Intramedullary Pin Research Articles

Stifle hyperextension identified in a dog with an excessively negative tibial plateau angle and a grossly intact cranial cruciate ligament following inappropriate cranial closing wedge ostectomy

AbstractA cross breed dog was examined due to an abnormal right pelvic limb gait following cranial closing wedge ostectomy surgery. Gait evaluation revealed stifle hyperextension during the stance phase of the gait. Manipulation of the stifle revealed no cranial or caudal drawer and no cranial tibial thrust. Radiographs showed complete healing of the proximal tibial osteotomy, with a tibial plateau angle (TPA) of –14°. Computed tomography showed 20° of external tibial torsion on the right pelvic limb. A mini‐medial stifle arthrotomy revealed no gross damage to the cruciate ligaments and intact menisci. A cranial opening wedge osteotomy of 17° was performed and the torsional alignment corrected, after which the tibia was stabilised with orthogonal plates and an intramedullary pin. The postoperative radiographs confirmed a satisfactory TPA of 3° and normal tibial alignment. At 6 months follow‐up, a video record revealed normal right pelvic limb gait.

Is the osteosynthesis of lateral malleolar fractures by pin/cerclage effective? A retrospective study

IntroductionLateral malleolar fractures are present in about 90% of ankle fractures. The standard treatment is plate osteosynthesis. Although the plates are thin, the risk of cicatricial complications is not insignificant and can lead to cutaneous or even infectious complications and the latter can cause functional repercussions. We therefore aimed to evaluate a technique consisting of osteosynthesis of the lateral malleolus using two cerclages and two intramedullary pins. HypothesisOur hypothesis is that the use of osteosynthesis by pin/cerclage of the lateral malleolus makes it possible to have objective reduction criteria, similar to the reference treatment. MethodsThis is a retrospective study of patients who had an interligamentous spiral fracture of the lateral malleolus. One group of patients had internal fixation of the lateral malleolus fracture by pins, and the other by plate. Our primary outcome was to compare the reduction of the fracture of the lateral malleolus between the two techniques using the “Dime sign”, the measurement of the talocrural angle and respect for Shenton's line. ResultsA total of 118 lateral malleolar fractures were included: 56 patients (47.5%) in the “pin” group and 62 patients (52.5%) in the “plate” group. The mean age of the patients was 46.6 years (17.4) with an average body mass index of 25.2kg/m2 (4.8) and 55.1% of the patients were women. We found a difference in the reduction criteria between the two groups by looking at Shenton's line: 73.2% (41/56) of postoperative X-rays in the “pin” group respected Shenton's line, compared to 90.3% (56/62) in the “plate” group (p=0.02). We did not find any difference regarding the “Dime sign” and the talocrural angle. ConclusionOur study shows the superiority of plate osteosynthesis for lateral malleolar fractures compared to pin/cerclage osteosynthesis, regarding one of the three radiological criteria for reduction. No significant difference was found in the one-year rates of complications and of hardware removal, between the two groups. Level of evidenceIV, retrospective study.

Fifth metacarpal neck fracture fixation: antegrade intramedullary pinning with two K-wires or percutaneous retrograde crossed pinning

Objective: The present study aimed to compare clinical and radiological outcomes in patients with displaced fifth metacarpal neck fractures after treatment with antegrade intramedullary pinning with two K-wires or percutaneous retrograde crossed pinning. Material Method: While seventeen patients were treated with antegrade intramedullary pinning (Group ), 14 were treated with percutaneous retrograde crossed pinning (Group 2). Clinical and radiological outcomes included Quick Dash, active range of motion (ROM), VAS, and dorsal angulation loss at weeks four and twelve and in the final follow-up. Results: The findings revealed that the groups had mean ages of 29.41±8.15 years and 27.78±7.42 years, res-pectively. While ROM was better in Group 2 at weeks four and twelve, we could not find a significant difference between the groups by active ROM in the final follow-up. Moreover, Group 1 had a better Dash score in the fourth week and twelth week , but both groups had similar Dash scores in the final follow-up. Finally, the groups had no preoperative and postoperative differences radiologically. Conclusion: The present findings uncovered that treatment of a displaced fifth metacarpal neck fracture by anteg-rade intramedullary pinning yielded a better in the first three months improvement in active ROM and Quick Dash than percutaneous retrograde crossed pinning.

