Intraosseous Fixation Research Articles

Radial tuberosity anatomy in intramedullar repair of distal biceps tendon ruptures. A radiological study.

The aim of this study was to measure cortex thickness and medullar canal width of the bicipital tuberosity, to evaluate the accessibility of a intramedullar fixation device and the resistance to pullout strengths of the anterior cortex. The final objective was to determine the length of tendon ingrowth size that will be expected when using this surgical technique. A total of 144 computer tomography images of the proximal radius were used. Bone thickness of the anterior and posterior cortex and medullar canal size were measured. The possible ingrowth of the tendon was measured both for an anatomical and non- anatomical reinsertion. Statistical and concordance analyses of results were performed. The average width of the medullar canal was 8,7mm proximal, 7,9mm distal and 7,7mm at the tuberosity. The average posterior and anterior cortex measured respectively 2,5mm and 2,9mm proximal, 3,2mm and 3,2mm distal and 2,8mm and 1,9mm at the radial tuberosity. The possible non-anatomical ingrowth was 7,6 mm on average and the possible anatomical ingrowth was 7,6mm on average. The radial tuberosity anatomy can accommodate the new distal biceps fixation device. The anterior cortex on which the new device relies for support has a similar thickness as the posterior cortex used in bicortical fixation devices which may suggest similar resistance to pull-out strengths. The availability for intra-osseous fixation of the tendon stump may avoids tendon gapping. The intra-osseous length for the tendon stump surpassed reported tendon slippage during mobilization and active contraction of the distal biceps tendon.

Arthrodesis of the first metatarsophalangeal joint using an intraosseous fixation device.

The complication rate for an arthrodesis of the first metatarsophalangeal joint remains high. To improve results, we used a complete intraosseous fixation device (IOFIX) with proposed biomechanical advantages. Our hypothesis is that this technique has at least an equal union rate and less hardware irritation compared to other techniques. Seventy procedures were performed in 55 patients. Average follow-up was 24.5 months. All patients returned to follow-up after 6 weeks and were evaluated for union. Fifty-nine feet (84%) completed full follow- up. Union occurred in 62 of 70 feet (88.5%). Eight feet had nonunion at 1 year follow-up. Average time to fusion was 51 days. Three of 59 feet had malunion. No hardware removal was necessary. In conclusion, an MTP1 arthrodesis using IOFIX provides consistent and good functional outcomes. Due to the low-profile design, no hardware removal was necessary. However, union rates seem slightly lower compared to other techniques.

Early Results and Patient-Reported Outcome Measures (PROMS) of an Intraosseous Device for Arthrodesis of the First Tarso-Metatarsal (TMT) Joint.

We describe a new surgical technique for arthrodesis of the first tarso-metatarsal (TMT) joint using an intraosseous fixation device and the early results including patient-reported outcome measures (PROMS). Seventeen consecutive procedures with this method were included. Indication for surgery was hallux valgus. The average age was 42years (range 26-65). PROMS were collected and the patients were asked to fill out a satisfaction questionnaire. A retrospective review of radiographs and electronic medical notes was conducted. Overall fusion rate was 94%. Complications included a case of failed fusion, a superficial wound infection and a deep vein thrombosis (DVT). At a mean follow-up of 24months (range 10-38) radiographic results demonstrated significant improvement in the intermetatarsal angle or IMA (11.7 ± 2.8 degrees to 6.9 ± 2.4 degrees, P < 0.001) and hallux valgus angle or HVA (28.1 ± 7.3 degrees to 12.2 ± 4.3 degrees, P < 0.001). The mean visual analog scale (VAS) score improved significantly from a mean of 7.6 (SD 0.85) preoperatively, to a mean of 2.1 (SD 1.83) post-operatively (P < 0.0001). The Manchester-Oxford Foot Questionnaire (MOXFQ) significantly improved from a mean of 35.8 (SD 10.2), to a mean of 9.2 (SD 17) (P < 0.0001). The final result was satisfactory for 88% of the patients. The early results show intraosseous fixation to be a safe and efficient method for the fusion of the first TMT joint providing good patient satisfaction.

