Instrument Breakage Research Articles

Successful retrieval of a broken pituitary rongeur tip from the lumbar intervertebral disc space using a magnetic probe: illustrative case.

Unexpected events such as instrument breakage during a routine lumbar microdiscectomy can pose a risk for nerve root injury, durotomy, infection, and anterior displacement into the retroperitoneal space. Removal of broken instruments requires planning, patience, and sometimes subsequent surgical procedures. Here, the authors explore the effectiveness of a magnetic probe for the retrieval of broken metallic (magnetic) pieces. A 47-year-old man with right leg radiculopathy due to a right L5-S1 disc extrusion had undergone a lumbar microdiscectomy that was complicated by the pituitary rongeur tip breaking in the L5-S1 disc space. The rongeur tip was successfully retrieved by widening the entry access without damaging the adjoining facet and utilizing a blunt nerve hook, a probe dissector, forceps tips, curette heads, and a magnetic probe. The use of a magnetic probe provides a safe and effective method for retrieving metallic fragments during lumbar disc surgery. This case highlights the importance of considering alternative techniques such as magnetic retrieval in the management of intraoperative instrument breakage. https://thejns.org/doi/10.3171/CASE24377.

Knowledge, awareness, and approaches of dentistry students about separated instruments in root canals: A cross-sectional study.

This survey aims to assess the understanding, viewpoints, and methods employed by undergraduate dental students in the fourth and fifth grades regarding broken endodontic instruments in root canal procedures. A survey comprising 27 questions across three sections-demographic information, practical application, and knowledge-approach-awareness inquiries-was developed. It was distributed to 282 students either in person or via a link shared through WhatsApp groups using Google Forms. Out of the total 219 respondents (77.6%), 10.6% experienced instrument breakage once during their clinical internship, while 2.8% encountered it more than once. The majority (86.7%) did not face instrument fracture incidents. Among these occurrences, it was observed that endodontic instruments were most commonly separated in molars, accounting for 51.9%. Nearly half (48.1%) of the students noted instrument breakage during the initial attempt to reach the apical part of the canal, while 55.6% reported breakage during root canal cleaning and shaping. Most dental students opted to leave the separated instrument in the root canal and proceed with filling it. Enhancing students' understanding and awareness of this matter will help prevent potential complications and enable them to handle such situations appropriately when they arise.

A first step towards the detection of damage processes in endodontic Ni-Ti alloy files, using acoustic emission

Despite major instrumental developments over the last decade, endodontic files are still not infallible. It is well known that NiTi rotary files can break without any visible sign of deformation. Instrument breakage under combined flexion-torsion loading is still common in clinical practice. Unfortunately, breakage of this type of instrument mainly occurs in narrow canals, through pinching in the apical region. When such an incident occurs, the endodontist must adopt a debris retrieval strategy that is both stressful and not guaranteed success. This study proposes a new method for experimental damage detection leading to the fracture of Ni-Ti shape memory alloy endodontic files. It is based on the acoustic emission (AE) technique and mechanical parameters measured in real-time and image analysis. It has been shown that the AE results correlate with the damage observations and torque and force measurements recorded during the tests.Having carried out numerous root canal treatment on resin blocks, it appears that this new detection and analysis technique can be used to analyze and anticipate the first signs of damage leading to endodontic file failure. The technological development of such a method, at the level of the engine itself, associated with the act in service procedure, would constitute a revolution in the field of endodontics.

Extraction of Broken Incarcerated Flexible Reamer Using Kuntscher Nail Reamer While Performing Femur Nailing: A Technical Note

Abstract Femur nailing is a standard surgical procedure used to treat femur fractures. Complications can arise such as breakage of the flexible reamer within the femoral canal. This case report presents a very rarely encountered scenario during a femur nailing procedure where a broken flexible reamer was extracted retrogradely from the femoral canal. The extraction was successfully accomplished using a Kuntscher nail reamer, showcasing an alternative technique for addressing such complications. The patient experienced a successful recovery with no significant postoperative complications. This case highlights the importance of proper instrumentation and the adaptability required in orthopedic procedures. Instrument breakage is one of the rare complications faced by surgeons during orthopedic procedures. Preparedness keeping various removal techniques in mind is of utmost importance to come out of such a distressful situation.

