulting screw fracture of the two distal locking screws. The indications for revision surgery to treat the fracture and change the implant were fulfilled. In the same procedure, the residual cutaneous defects were closed. Given the previously complication-prone course and adifficult local blood flow situation, the choice of reconstruction procedures was limited. Abridge flap of the medial lower leg was performed in an interdisciplinary approach. The lifting defect was covered with split-thickness skin. In this way, the wound was finally adequately covered after 1year.

Multi-objective constraints for path planning in screw fixation of scaphoid fractures

PurposeScaphoid fractures, a common type of clinical fracture, often require screw placement surgery to achieve optimal therapeutic outcomes. Path planning algorithms can avoid more risks and have vital potential for developing precise and automatic surgeries. Despite the success of surgical path planning algorithms, automatic path planning for scaphoid fractures remains challenging owing to the complex bone structure and individual variations. MethodsThus, we propose a Multi-objective constrained Path planning Algorithm (MPA) for fracture screw placement, which includes the identification of the center of the fracture surface. Further, three constraint conditions were introduced to eliminate infeasible paths, followed by adding three objectives to the remaining paths for more accurate planning. Finally, the Nondominated Sorting Genetic Algorithms (NSGA)-II algorithm was used to optimize the surgical paths. ResultsWe defined the vertical compression distance (VCD), a common observation index in clinics. The experiments show that the average VCD of the MPA paths is measured at 23.88 mm, outperforming the clinical planning paths by 21.71 mm. Ablation experiments demonstrated that all three objectives (distance, length, and angle) effectively optimized the path planning. Additionally, we also used finite element analysis to compare and analyze the MPA path and clinical path. The experimental results showed that the MPA path always outperformed the clinical path in terms of scaphoid strain and screw stress. ConclusionThis study presents a solution for the path planning of scaphoid fractures. Our future research will attempt to enhance the model's performance and extend its application to a broader range of fracture types.

A clinical prospective study on the surgical management of zygomatico-maxillary complex fractures using two-point fixation

The ZMC fractures are one of the most frequently occurring maxillofacial injuries due to its prominence and facial contour. The ZMC forms a principle buttress of face and helps transmit occlusal forces to skull base. Fracture of zygomatic bone leads aesthetic and functional deformity. Restoration to premorbid condition is most predictable by ORIF. In this study was to evaluate efficacy of two-point internal fixation using conventional miniplates and screws for ZMC fractures. 35 patients with established unilateral isolated ZMC fractures were operated using two-point fixation method i.e. the maxillary buttress and the fronto-zygomatic suture, followed up for 3 months. Patients were assessed clinically and radiographically at different follow up intervals. Charts of patients were reviewed for age, gender, etiology, malar height analysis and vertical dystopia. 35 patients in this study, underwent ORIF under GA with two-point fixation. Preoperatively, mean malar height of the patients recorded was 66.55 ± 3.02. There was a significant increase in malar height postoperatively (P < 0.0001). 70.24 ± 2.05, at 1st week, and 69.87 ± 1.98. in 3rd and 6th weeks. Preoperatively, mean vertical dystopia of patients was 2.24 ± 0.71. Postoperative resolution of vertical dystopia was statistically significant (P<0.0001), with value of 0.52 ± 0.52.Integrity of ZMC is important in maintenance of normal facial width and prominence of cheek. Two‑point fixation shows satisfactory results functionally, esthetically and also provides additional advantage by eliminating another surgical site. Thus we conclude that our study provides a basis for further research.