Хирургическое лечение диафизарных переломов плечевой кости с применением аппарата внешней фиксации

The article presents the results of surgical rehabilitation of 21 patients with diaphyseal fractures of humerus diaphysis, with localization in the middle-lower third of the diaphysis, using transosseous osteosynthesis with an external fixation device. Evaluation of the results was carried out by retrospective analysis of the outcomes of surgical rehabilitation of patients with humerus diaphysis fractures using transosseous osteosynthesis by external fixation apparatus in the period from 2015–2020. It showed that the modified closed transosseous osteosynthesis by external fixation apparatus and the use of a rod line-up allows significantly reducing the risks of complications in comparison with the traditional technology of bone and intraosseous fixation and achieving excellent and good results in 85.7% of patients with diaphyseal fractures of the humerus.

Intraosseous device for arthrodesis in foot and ankle surgery: Review of the literature and biomechanical properties.

BACKGROUNDArthrodesis is the surgical fusion of a diseased joint for the purposes of obtaining pain relief and stability. There have been numerous fixation devices described in literature for foot and ankle arthrodesis, each with their own benefits and drawbacks. AIMTo review the use of intraosseous devices in foot and ankle surgery. METHODSThere were 9 papers included in the review (6 clinical and 3 experimental studies) all evaluating arthrodesis in the foot and ankle using the IOFIX device (Extremity Medical™, Parsippany, NJ, United States). Outcome scores, union rates, as well as complications were analysed. RESULTSIOFIX appears to be safe and effective in achieving arthrodesis of the 1st metatarsophalangeal, and talonavicular joints with early rehabilitation. In comparison to plate/screw constructs there were fewer soft tissue complications and issues of metalwork prominence. Cadaveric and biomechanical studies on the use of intramedullary fixation for fusion of the tarsometatarsal and ankle joint showed decreased load to failure, cycles to failure and stiffness in comparison to traditional fusion methods using plates and screws, however IOFIX devices produced higher compressive forces at the joint. CONCLUSIONWe describe the reasons for which this biomechanical behavior of the intraosseous fixation may be favorable, until prospective and comparative studies with larger sample size and longer follow-up confirm the effectiveness and limitations of the method.

Bone Coverage around Hydroxyapatite/Poly(L-Lactide) Composite Is Determined According to Depth from Cortical Bone Surface in Rabbits.

Composites of unsintered hydroxyapatite (HA) and poly(L-lactide) (PLLA) reinforced by compression forging are biodegradable, bioactive, and have ultrahigh strength. However, foreign body reactions to PLLA and physical irritation can occur when not covered by bone. We aimed to confirm the relationships between the depth of the implanted HA-PLLA threaded pins and the new bone formation. We inserted HA-PLLA composite threaded pins (diameter: 2.0 or 4.5 mm) into the femoral and tibial bones of 32 mature male Japanese white rabbits (weight 3.0–3.5 kg) with the pin head 1 or 0 mm below or protruding 1 or 2 mm above surrounding cortical bone. Eight euthanized rabbits were radiologically and histologically assessed at various intervals after implantation. Bone bridging was complete over pins of both diameters at ~12 weeks, when inserted 1 mm below the surface, but the coverage of the pins inserted at 0 mm varied. Bone was not formed when the pins protruded >1 mm from the bone surface. No inflammation developed around the pins by 25 weeks. However, foreign body reactions might develop if composites are fixed above the bone surface, and intraosseous fixation would be desirable using double-threaded screws or a countersink to avoid screw head protrusion.

Does the IOFix implant improve union rates?