Complications of ankle arthroscopy: frequency, prevention, and treatment.

The complication rate of ankle arthroscopy (AA) ranges from 3.5% to 14%. To avoid such complications, it is essential to have a thorough understanding of the anatomy of the ankle, to perform the procedure very carefully and with appropriate instrumentation, and to use a non-invasive distraction technique. The most frequent complications are neurological (cutaneous nerve injuries), which are usually caused by direct injury during arthroscopic portals or by a distracting pin when using an invasive distraction technique. They usually resolve spontaneously within a few months. The iatrogenic formation of a pseudoaneurysm is a severe but extremely rare complication (an incidence of 0.008%). There are several treatments for pseudoaneurysms: external compression; direct thrombin injection, surgical intervention (resection of the damaged segment of the artery and reconstruction with a reversed long saphenous vein interposition graft), and endovascular embolisation. Other rare complications include wound infections (localised superficial infection), problems at the portal incisions (prolonged portal drainage, residual pain in the portal, portal scar dehiscence, cyst at the portal site), type I complex regional pain syndrome, instrument breakage, painful scars and nodules, and a number of other rarer complications. In conclusion, when performing AA, it is important to remember the potential complications and try to avoid them. When they do occur, it is essential to diagnose and treat them appropriately.

Comparative Evaluation of Stress Distribution Against the Root Canal Wall at Three Different Levels by Using TruNatomy, XP-endo Shaper, F360, and 2Shape Files-A Finite Element Analysis.

The aim of this in vitro study was to assess the stress distribution of novel endodontic rotary files of different cross sections and metallurgy against the root canal wall at three different levels by using finite element analysis. A total of 60 novel NiTi rotary files were included in this study after being scanned for any surface deformities using a scanning electron microscope. The scanned files were assigned into 4 groups of 15 samples each based on their metallurgy and design: Group A-TruNatomy, Group B-XP-endo Shaper, Group C-F360, and Group D-2shape files. ANSYS® 15 Workbench finite element software (Canonsburg, Pennsylvania, United States) was used to numerically analyse the stress created by computer-aided models of these instruments on the dentinal wall of a simulated root canal to test the mechanical behaviour of these files. All data were analysed using one-way ANOVA with post hoc Tukey analysis, the Shapiro Wilk test, and Levene's test. The significance level was set at 5%. XP-endo Shaper files employed minimal stress on the surface of dentine during instrumentation, and F360 files exerted maximum stress on the dentinal wall. However, no statistically significant difference was found among the groups in relation to the amount of stress produced at the distinct levels of the root canal wall (p>0.05). There was no discernible difference in stress generation among the four groups in the current investigation. Therefore, it can be inferred that the upgrade in design and metallurgy of rotary files has the potential to downgrade the stress during the shaping of the canal and the menace of instrument breakage during their clinical usage.

Comparative evaluation of stress distribution against the root canal wall at three different levels using novel NiTi rotary files - A finite element analysis.

Recent innovations in the physical and mechanical features of endodontic file systems have diminished the prospect of stress generation and fracture risk in novel endodontic files. The purpose of this research was to comparatively evaluate the stress distribution of recently introduced endodontic rotary files with distinct features and metallurgy at three different levels of the root canal wall by finite element analysis. Forty endodontic files were used in this experiment after being inspected through a scanning electron microscope for any surface deformities. Based on their metallurgy and design, the scanned files were divided into four groups, each with 10 samples: Group A-2Shape files, Group B-F360, Group C-One Curve, and Group D-TruNatomy. To assess the mechanical behavior of these files, the stress produced by computer-aided models of these instruments on the dentinal wall of a simulated root canal was numerically analyzed using ANSYS® 15 Workbench finite element software. A one-way ANOVA was used to assess all the raw data with post hoc Tukey analysis, the Shapiro-Wilk test, and Levene's test. F360 files exerted the maximum stress on the dentinal wall, while TruNatomy files exerted the least stress at all the distinct levels of dentinal walls. There was no statistically significant variation in the stress generated between the four groups. Therefore, it can be concluded that improvements in rotary file design and metallurgy have the potential to reduce the stress during canal shaping and the risk of instrument breakage during clinical use.