Impact of Diamond-like Carbon Films on Reverse Torque: Superior Performance in Implant Abutments with Internal Conical Connections

The loosening or fracture of the prosthetic abutment screw is the most frequently reported complication in implant dentistry. Thin diamond-like carbon (DLC) films offer a low friction coefficient and high wear resistance, functioning as a solid lubricant to prevent the weakening of the implant–abutment system. This study evaluated the effects of DLC nanofilms on the reverse torque of prosthetic abutments after simulated chewing. Abutments with 8° and 11° taper connections, with and without DLC or silver-doped DLC coatings, were tested. The films were deposited through the plasma enhanced chemical vapor deposition process. After two million cycles of mechanical loading, reverse torque was measured. Analyses with scanning electron microscopy were conducted on three samples of each group before and after mechanical cycling to verify the adaptation of the abutments. Tribology, Raman and energy-dispersive spectroscopy analyses were performed. All groups showed a reduction in insertion torque, except the DLC-coated 8° abutments, which demonstrated increased reverse torque. The 11° taper groups experienced the most torque loss. The nanofilm had no significant effect on maintaining insertion torque, except for the DLC8 group, which showed improved performance.

Satisfactory 2-year outcome of minimal invasive hybrid stabilization with double treated screws for unstable osteoporotic spinal fractures.

This study evaluates whether the fracture level alters the outcomes of minimally invasive hybrid stabilization (MIHS) with double-threaded, uncemented polyaxial screws for unstable osteoporotic vertebral fractures. This prospective cohort study included 73 patients (71.23% females, mean age: 79.9 ± 8.8 years) with unstable OF 3-4 fractures treated by MIHS between Nov 2015-Jan 2018. Patient characteristics, operative data, clinical outcomes, complications, radiological outcomes, and midterm (24-month) follow-up regarding functionality, pain, and quality of life were analyzed. Patients had thoracolumbar (71.23%), thoracic (10.97%), and lumbar (17.8%) fractures. Operative time was < 120min in 73.97% of patients, with blood loss < 500ml in 97.25% of cases. No in-hospital mortality was recorded. Spine-associated complications occurred in 15.07% of patients, while 36.98% of patients had urinary tract infections (n = 12), pneumonia (n = 5), and electrolyte disturbances (n = 9). The mean length of hospital stay was 13.38 ± 7.20 days. Clinically-relevant screw loosening occurred in 1.7% of screws, and secondary adjacent fractures were diagnosed in 5.48% of patients. The alpha-angle improved significantly postoperatively (mean change: 5.4°) and remained stable for 24 months. The beta-angle improved significantly from 16.3° ± 7.5 to 10.8° ± 5.6 postoperatively but increased slightly to 14.1° ± 6.2 at midterm follow-up. Although no differences were seen regarding baseline data, clinical outcomes, and complications, fracture level significantly altered the COMI score at 24 months with no effect on pain score or quality-of-life. MIHS using polyaxial screws is a safe treatment for single-level osteoporotic spinal fractures. Fracture level did not alter radiological reduction loss; however, it significantly altered patients' function at 24 months.

Anterior Column Release: With Great Lordosis Comes Great Risk of Complications-A Case Series.

Retrospective review. We sought to characterize complications associated with anterior column release (ACR). Correction of positive sagittal imbalance was traditionally completed with anterior column grafts or posterior osteotomies. ACR is a minimally invasive technique for addressing sagittal plane deformity by restoring lumbar lordosis. We conducted a retrospective review of consecutive patients who underwent ACR in a prospectively kept database at a tertiary care academic center from January 2012 to December 2018. The prespecified complications were hardware failure (rod fracture, hardware loosening, or screw fracture), proximal junctional kyphosis, ipsilateral thigh numbness, ipsilateral femoral nerve weakness, arterial injury requiring blood transfusion, bowel injury, and abdominal pseudohernia. Thirty-eight patients were identified. Thirty-five patients had ACR at L3-4, 1 had ACR at L4-5, and 1 patient had ACR at L2-3 and L3-4. Eighteen patients (47.4%) had one of the prespecified complications (10 patients had multiple). Ten patients developed hardware failure (26.3%); 8 patients (21.1%) had rod fracture, 4 (10.5%) had screw fracture, and 1 (2.6%) had screw loosening. At discharge, rates of ipsilateral thigh numbness (37.8%) and hip flexor (37.8%)/quadriceps weakness (29.7%) were the highest. At follow-up, 6 patients (16.2%) had ipsilateral anterolateral thigh numbness, 5 (13.5%) suffered from ipsilateral hip flexion weakness, and 3 patients (5.4%) from ipsilateral quadriceps weakness. Arterial injury occurred in 1 patient (2.7%). Abdominal pseudohernia occurred in 1 patient (2.7%). There were no bowel injuries observed. ACR is associated with a higher than initially anticipated risk of neurological complications, hardware failure, and proximal junctional kyphosis.