Intramedullary pin fixation in 3D printed canine femur bone model for preoperative surgical planning

Intramedullary pin fixation in 3D printed canine femur bone model for preoperative surgical planning

Designing of double-threaded intramedullary pin and evaluation of ex vivo biomechanical resistance to axial compression load on the canine long bone fracture gap model

Intramedullary (IM) pinning is a biological method of fracture fixation; but is associated with complications ofpin migration, proximal fragment collapse and rotational instability. The study aimed to design double threaded(DT) IM pin and evaluated its biomechanical resistance to axial compression load in comparison to end-threaded(ET) and simple Steinman (SS) IM pin on the canine long bone fracture gap model. The DT IM pin was designedconsidering various morphometric measurements (17 femur and 8 tibia bones) on lateral radiographs of the routinely done healthy dogs. For ex vivo biomechanical study, a distal third fracture was created in the 17 (8 femoral, 9 tibial) canine cadaveric bones. A normograde IM pinning using SS, ET and DT was done keeping atleast 10 mm gap at the fracture site (fracture gap-model). A pin occupying 60-70% of the narrowest medullary canal was used for ETand DT, and >80% for SS models. The bone-implant constructs were subjected to axial compression load (N) till5 mm displacement of the proximal bone fragment or till dislodgement of the implant using 0.5 mm/min velocity ona servo-hydraulic testing machine. The magnitude of the axial compression load/mm displacement was influencedby the bone (femur vs tibia) and implant types. In femur, the DT pins sustained higher compression loads followedby SS and ET. However, for tibia, the load required was highest with DT followed by ET and SS pin. The studyreports the first of its kind indigenously designed biomechanically superior double threaded pin for the canine longbone fracture fixation

Clinical Evaluation Osteogenic Properties of Demineralised Bone Matrix (DBM) Xenograft in Femur Fracture in Dogs

Background: Fracture is one of the common problems encountered in dogs. Fracture healing most of the times results into complications like delayed union, mal-union and non-union. To deal with these complications bone grafting is an important technique lying with clinicians. Methods: The present study was conducted on 14 clinical cases of dogs with femur fracture. After preliminary examination the dogs were randomly divided into two groups. In group A (n=8) fractures were managed by intramedullary pinning and in group B (n=6), fractures were managed by IM pinning and demineralised bone matrix (DBM) xenograft implantation at the fracture site. The efficacy of the treatment was assessed on the basis of clinical, hemato-biochemical and radiographic observation on day 0 and on 7th, 15th, 30th, 45th and 60th post-operative days. Result: The pain, lameness and weight bearing scores on the affected limb showed non-significant (P greater than 0.05) variations between the two groups on different post-operative intervals. The hematological parameters also varied non-significantly (P greater than 0.05) between the two groups. A significant (P less than 0.05) increase in the serum alkaline phosphatase values was observed upto 30th post-operative day in group B animals as compared to group A animals and thereafter it gradually decreases and return to normal level on 60th post-operative day in both the groups. Radiographic scores were better in group B dogs. Early radiographic signs of fracture healing were observed in group B dogs than group A dogs. No any graft related complications were observed during the study.