Shaping Ability of Different Rotary and Reciprocating File Systems in Simulated S-Shaped Root Canals.

This study aimed to examine the shaping ability of six rotary and reciprocating file systems, as well as hybrid techniques in simulated S-shaped root canals. A hundred and twenty S-shaped radiopaque thermosetting epoxy resin blocks were grouped according to the system used for biomechanical preparation. Six groups of 15 canals each were prepared using TruNatomy, Procodile, VDW Rotate, Hyflex CM, OneCurve, and WaveOne Gold, respectively. Two additional hybrid (Procodile/Hyflex CM and Procodile/TruNatomy) groups (n=15 each) were added after evaluating the results of individual systems. All canals were enlarged to 0.25 mm apically. Canal transportation, centering ability, diameter increase, and iatrogenic errors were assessed by superimposed pre-operative and post-operative images. AutoCAD was used for data analysis. All groups were statistically compared with analysis of variance and Tukey honest significant difference test (p<0.05). Hyflex CM resulted in the most conservative diameter increase in all thirds (coronal, middle, and apical; p<0.001). Procodile showed the best (p<0.001) centering ability in the coronal and middle thirds, while TruNatomy resulted in the least canal transportation and most centering preparation in the apical third (p<0.001). Hybridisation of Procodile and Hyflex CM produced the least canal transportation and best centering ability in the middle third (p<0.001). No instrument breakage occurred, and no ledge, elbow, or apical zip formation was observed during canal preparation. Hybridisation of Procodile and Hyflex CM showed remarkable results in preserving the canal diameter in all thirds and resulted in the least canal transportation and best centering ability in the middle third of the canal. However, when treatment cost and duration limit the clinical applicability of the hybrid technique, clinicians can use a single file system (Hyflex CM or TruNatomy) since it shows satisfactory results in all parameters when compared with a hybrid system.

Intraoperative phacoemulsification tip fracture

Introduction: Intraoperative instrument fractures pose a serious risk during cataract surgery through the retention of metallic foreign bodies and subsequent injury to intraocular structures. Patient and Clinical Findings: An 83-year-old woman underwent phacoemulsification and insertion of an intraocular lens, during which an intraoperative phacoemulsification tip fracture was encountered during quadrant removal. Diagnosis, Intervention, and Outcome: A thorough examination of the operative field revealed the broken tip fragment in the drape bag, with no intraocular fragments. The surgery was completed with a replacement phacoemulsification probe without issues, and the patient made an uneventful recovery. Conclusions: Early diagnosis and management after instrument breakage are necessary to prevent the retention of metallic foreign bodies.

Domino connector for thoracic pedicle subtraction osteotomy reduction: surgical technique and patient series.

Different techniques have been previously described to close the pedicle subtraction osteotomy (PSO) site for correction of sagittal malalignment; the use of a side-to-side domino connector as a correction tool in the thoracic spine has not been specifically studied. Twenty adult patients who underwent single-level thoracic PSO from T1 to T12 were included and retrospectively reviewed (two centers). Preoperative and postoperative full-body X-rays, perioperative data, clinical data and complications were recorded with a minimum 2years of follow-up. Surgical technique and the nuances in using the domino connector were described in detail. Patients had a mean age of 40y; 40% were female. Two different techniques involving the domino were applied for closure of the PSO site depending on the type of kyphosis (smooth vs. angular deformity). Both techniques provided significant correction of the local kyphosis (from 48° to 18°) with reciprocal reduction of compensatory cervical lordosis (from 37.6° to 18.6°, p < 0.01) in upper thoracic PSO or lumbar lordosis (from 74.5° to 46.6°, p < 0.01) in lower thoracic PSO. Four patients presented postoperative complications that resolved (hemothorax, GI bleeding), and two patients presented transient neurological deficit. Oswestry Disability Index score improved in the majority of the patients (from 32.7 to 22.5, p < 0.05). There were no pseudarthroses, symptomatic instrumentation breakage, or surgical site infection. Use of a side-to-side domino connector in combination with two different rod cantilever techniques is effective for the reduction of thoracic pedicle subtraction osteotomy achieving satisfactory radiological and clinical outcome.