Distal Junctional Failure: A Feared Complication of Multilevel Posterior Spinal Fusions.

Objectives: Distal junctional failure (DJF) is less commonly described than proximal junctional failure following posterior spinal fusion, and particularly adult spinal deformity (ASD) surgery. We describe a case series of patients with DJF, taking into account sagittal spinopelvic alignment, and suggest potential risk factors in light of the current literature. Methods: We performed a single-center, retrospective review of posterior spinal fusion patients with DJF who underwent subsequent revision surgery between June 2009 and January 2019. Demographics and surgical details were collected. Radiographical measurements included the following: preoperative and postoperative sagittal and coronal alignment for each index or revision surgery. The upper-instrumented vertebra (UIV), lower instrumented vertebra (LIV), and fusion length were recorded. Results: Nineteen cases (64.7 ± 13.5 years, 12 women, seven men) were included. The mean follow-up was 4.7 ± 2.4 years. The number of instrumented levels was 6.79 ± 2.97. Among the patients, 84.2% (n = 16) presented at least one known DJF risk factor. LIV was frequently L5 (n = 10) or S1 (n = 2). Six patients had an initial circumferential fusion at the distal end. Initial DJFs were vertebral fracture distal to the fusion (n = 5), screw pull-out (n = 9), spinal stenosis (n = 4), instability (n = 4), and one early DJK. The distal mechanical complications after a first revision included screw pull-out (n = 4), screw fracture (n = 3), non-union (n = 2), and an iatrogenic spondylolisthesis. Conclusions: In this case series, insufficient sagittal balance restoration, female gender, osteoporosis, L5 or S1 LIV in long constructs were associated with DJF. Restoring spinal balance and circumferentially fusing the base of constructs represent key steps to maintain correction and prevent revisions.

The Fracture Resistance Comparison between Titanium and Zirconia Implant Abutments with and without Ageing: Systematic Review and Meta-Analysis.

Implant abutments are essential components of implant prosthetic restorations. The golden standard for abutment material is titanium; however, due to its properties, the esthetic result can be compromised. The most popular esthetic material alternatives are one- and two-piece zirconia. The study aimed to answer the questions of whether zirconia abutments can be used interchangeably with titanium in both anterior and posterior regions and how aging of the abutment affects durability. For this study, an electronic search of MEDLINE (PubMed) and Scopus (Embase) was conducted. The PRISMA guidelines were followed, and a systematic review was registered with PROSPERO. The search revealed 4031 results, of which 17 studies were selected. The strongest material for abutments is titanium, closely followed by two-piece zirconia. One-piece zirconia abutments were the weakest. The cyclic loading above 1,000,000 cycles decreased the fracture resistance of the abutments. Differences in implant diameter, angulation, and restoration affected the fracture strength of all compared materials. The main mode of failure for titanium abutments was screw bending or screw fracture. One-piece zirconia most often presented catastrophic failure with internal hexagon fracture below the implant neck. Two-piece zirconia exhibits a combination of failure modes. Two-piece zirconia abutments may be suitable for use in the posterior region, given their comparable fracture resistance to titanium abutments. Despite the fact that one-piece zirconia is capable of withstanding forces that exceed those exerted during mastication, it is recommended that it be employed primarily in the anterior dentition due to its propensity for unfavorable failure modes.