Metaizeau Technique for Displaced Radial Neck Fracture among Children in Erbil, Kurdistan Regional Government, Iraq

Background and objectives: Radial neck fracture if not propely managed can lead to complications including pain and avascular necrosis. The Metaizeau technique of closed intramedullary pinning is a treatment option and it is the aim of this study to assess its outcome. Methods: Metaizeau technique was used in managing radial neck fracture of 21 children at two emergency hospitals in Erbil, Kurdistan region, Iraq. between July 2018 and September 2019. Postoperative outcome were assessed according to the Metaizeau classification and Mayo performance score to assess degree of residual angulation as well as for postoperative complications such as joint stiffness. Results: Median follow up time was 10 months (7-12 months). The children’s median age was nine years (6-11 years), among which 11 (52%) cases were females. According to Judet classification, 9 (43%) children had class IVb fracture while 8 (38%) had class IVa and only 4 (19%) cases had class III fracture. The median fracture angulation prior to the surgery was 75° (ranged between 50-85°). By the end of the follow up, 19 (90.5%) cases achieved excellent results according to the Metaizeau classification while the remaining two (9.5%) had good outcome with mild degree of angulation of 8° and 14° respectively. Conclusions: Metaizeau method is technically easy with a simple learning curve and is highly effective with excellent functional outcomes and that the rate of postoperative complications is rare compared to reported cases of radial neck fracture managed with open reduction and internal fixation

Tratamento de má união de tíbia e fíbula em tamanduá-bandeira (Myrmecophaga tridactyla)

ABSTRACT Vehicle collisions involving giant anteaters contribute significantly to the decline of this population. Although mortality rates at the time of trauma are high, many animals survive despite severe trauma and limb fractures. Treating these individuals is extremely challenging. This report describes the use of a corrective osteotomy to treat an angular deformity caused by inadequate healing of a tibial and fibular fracture in a young giant anteater. The animal was rescued on a highway by the Brazilian Institute for the Environment and Renewable Natural Resources (Ibama). He was presented at the University Veterinary Hospital with lameness of the left pelvic limb and edema in the middle region of the tibial shaft. The radiographic examination showed an exuberant callus and significant bone deviation in the middle third of the left tibia and fibula. Corrective wedge osteotomy and fixation with a 3.5mm locking plate and 2.5mm intramedullary pin were performed. In the immediate postoperative period, there was functional recovery of the limb and complete consolidation of the osteotomy was identified 60 days after the operation. The corrective wedge osteotomy technique was effective for the treatment of inadequate tibial consolidation in a young giant anteater, providing complete recovery of all limb functions.

Evaluation of Fracture Healing After Thyroidectomy in Rabbits Model

This research aims to investigate the fracture healing effects caused by thyroidectomy. The experiment involved sixteen matured male rabbits of local breed which divided into 2 equal groups (control and treated). Rabbits anesthetized by premedicated atropine sulphate, then 15 minutes later, a mixture of Xylazine Ketamine was used. The control group rabbits were induced with mid-shafted femoral fracture, with that, the fixation by intramedullary pinning was considered Meanwhile, the treated group rabbits were induced with same method mentioned above, but fracture were fixed after thyroidectomy and measurement of thyroxin a week after thyroidectomy. Results which were obtained from the clinic revealed signs of severe inflammatory reaction in control group which were higher comparing to treated group. These sings were disappeared within 4-5 days in treated group, while, it took 5-6 days in control animals. Also, radiological results of 2 groups showed that a periosteal reaction was observed towards the end of the 2nd week in the control group, whereas, the treated group showed its reaction at the end of fourth week, there was an invisible fracture line for both control and treated groups at the end of fourth and seventh week, respectively. In addition, bony bridge in the control groups became remodeled into a lamellar bone earlier than treated group. The results of measuring thyroxin hormone before and after the thyroidectomy confirmed the essential role of this hormone in fracture healing. To conclude that the fracture healing maturity was greater in control group than in treated group.

Limb Gait Score of Femur Fracture Fixated by Intramedullary Pinning in Dogs.