BackgroundFirst metatarso-phalangeal joint fusion is the current gold standard for severe hallux rigidus. Data regarding the union rate and the re-operation rate when IOFix (an Intra-osseous fixation device, Extremity medical, New Jersey, USA) is used for hallux rigidus fusion is limited but promising. The aim of this study was to review our outcomes with the IOFix implant.MethodsWe have conducted a retrospective chart review, following the approval of the hospital IRB committee. Exclusion criteria included bilateral operations on the same patient, multiple surgeries, charcot foot or other structural foot abnormalities (except hallux valgus), rheumatoid arthritis and a recent foot trauma. We collected demographic data, physical examination documentation, functional score evaluations (AOFAS), and Plain radiographic studies.ResultsThirty patients were included in the study. The mean age was 60.36 ± 9.12 (range 36 to 77) years, 18 (60%) female patients and 12 (40%) male. Fourteen (53.33%) were left side pathologies. The average follow up period was 36.2 ± 12.31 (range 12 to 54) months. Union was obtained in 28 (93.33%) patients, of whom none had requested a hardware removal due to a prominent hardware during a minimum of 2 year follow up period. The mean postoperative AOFAS score was 80.5 ± 10.87 (range 35 to 90). A more stringent inclusion criteria and fusion definitions would have led to an exclusion of two more patients and a dropout of two patients from the “fused” group, which would have led to a fusion rate of 85.71%.ConclusionsThis is the largest series of hallux rigidus patients that were operated with an IOFix device. The rates of fusion and hardware removal in MTPJ1 arthrodesis performed with an IOFix implant were found to be similar at most when compared to previously described rates that were obtained with other cheaper and more simple fixation devices.Level of evidence4

Mechanical properties of the bone-implant systems in conditions of the stable functional osteosynthesis

Fractures of the diaphysis of leg bones make up 45% of all long bone fractures, they are one the most common injuries to the bones of the limb segments, the treatment of which is accompanied by a large number of complications, therefore the problem of improving the treatment of patients with this injury is still relevant for present traumatology and orthopedics. The use of compression distraction systems, intramedullary and extramedullary osteosynthesis systems allows a stable functional osteosynthesis and eliminates the need for additional gypsum immobilization of a segment or limb in the postoperative period. Biomechanical relations in the bone-implant system in conditions of a stable functional osteosynthesis constitute an important factor allowing to objectify the mode of motion rehabilitation in the early postoperative period. This work studies the results of the comparative bench tests of groups of cadaver tibia in experimental injuries of type 42 A 1.1. (according to the Association for Study of Internal Fixation (AO/ASIF)) synthesized with different types of implants, such as Fixion expanding system of fixation, external fixation devices, Limited Contact Dynamic Compression Plate (LC-DCP) and blocked intramedullary osteosynthesis system (BIOS)). Each system was axially compressed using INSTRON 1185. Resistance to axial compression has been analyzed. It is noted that all these types of fixations increase the strength of the systems in the range of 22–81% compared to the intact specimens. Intraosseous fixation systems demonstrated the highest strength, which has the most optimal biomechanical relations in the bone-implant system, allowing to objectify the regime of motion rehabilitation.