Structural bone grafting with reverse shoulder arthroplasty for osteoarthritis with severe glenoid bone loss: outcomes using a long post

Severe posterior glenoid bone loss with glenohumeral osteoarthritis with an intact rotator cuff can be managed with reverse shoulder arthroplasty but requires lateralization and version correction to avoid potential complications, such as instability, notching and implant failure. Angled bone grafting with humeral head autograft can provide durable glenoid bone stock, but results have been mixed. The purpose of this study was to evaluate patient-reported and objective outcomes as well as complication and failure rates for patients who underwent angled humeral head autografting for severe retroversion. All patients who underwent a primary reverse shoulder arthroplasty with angled humeral head autograft and Stryker Tornier long central postbaseplate for severe glenoid bone loss in the setting of glenohumeral osteoarthritis with an intact rotator cuff at our institution between November 2018 and February of 2022 were identified. Individuals with a primary diagnosis of osteoarthritis and preoperative glenoid retroversion of ≥30° were included. Patients undergoing revision procedures, planned 2-stage arthroplasty were excluded. Differences in pre- and postoperative range of motion, as well as patient-reported outcomes were assessed. Intraoperative complications, postoperative complications, and re-operation rates were analyzed. A total of 24 shoulders in 23 patients (61% male), with a mean age of 65.6years were included. Average preoperative retroversion was 37.4° (range: 30°-51°). Mean follow-up was 2.9years (range: 2-4.3years). Significant improvements were found in flexion, abduction, and external rotation. Patient-reported subjective outcomes were excellent, with average American Shoulder and Elbow Surgeons score of 93.6 and average Subjective Shoulder Value score of 93.8%. Sixteen (67%) shoulders received postoperative computed tomography scans and all were found to have incorporated. Complications included one shoulder hematoma requiring incision and drainage without revision, and a post-traumatic fracture of the inferior glenoid screw at 11months, requiring revision reverse shoulder arthroplasty with bone grafting. No atraumatic catastrophic failures occurred due to component loosening. This study suggests that using angled humeral head bone grafting is a good solution for version correction in extreme posterior glenoid bone loss. Significant improvements are reported in range of motion, pain, and subjective functional scores, with excellent graft incorporation rates and a low complication profile at early follow-up. Further work should focus on gathering higher levels of evidence, detailed radiographic analyses, and exploring humeral head bone grafting for other indications.

A Randomized Controlled Study on the Efficacy of Different Approaches of Intramedullary Nailing with Blocking Screws for Proximal Tibial Fractures

A Randomized Controlled Study on the Efficacy of Different Approaches of Intramedullary Nailing with Blocking Screws for Proximal Tibial Fractures

Risk of Axillary Nerve Injury With Medial Support Screws in Intramedullary Nails: An Anatomical Study.

In recent years, intramedullary nails with medial support screws for proximal humeral fractures have become available. Although these devices have a potential risk of iatrogenic axillary nerve injury, no studies have investigated the anatomical relationship between the medial support screws in the modern intramedullary nail and the axillary nerve. This study aimed to clarify the anatomical relationship between the medial support screws in the intramedullary nail and the axillary nerve. In total, 29 cadaveric shoulders (mean age: 82.6 years old (range: 61-105); 15 males and 14 females) were included in this study. Shoulders within whole-body cadavers were used in all cases. A single proximal humeral nail with medial support screws (ARISTO Proximal Humeral Nail; MDM, Tokyo, Japan) was used. The distance of each medial support screw from the axillary nerve and its branches was measured. In two (6.90%) of 29 shoulders, the axillary nerves came into contact with the medial support screws. In the remaining 27 of 29 shoulders (93.1%), the nerves were located proximal to the medial support screws. Medial support screws in proximal humeral fracture nails had the potential to injure the axillary nerve and its branches.