Intraoperative breakage of a laparoscopic needle holder confirmed by postoperative abdominal X-ray: A case report and literature review

Introduction: Intraperitoneal retention of surgical instrument fragments may lead to severe complications. Therefore, such foreign bodies must be detected before surgery completion. We present a case with intraoperative breakage of a laparoscopic needle holder confirmed by a routine postoperative abdominal X-ray and review the literature regarding intraoperative laparoscopic instrument breakage. Case Report: A 58-year-old woman with stage IB1 cervical adenocarcinoma underwent a laparoscopic radical hysterectomy. Surgery was completed without major complications; however, an abdominal X-ray as a routine postoperative examination revealed a radiopaque shadow of approximately 3 mm corresponding to a broken part of the tissue-pad of the laparoscopic needle holder tip. It was successfully removed using laparoscopy with fluoroscopic guidance without further complications. According to the literature review, most of the instrument breakage were noticed during surgery as they were either obvious or impaired function. In our case, since the detached foreign body was extremely small and did not significantly affect needle holder function, it remained unnoticed until the postoperative X-ray was taken. Conclusion: Postoperative abdominal X-rays identify instrumental fragments infrequently; however, they may help detect intraperitoneal retention of foreign bodies and avoid serious complications following laparoscopic surgery.

Evaluation of a broken instrument removal training course for general dentistry residents.

To help general dentistry residents better manage the intracanal broken instrument situation, we introduced a hands-on training course into the endodontic curriculum of a general dentistry residency programme. Thirty general dentistry residents and 30 residents with endodontic specialty training background in a general hospital served as the experimental group and reference group, respectively. The experimental group underwent a training course including a 30-min lecture and two hands-on sessions (2 h each). After the course, residents from both groups were asked to perform the instrument removal procedure on simulated root canals. Success rate, procedure time and canal volume change were compared between groups. Questionnaire results were also analysed. All residents successfully managed to remove the broken instruments in the test. Procedure time was significantly longer for general dentistry residents (15.8 ± 5.7min vs 13.7 ± 4.5min, Mann-Whitney U test, p=.038). Canal volume change was significantly greater for general dentistry residents (8.53 ± 3.82 μl vs 5.94 ± 2.73 μl, independent-samples t-test, p=.004). In the questionnaires, trainees gave overall positive ratings for the course. The marginal homogeneity test on before and after scores of the questionnaire items showed the training helped the trainees to reduce the stress level associated with instrument breakage (p <.001). It also motivated the trainees to remove the broken instrument in some straightforward cases (p < .001). The broken instrument removal training course could help the general dentistry residents better manage the intracanal broken instrument situation.

Frequency and structure of arthroscopy complications in patients with knee joint osteoarthritis

BACKGROUND: Arthroscopy is one of the most popular techniques in traumatology and orthopedic practice. The development of the criteria for selection of patients and indications for knee arthroscopy should be carried out for the improvement of arthroscopic technology. It is important to develop safe and informative surgical access to intra-articular structures, optimize stages and techniques, minimize the complications of arthroscopic surgery.&#x0D; AIM: The publications describing results of knee arthroscopy in patients with knee osteoarthritis have been analyzed in the study.&#x0D; MATERIALS AND METHODS: A systematic literature review has been conducted by searching in the Pub-Med/MEDLINE database and eLibrary. The search depth was 20 years; a keyword searching has been performed (including the keywords complications, indications/contraindications for arthroscopy). Possible relevant peri-, intra- and postoperative complications of knee arthroscopy are discussed.&#x0D; RESULTS: Knee joint arthroscopy is the treatment of choice for trauma, injury and orthopedic disease. However, arthroscopy of the knee joint does not always bring a positive effect. The number of negative consequences of this surgical intervention, according to the statistics, range from 0.1 to 2.6% of all cases of knee joint arthroscopy. Complications can be local and systemic and develop both in the early postoperative and in the long-term period after the operation. The review is devoted to the analysis of the data concerning the frequency and structure of knee arthroscopy complications in patients with osteoarthritis of knee joints.&#x0D; CONCLUSIONS: Intra- and postoperative complications of arthroscopic surgery of the knee joint include nerve and vascular lesions, port disposition, thrombosis, pulmonary embolism, instrument breakage, and compartment syndrome associated with a defect in the joint capsule and leakage of irrigation fluid. In the postoperative period, complications such as hemarthrosis, thrombosis, pulmonary embolism, infection and synovial fistulas are possible. Complications of the late postoperative period of arthroscopic interventions are arthrofibrosis, Ahlbacks disease or aseptic osteonecrosis of the femur or tibia, as well as complex regional pain syndrome.