Clinical application of intraosseous internal fixation in ankle-foot arthrodesis

Objective To investigate the short-to medium-term therapeutic effects of a new internal fixation device, intraosseous internal fixation (IO-FIX), in the foot-ankle arthrodesis. Methods From August 2016 to December 2018, 32 patients (40 feet) underwent foot-ankle arthrodesis with IO-FIX at De-partment of Orthopaedic Surgery, The Ninth People’s Hospital of Shanghai.They were 6 males and 26 fe-males, aged from 23 to 83 years (61.7±15.1 years).There were 28 cases (36 feet) of hallux valgus, 2 cases (2 feet) of ankle arthritis, one case (1 foot) of ankle rheumatoid arthritis and one case (1 foot) of naviculocuneiform arthrosis.The therapeutic effects were assessed in terms of imaging evaluation, American Orthopaedic Foot and Ankle Society (AOFAS) score, fusion rate and full weight-bearing time. Results The follow-up ranged from 3.0 to 31.3 months (mean, 12.6 months).The total fusion rate was 95.0%(38/40); the total AOFAS score increased significantly from preoperative 41.9±9.5 to postoperative 86.9±4.7 (P< 0.05).The 28 patients (36 feet) with hallux valgus achieved a successful fusion rate of 97.2%(35/36) and full weight-bearing at 8 weeks after operation.Their fusion time ranged from 45 to 64 days (57.1 days).Their metatarsophalangeal angle was decreased significantly from 52.1°±13.5° preoperatively to 13.4°±4.9° postoperatively and their 1-2 intermetatarsal angle significantly from 14.5°±2.4° to 8.9°±2.4° (P<0.05). Their AOFAS ankle-hindfoot score was improved significantly from 41.8±9.9 to 87.0±4.8 (P<0.05). All the 3 cases of ankle arthrodesis achieved good bone union and full weight-bearing within 12 weeks and their AOFAS ankle-hindfoot score was improved significantly from preoperative 43.4±3.5 to 86.3±3.5 at the final follow-up. Conclusion In foot-ankle joint arthrodesis, due to advantages of stable fixation, zero profile, limited soft tissue irritation, reinforced bone bridge and easy reproducibility, IO-FIX can lead to satisfactory short-to mid-term therapeutic effects. Key words: Foot; Arthrodesis; Internal fixators

A Colombian experience involving SpineJack®, a consecutive series of patients experiencing spinal fractures, percutaneous approach and anatomical restoration 2016-2017.

Spinal fractures are becoming more frequent and should be handled as a severe and endemic pathology that requires timely diagnosis and adequate treatment. The classification of the AOSpine is currently the classification used for this type of fractures, not only for its approach, but to predict surgical management. These patients had spinal fracture reduction procedures done through percutaneous way with expander endovertebral implants, and intraosseous fixation using SpineJack® intravertebral implants plus Cohesion® cement. Within the follow-up scheme, subsequent measurements were taken after a week, a month after surgery, 3 months after the procedure and after 6 months of follow-up. STATA® (Statistical Analysis System, version 12.1, SAS Institute Inc., Cary, NC, USA) was used for all analyzes. The Wilcoxon or Student's t-test was used for comparisons in pairs depending on the normality of the distribution. A clinical follow-up is performed to 20 consecutive patients experiencing spinal compression fractures (SCF) who received percutaneous treatment involving SpineJack® and Cohesion® cement, resulting in a statistically significant decrease of both pain and pain-related disability. No complications arose from the procedure. According to the observations, which reflect what is found in the world literature, this is an effective and safe way of handling SCF.

Result of IOFIX (Intra Osseous FIXation) device for first metatarsophalangeal joint arthrodesis: A single surgeon’s series

BackgroundArthrodesis of the first metatarsophalangeal joint (MTPJ) is a common procedure to treat significant first MTPJ arthritis. However, dorsal plates used for this have been associated with high incidence of metalwork removal. The IOFIX (Intra-Osseous FIXation) is a fixed angle device that is noted to provide a more uniform compression over a larger aspect of the fusion surfaces than a screw construct alone with the advantage of minimizing soft tissue irritation which can reduce the need for subsequent implant removal. MethodsTwenty one consecutive patients who underwent primary first MTPJ fusion with the IOFIX were reviewed. The mean age of the cohort was 63 years (range 47–81), with 80% female. The ratio of left to right was 9:12. The mean follow up of was 28 months (range 13.4–48.2 months).Outcomes analyzed were rate of fusion, Manchester-Oxford foot questionnaire (MOXFQ) score, patient satisfaction, improvement in the intermetatarsal angle and complications. ResultsComplete fusion of the first MTPJ was achieved in twenty (95%) patients. One patient had a non union and another patient developed a delayed union. The mean preoperative MOXFQ score improved from 49.7 (95% confidence interval: 46-52) to 17.9 (95% confidence interval: 12-22), p<0.05.Improvement gained in all the domains of the MOXFQ score (walking/standing, pain and social) was statistically significant (p<0.05). Eighteen out of 21 patients (85%) were very pleased or fairly pleased with the procedure. ConclusionEarly results show that the rate of fusion achieved by using the IOFIX device for the first MTPJ arthrodesis in our series was found to be comparable to other devices quoted in the literature.