Intramedullary headless screw fixation for fractures of the proximal phalanges of the hand: a three-year follow-up

ObjectiveThe objective of this study was to evaluate the long-term outcomes of trans-articular intramedullary fixation using cannulated headless screws for proximal phalanx fractures in the hand.BackgroundVarious surgical techniques have been described for the fixation of proximal phalanx fractures, with Kirschner wires, plates, and screws being commonly used. The objective of this study was to evaluate the long-term outcomes of trans-articular intramedullary fixation using cannulated headless screws for proximal phalanx fractures in the hand. Methods Eight patients, with nine proximal phalanx fractures, treated with intramedullary screw fixation, were included for a follow-up visit three years post-surgery. Subjective and objective outcome measures were assessed using the Michigan Hand Questionnaire (MHQ), active range of motion (aROM), grip strength, conventional X-rays, and digital tomosynthesis images.MethodsEight patients, with nine proximal phalanx fractures, treated with intramedullary screw fixation, were included for a follow-up visit three years post-surgery. Subjective and objective outcome measures were assessed using the Michigan Hand Questionnaire (MHQ), active range of motion (aROM), grip strength, conventional X-rays, and digital tomosynthesis images.ResultsWe observed a mean MHQ score of 83%, a total aROM of 216.4°, and a Jamar grip strength of 29.9 kg in the injured hand. Digital tomosynthesis revealed complete fracture consolidation in all cases. Joint arthrosis was detected in only one case, attributed to a misplaced screw.ConclusionsOur findings indicate favorable long-term clinical outcomes, including range of motion, grip strength, patient satisfaction, and prevention of joint damage, with the use of intramedullary headless screw fixation.Level of evidence: Level IV, Therapeutic

Functional Outcomes of Subtrochanteric Femur Fracture Fixed with Dynamic Condylar Screw

Abstract: Background: Orthopedic surgeons find it most difficult to manage subtrochanteric femur fractures because of its notorious location, where difficulties might arise. Various techniques, including intramedullary and extramedullary implant stabilization have been tried with varying level of success. Objective: Our study aimed to assess the functional results of dynamic condylar screws in sub trochanteric femur fractures in order to aid the underprivileged masses in our area. Materials and Methods: This prospective observational study was conducted in Akbar Medical Center Dabgari Garden Peshawar, Pakistan from September, 2018 to August, 2022. All patients of either gender having age above 20 years with proximal femoral fracture without concomitant fracture, with negative hepatitis profile and no diabetes were managed using a dynamic condylar screw. Functional outcome of the surgery was evaluated using Harris Hip Score. Result: There were total 88 patients in the study with male to female ratio of 3:1 having mean age of 33.96±9.63. Postoperative functional outcome in terms of Harris hips score range from 64 to 94 with a mean of 83.87 ±7.27 SD. Excellent functional outcome were observed in 14.8% patients, good results in 64.8% patients, fair outcomes in 11.4% and poor outcome were observed in 9.1% patients. Conclusion: DCS results are excellent and good functional outcome in majority of patients. Therefore, it can be used as a good alternative to other intra and extramedullary implants fixation. Keywords: Dynamic condylar screw, Femur, Fractures, Harris hip scores, Subtrochanteric, Medullary devices.

Fixation of Long Oblique and Spiral Metacarpal Shaft Fractures With Intramedullary Screw and Cerclage Wires

Introduction: Long oblique and spiral metacarpal shaft fractures are length-unstable fracture patterns susceptible to malrotation and shortening. We expand the use of intramedullary screw fixation for traditional length-unstable fracture patterns including long oblique and spiral with cerclage wire augmentation. Materials and Methods: Surgical technique of intramedullary screws for long oblique and spiral metacarpal shaft fractures, augmented with cerclage wires, is described. Case series of patients who underwent this technique over a 3-year period from 2 surgeons at a single institution were evaluated. The inclusion criteria included patients who underwent this technique with long oblique or spiral metacarpal shaft fractures. The exclusion criteria included open injuries, and base or neck fractures. Results: A total of 8 patients were included with an average age at surgery 42 years old (range, 25 to 70). Six of the 8 patients achieved full range of motion at the time of final follow-up. One patient had ~5 to 10-degree deficit in both flexion and extension, and the other had 20-degree loss in both flexion and extension. The follow-up averaged 62 days (range, 25 to 144 days). There were no patients with nonunion, malunion, hardware failure, or postoperative fracture subsidence or malrotation. The average time to union was 6.1 weeks (range, 3.5 to 12.4 wks). Conclusions: This hybrid technique expands the use of intramedullary screws to traditional length-unstable fractures including long oblique and spiral patterns. Patients demonstrate return to full range of motion, union approximately in 6 weeks, with minimal complications following this minimally invasive technique.