An in vitro comparative assessment of manual hand file, rotary protaper ni-ti, erbium:yttrium-aluminum-garnet laser, canal brush, and ultrasound methods for smear layer removal.

Selection of instruments is important to prevent any complications such as ledge formation and instrument breakage. The main drawback linked with instrumentation is smear layer formation. This study was done for comparison of manual hand file, rotary ProTaper Ni-Ti, erbium:yttrium-aluminum-garnet (Er:YAG) laser, ultrasound, and CanalBrush (CB) methods for smear layer removal. Sixty freshly extracted single-rooted mandibular first premolars extracted for orthodontic treatment purpose were selected and classified into six groups. Group I was negative control in which no final agitation of irrigant was performed. In Group II, solution activation was performed with ProTaper Universal System, in Group III, solution activation was done with canal brush, in Group IV, ultrasound activation was done, in Group V, solution agitation was performed with Er:YAG laser agitation, and in Group VI, canal preparation with hand files was performed. Smear layer score was evaluated after canal preparation with each method. Score 1 was seen in 3 (30%) in Group IV and 6 (60%) in Group V, score 2 was seen in 3 (30%) in Group I, 8 (80%) in Group II, 7 (70%) in Group III, 5 (50%) in Group IV, 3 (30%) in Group V, and 4 (40%) in Group VI. Score 3 was observed in 7 (70%) in Group I, 2 (20%) in Group II, 3 (70%) in Group III, 2 (20%) in Group IV, 1 (10%) in Group V, and 6 (60%) in Group VI. A statistically significant difference was found in smear layer removal score in all groups (P < 0.05) except between Group I versus VI (P > 0.05). Complete removal of the smear layer was not observed in any of the methods used in the study; however, Er: YAG laser was found to be better as compared to other methods.

Apicoectomy of palatal root in upper 1 molar to remove endodontic instrument: Rare case report

A wide range of accidents might happen during the treatment of the root canal system, where the instrument breakage is one of the most unpleasant occurrences. Several techniques have been developed to facilitate the removal of the broken instruments. The aim of this article is to present the surgical removal of a broken endodontic file from the periapical region of the palatal root of a maxillary first molar depicting importance of radiographs.

Effects of Growing Rod Technique with Different Surgical Modes and Growth Phases on the Treatment Outcome of Early Onset Scoliosis: A 3-D Finite Element Analysis.

Early onset scoliosis (EOS) is emerging as a serious threat to children’s health and is the third largest threat to their health after myopia and obesity. At present, the growing rod technique (GRT), which allows patients to regain a well-balanced sagittal profile, is commonly considered as an invasive surgical procedure for the treatment of EOS. However, the risk of postoperative complications and instrumentation breakage remains high, which is mainly related to the choice of fixed mode. Several authors have studied primary stability and instrumentation loads, neglecting the mechanical transmission of the spinal long-segment model in different growth phases, which is fundamental to building a complete biomechanical environment. The present study aimed to investigate the kinematic and biomechanical properties that occur after GRT, across the long spinal structure and the posterior instrumentation, which are affected by unilateral or bilateral fixation. Accordingly, spinal segments (C6-S1) were loaded under flexion (Flex), extension (Ext), left lateral bending (LB), right lateral bending (RB), left torsion (LT), and right torsion (RT) using 11 established spinal models, which were from three growth phases. The stress distribution, spinal and intervertebral range of motion (ROM), counter torque of the vertebra, and bracing force on the rods were measured. The results showed that bilateral posterior fixation (BPF) is more stable than unilateral posterior fixation (UPF), at the expense of more compensations for the superior adjacent segment (SAS), especially when the superior fixed segment is closer to the head. Additionally, the bracing force of the instrumentation on the spine increases as the Cobb angle decreases. Accordingly, this biomechanical analysis provides theoretical suggestions for the selection of BPF or UPF and fixed segments in different growing phases.