Early results of an intraosseous device for arthrodesis of the hallux metatarsophalangeal joint.

Background:Arthrodesis of the hallux metatarsophalangeal (MTP) joint is commonly done as a primary procedure either to correct severe hallux valgus deformities or for rheumatoid arthritis, hallux rigidus, in patients with neuromuscular disorders and as a salvage procedure for failed bunion surgery or infection. Prominent metalwork frequently can cause soft tissue impingement and thus require removal. In contrast, osteosynthesis with a completely intraosseous implant has the advantage of less damage to the periosteal circulation. We describe a surgical technique and the early results of arthrodesis of the hallux metatarsophalangeal (MTP) joint using an intraosseous fixation device.Materials and Methods:Twelve consecutive patients operated with this method were retrospectively reviewed. The average age was 57 years (range 44–88 years). A retrospective review of radiographs and electronic medical notes was conducted. The patients were also asked to fill a satisfaction questionnaire.Results:Overall fusion rate was 91% with a mean hallux valgus angle of 15° (range 4–20°) and a mean dorsiflexion angle of 20° (range 7–30°). Complications included a case of failed fusion, a delayed union, and a case of persisting transfer metatarsalgia. At a mean followup of 14 months (range 5–28 months), the mean visual analog scale improved significantly from a mean of 8.4 (range 7–10) preoperatively, to a mean of 3.1 (range 0–7) postoperatively (P < 0.0001). The mean American Orthopaedic Foot and Ankle Society hallux score also significantly improved from 29.4 (range 10–54) to a mean of 73.3 (range 59–90) (P < 0.0001). The final result was satisfactory for 83% of the patients.Conclusions:The early results show intraosseous fixation to be a safe and efficient method for the fusion of the hallux MTP joint providing relief from pain and patient satisfaction.

Adolescent patellar instability: current concepts review.

Patellar instability most frequently presents during adolescence. Congenital and infantile dislocation of the patella is a distinct entity from adolescent instability and measurable abnormalities may be present at birth. In the normal patellofemoral joint an increase in quadriceps angle and patellar height are matched by an increase in trochlear depth as the joint matures. Adolescent instability may herald a lifelong condition leading to chronic disability and arthritis. Restoring normal anatomy by trochleoplasty, tibial tubercle transfer or medial patellofemoral ligament (MPFL) reconstruction in the young adult prevents further instability. Although these techniques are proven in the young adult, they may cause growth arrest and deformity where the physis is open. A vigorous non-operative strategy may permit delay of surgery until growth is complete. Where non-operative treatment has failed a modified MPFL reconstruction may be performed to maintain stability until physeal closure permits anatomical reconstruction. If significant growth remains an extraosseous reconstruction of the MPFL may impart the lowest risk to the physis. If minor growth remains image intensifier guided placement of femoral intraosseous fixation may impart a small, but acceptable, risk to the physis. This paper presents and discusses the literature relating to adolescent instability and provides a framework for management of these patients. Cite this article: Bone Joint J 2017;99-B:159-70.