Fracture resistance of hybrid ceramic abutments with different restoration lengths: A pilot study.

In this pilot study, the fracture resistance of hybrid abutments with different restoration lengths was investigated. Sixteen monolithic zirconia restorations of an upper right incisor were designed to fit a titanium base abutment. Eight central incisors had a crown length of 8 mm (T1) and the other half a length of 12 mm (T2). All crowns were cemented on the titanium base using a resin cement. After cementation, the samples were placed in a thermocycler for 5000 cycles. Fracture strength was measured using a universal test machine. Deformations and fractures of the samples were investigated. The mean fracture resistance of T1 was 515 N (SD 96 N, 339-650) and 305 N (SD 57 N, 234-408) for T2 (p < 0.001). Both groups showed deformation of the titanium base, with no significant difference between both groups (p = 0.200). A difference in fracture type (p = 0.013) was observed, with significantly more screw fractures occurring in group T1 (p = 0.026). Within the limitations of this study, hybrid restorations with standard titanium base abutments can withstand forces that have been associated with chewing, irrespective of the crown length. However, the shorter crowns demonstrated more fatal fractures.

Advanced Pelvic Girdle Reconstruction with three dimensional-printed Custom Hemipelvic Endoprostheses following Pelvic Tumour Resection

PurposeResection of pelvic bone tumours and subsequent pelvic girdle reconstruction pose formidable challenges due to the intricate anatomy, weight-bearing demands, and significant defects. 3D-printed implants have improved pelvic girdle reconstruction by enabling precise resections with customized guides, offering tailored solutions for diverse bone defect morphology, and integrating porous surface structures to promote osseointegration. Our study aims to evaluate the long-term efficacy and feasibility of 3D-printed hemipelvic reconstruction following resection of malignant pelvic tumours.MethodsA retrospective review was conducted on 96 patients with primary pelvic malignancies who underwent pelvic girdle reconstruction using 3D-printed custom hemipelvic endoprostheses between January 2017 and May 2022. Follow-up duration was median 48.1 ± 17.9 months (range, 6 to 76 months). Demographic data, imaging examinations, surgical outcomes, and oncological evaluations were extracted and analyzed. The primary endpoints included oncological outcomes and functional status assessed by the Musculoskeletal Tumor Society (MSTS-93) score. Secondary endpoints comprised surgical duration, intraoperative bleeding, pain control and complications.ResultsIn 96 patients, 70 patients (72.9%) remained disease-free, 15 (15.6%) had local recurrence, and 11 (11.4%) succumbed to metastatic disease. Postoperatively, function improved with MSTS-93 score increasing from 12.2 ± 2.0 to 23.8 ± 3.8. The mean operating time was 275.1 ± 94.0 min, and the mean intraoperative blood loss was 1896.9 ± 801.1 ml. Pain was well-managed, resulting in substantial improvements in VAS score (5.3 ± 1.8 to 1.4 ± 1.1). Complications occurred in 13 patients (13.5%), including poor wound healing (6.3%), deep prosthesis infection (4.2%), hip dislocation (2.1%), screw fracture (1.0%), and interface loosening (1.0%). Additionally, all patients achieved precise implantation of customized prosthetics according to preoperative plans. T-SMART revealed excellent integration at the prosthesis-bone interface for all patients.ConclusionThe use of a 3D-printed custom hemipelvic endoprosthesis, characterized by anatomically designed contours and a porous biomimetic surface structure, offers a potential option for pelvic girdle reconstruction following internal hemipelvectomy in primary pelvic tumor treatment. Initial results demonstrate stable fixation and satisfactory mid-term functional and radiographic outcomes.