Influence of operator expertise on glide path and root canal preparation of curved root canals with rotary and reciprocating motions.

This study intended to help practitioners selecting the appropriate motion according to their level of expertise for glide path and complete root canal preparation of curved canals in terms of instrument fracture and preparation time. A total of 160 curved root canals (angle >30°, radius <6 mm) were allocated randomly to 4 groups: A/B for expert operators and C/D for nonexpert operators. A/C were shaped with rotary and B/D with reciprocating instruments. Preparation time was registered and compared with Kruskal-Wallis non-parametric test and Dunn's post hoc test. Instrument separation was also registered and compared with chi-square test. A fractographic analysis was performed with scanning electron microscopy. The use of reciprocation motions allowed nonexpert operators to avoid instrument breakage during glide path and to prepare root canals faster. Experts were equally effective in rotary/reciprocating root canal shaping and faster with rotary motions than nonexpert operators, who also fractured significantly more rotary instruments.

Clinical and functional outcome of different modalities of meniscus repair

Meniscus injuries are common results of sports related injuries and motor vehicle accidents current arthroscopic meniscus repair is indicated for management of meniscal tears because of early rehabilitation and return to work, minimal complications.Present study is hospital based prospective study of 30 cases admitted at P.D.U. Medical College and hospital, Rajkot from 2018 to 2020.commonage group was between 18 to 60 years with mean age of 34.03years, 22 were male and 3 were female. meniscal injury on right knee were 20 cases and left knee were 10.Type of meniscal tear were longitudinal 26 cases,3 cases of radial tear and 1 case of horizontal tear. Meniscal injuries associated with partial ACL Tear were 13 cases, there were 1 cases of associated with loose bodies and lateral meniscus cyst, loose bodies were removed and cyst excised arthroscopically .Average duration of hospital stay was 5 days ranging from 3to 6 days earliest return to activity on average was 5.5 weeks with range of 4 to 6weeeks. There were 1 case of superficial stich infection and 1 of haemarthrosis which resolved on 4thday.intraoperatively 1 case of breakage of instrument but no damage to cartilage or meniscal tissue. All meniscus repair techniques outside in, inside out, and all inside technique combination of all yields comparative clinical and functional outcome and statistically difference of result is not significant. Excellent to good results were in 99.66%cases.

Evaluation of primary hip arthroscopy complications in mid-term follow-up: a multicentric prospective study.

Hip arthroscopy is a common procedure in hip preservation surgery. Its complication rate is relatively low. This prospective multicentric study evaluates complication rate in patients undergoing primary hip arthroscopy. The study cohort consisted of 908 patients mean age of 37years (14-67years). Patients were prospectively included in the study in the years 2009-2017. All complications were recorded and evaluated. The minimum follow-up was 36months. Results were statistically evaluated and risk factors for complications were identified. The overall complication rate was 7.3% (67/908 cases), the minor complication rate of 4.9% (45/908 cases) and the major complication rate 2.4% (22/908 cases). The most common severe complications were iatrogenic cartilage damage and instrument breakage, while the most common minor complications were perineal hypoaesthesia and heterotopic ossifications. The conversion rate to total hip replacement was 4.2% (39/908 patients). Hip arthroscopy is a safe procedure with low complication rates. Surgeon training and experience greatly influence the complication rates.

Intraoperative breakage of a 25-G vitrectomy probe tip

We report breakage of the tip of a 25-G advanced ULTRAVIT vitreous cutter during vitrectomy for vitreous hemorrhage. During the procedure, we noticed that the cutter tip broke. We switched to another vitrectomy pack of the same brand, and the procedure continued without further complications. Intraoperative and postoperative examinations revealed no broken pieces remaining in the eye. Breakage of 25-G instruments intraoperatively during vitrectomy is a rare occurrence that can lead to complications. Keeping the vitrectomy probe at a safe distance from the light pipe and inspecting the instruments while working inside the eye can help avoid such an event.