Intra-Osseous Arthrodesis Techniques in the Foot and Ankle

Category: Ankle Arthritis Introduction/Purpose: Arthrodesis is considered the standard operative treatment for end-stage arthritis in the foot and ankle. The long-term effects of implant choices for fusions are largely unexplored in the literature. Many companies advertise implants as being "lower profile" and "less painful." The purpose of this study was to perform a clinical and radiographic review to determine outcomes, specifically rates of symptomatic hardware, using four major arthrodesis techniques in joints in the foot and ankle. Methods: A retrospective study was conducted including one-hundred and twenty-three patients (a total of 197 joints) who underwent arthrodesis of the ankle, or joints in the midfoot or hindfoot. A total of 197 joints underwent arthrodesis in this patient group. Four groups were created based on fixation methods; standard screw fixation, plate and screw fixation, screw-in- post fixation(so-called "intra-osseous" fixation), and a group using a combination of fixation methods. Through chart review and radiographic analysis, outcomes including fusion rate, pain at specific follow-up intervals(6-weeks, 3-months, 6-months, and 1-year), and symptomatic hardware requiring hardware removal were compared across groups. Results: No differences were found in fusion rates between the four groups. Non-union rates, hardware loosening, infection, and wound breakdown rates were all comparable across the cohort. Rates of reported pain at 6-weeks and 3-months were similar for all groups but the "plate and screw fixation" group reported significantly more pain at 6 months(p=0.035) and 1 year(p=0.022) than the other three groups and, subsequently, rates of symptomatic hardware requiring removal were significantly higher in this group as well. The patient population had higher rates of diabetes mellitus, human-immunodeficiency virus (HIV) and hepatitis C virus (HCV) than reported in recent studies of comparable design. Conclusion: In this high risk patient population, implant choice in arthrodesis of the midfoot, hidfoot or ankle has a significant effect on patient-reported pain during follow-up. In this cohort, the group fused with intra-osseous fixation methods did not demonstrate superiority with regards to rates of patient-reported post-operative pain related to hardware. Clinicians should expect significantly increased rates of symptomatic hardware when using plate fixation in fusions of the ankle, midfoot and hindfoot.

Anatomic Interosseus Membrane Reconstruction Utilizing the Biceps Button and Screw Tenodesis for Essex-Lopresti Injuries

Longitudinal radioulnar dissociation, also known as the Essex-Lopresti lesion, is a potentially debilitating condition causing painful instability of the forearm that often results from high-injury trauma with compromise of the proximal radius, triangular fibrocartilage complex, and the interosseous membrane. Indications for reconstruction of the interosseous membrane primarily include chronic instability of the forearm. Our reconstructive technique utilizes an anatomic allograft reconstruction with intraosseous fixation, in an effort to biologically reconstruct and anatomically tension the central band of the interosseus membrane.

Fully Threaded Versus Partially Threaded Screws: Determining Shear in Cancellous Bone Fixation

Many researchers have studied and compared various forms of intraosseous fixation. No studies have examined the effects of shear through stiffness and failure strength of a fully threaded versus a partially threaded screw. Our hypothesis was that the fully threaded lag screw technique would provide greater shear strength and resistance. Thirty-six synthetic sawbone blocks were used to test screw fixation. In group 1 (n = 9), 2 blocks were fixed together using a fully threaded 4.0-mm stainless steel cancellous bone screw and the lag technique. In group 2 (n = 8), 2 blocks were fixed together using the standard manufacturer-recommended method for inserting 4.0-mm partially threaded stainless steel cancellous bone screws. The constructs were then mechanically tested. Shear was applied by compressing each construct at an axial displacement rate of 0.5 mm/s until failure. The fully threaded screw had a significantly greater (p = .026) initial stiffness (106.4 ± 15.8 N/mm) than the partially threaded screw (80.1 ± 27.5 N/mm). The yield load and displacement for the fully threaded group (429.4 ± 11.7 N and 7.2 ± 0.35 mm) were 64% and 67% greater than those for the partially threaded screw group (261.4 ± 26.1 N and 4.3 ± 1.03 mm), respectively. The results of the present study have demonstrated the importance of a full-thread construct to prevent shear and to decrease strain at the fracture. The confirmation of our hypothesis questions the future need and use of partially threaded screws for cancellous bone fixation.

Évaluation d’une modification de la technique d’arthrodèse totale du poignet rhumatoïde selon Mannerfelt. À propos de 19 cas

We studied a technical modification of Mannerfelt's total wrist fusion technique in a series of 19 wrists. A fully intramedullary technique without dorsal carpal fixation was used to protect the extensor tendons. Two intramedullary Rush pins without dorsal staples were used during the arthrodesis procedure. Nineteen rheumatoid arthritis wrists (2 bilateral cases) were reviewed with a mean follow-up of 4.9 years (range 2–10 years). Clinical outcomes were assessed using the VAS pain scale, DASH-score and wrist strength measurements. Wrist fusion was assessed on AP and lateral X-rays of the wrist. The position of the carpal Rush pin entry points and distal hook orientation were also assessed. Pain was 8.9 preoperatively and 1.1 at the last follow-up with 95% patients satisfied. Mean DASH-score was 46.9 points. The pinch strength was 79% and the grip strength was 68% of the contralateral wrist. Carpal height, carpal anterior subluxation and ulnar deviation were stable at the last follow-up. All of the wrists were in straight position and no extensor tendon ruptures were noted. Fusion was complete in all cases within 6 to 12 weeks, except in one case. The technical modification proposed in the current study —intraosseous fixation only— appears to be a good alternative to Mannerfelt's original technique. Every case treated with this modified technique had good functional results and none required pin removal.

Does the IOFIX improve compression in ankle fusion?

The new IOFIX is an intra-osseous fixation device comprising an "X-post" through which a lag screw passes to apparently improve force distribution across an arthrodesis. We conducted a novel human cadaveric study. Our null hypothesis was no difference in force exists in an ankle arthrodesis model stabilized with the IOFIX or a conventional single lag screw. In ten cadaver ankles a pressure transducer was compressed as an IOFIX and standard single lag screws were alternately compared. The median average force created by the IOFIX was 3.95kg and 2.4kg for the single conventional lag screw (p⩽0.01). The IOFIX improved contact area across the arthrodesis with a median average of 3.41cm(2) compared with 2.42cm(2) in the lag screw group (p⩽0.03). Our results suggest an IOFIX improves force distribution across an ankle arthrodesis compared with a single conventional lag screw.

Fixation of acute distal biceps tendon ruptures using mitek anchors: a retrospective study.

Purpose of this Study:The aim of this study was to evaluate the outcomes of surgical intra-osseous fixation of the distal tendon of the ruptured biceps brachii muscle using Mitek anchors.Materials and Methods:Between 2005 and 2011, seven patients underwent unilateral distal biceps tendon repair using Mitek anchors. All patients were men aged between 36 and 47 years. Six patients were assessed by physical examination and use of the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire.Results:Surgery was performed within 3 to 17 days of rupture with a mean follow-up of 35 months. Of the six fully completed DASH questionnaires, three patients had a score of 0, and three patients had scores of 5.8, 10 and 10.8, respectively (10.1 is the mean score for the general population). Transient paraesthesias in the lateral antebrachial cutaneous nerve region occurred in two patients and one patient experienced a transient stiffness of the elbow due to scarring of the wound. No major complicatons have occurred.Conclusion:The use of Mitek anchors for the re-insertion of the ruptured distal biceps tendon proved to be a safe and effective technique with excellent functional results in our series.

Suture Suspension Brow-Lifting: The Minitac System

As their face ages, a significant number of individuals require elevation of the eyebrows to improve brow-ptosis and pseudo-ptosis of the upper eyelids. This may be for functional disability, i.e. when there is a reduction in visual fields, or for purely cosmetic reasons. Eyebrow elevation can be achieved by non-surgical or by direct surgical methods. There are advantages and disadvantages to the non-surgical use of Botulinum Toxin or fillers, and minimally invasive techniques such as endoscopic methods or Endotine® fixation. Bicoronal brow lift procedures appear to be reducing in popularity compared to the other methods. Suture suspension of the brow is not new but recently Minitac®, a kit system that allows intra-osseous fixation using two non-absorbable paired needle sutures, has been introduced. Whilst this system was primarily developed for ligament to bone approximation, we demonstrated in this mini-series that it can be adapted to provide a simple and effective means for brow lifting, whilst controlling the vectors of elevation. Due care and the understanding of anatomy are essential.