Animal posture, limb gait, and body weight-bearing in dogs can be evaluated by limb gait score. In this study, nine adult male dogs of local breed were used to induce a complete transverse femoral mid-shaft fracture fixed internally by intramedullary pining under general anesthesia with the aseptic technique and followed for 60 days postoperative. The data were analyzed, including five degrees that indicate the correlation among animals' posture, limbs, and body weight tolerance per day. The results demonstrated that in grade 5, the animals completely hold the affected limb during standing position 1st-3rd day postoperative. From the 4th-10th day postoperative, in grade 4, the animals supported the body weight on the affected limb in the standing position and hold it during waking. In grade 3, from 11th-21th day postoperative, the operated animals supported body weight on the affected limb in slow waking and hold it in speed waking and running. From the 22nd-28th day postoperative, in grade 2, the animals used the limb in speed walking, from the 29th-35th day postoperative. In grade1, the animals could use the limb in running from the 36th-2nd day postoperative. In grade 0, the animals used the limb normally in walking, running, and jumping until the end of experimental periods (60th day postoperative). The results indicated that limb gait scores in dogs can be used for the evaluation of the relationships among animals' posture, limb gait, and body-weight bearing per day during bone regeneration processing of femur fracture fixed by intramedullary pining.

Ankle Joint Arthrodesis: Realities and Prospects against the Background of New Technologies. Literature Review

Arthrodesis is one of the methods for treating advanced stages of the ankle joint deforming arthrosis. A distinctive feature of this operation is the variability of bone fragments fixation. There are various options for arthrodesis, but they are mainly divided into internal and external fixation. Moreover, the increasing popularity of arthroscopic arthrodesis technology and ankle arthroplasty developments have opened new possibilities for doctors but have also posed new challenges. Aim. To evaluate treatment options for ankle arthrosis of various etiologies and provide recommendations for clinical improvement. To give a prospective analysis of technology development. Clinical outcomes of arthroplasty, arthrodesis, and arthroscopy were not significantly different. Patients with endoprosthesis had significantly more frequent reoperations. Conclusion. In arthrodesis with the Ilizarov apparatus, there are more advantages due to variability and many modifications, and the scope of internal fixation expands. There is disagreement over the optimal choice of internal fixation for arthrodesis. The choice is determined by factors such as the patient’s condition and the doctor’s preferences. In uncomplicated ankle osteoarthritis, an antegrade intramedullary pin is preferred over a retrograde pin. Ankle joint arthroscopy has technical advantages, and its use in severe joint deformities has become a direction for future research. The results obtained can be applied in the motor rehabilitation of patients after arthrodesis. Arthroscopy and arthrodesis are the most promising for postoperative motor rehabilitation of patients compared to endoprosthetics.

Use of 3-D Models for Surgical Planning of a Malunion in a Dog

Background An 8-year-old, 18.9 kg, male, intact Kai Ken with a femoral shaft fracture experienced recurrent implant breakage after two fracture reductions using an internal fixator. Objectives This case report is aimed at using a three-dimensional (3-D) printer to diagnose residual femoral rotational deviation. Implant failures and malunion occurred after two attempts at synthesis. Thus, a 3-D model was designed for preoperative planning of a third surgery. Methods To evaluate the alignment in the postoperative state after the second surgery, we removed a broken plate from the affected limb. Subsequently, a computed tomography image produced a bone replica using 3-D printing. The distal fragment was fixed and rotated externally by 42°. In addition to correcting the rotational deformity of the femur, we used an intramedullary pin and two locking plates to stabilize the proximal and distal femoral fracture segments. Results The bone union was confirmed four months after surgery, and no postoperative complications were observed 11 months after surgery. Conclusion 3-D printing is a valuable tool that increases the accuracy of presurgical planning.

Management of Long Bone Fractures Using Diverse Fracture Fixation Techniques in Small Animals

Total 11-cases of different breeds of dogs and one case of Persian cat having long bone fractures were successfully managed using totally intravenous anaesthesia (TIVA). For TIVA, combination of xylazine and ketamine were used for induction whereas sole ketamine was used for maintenance and atropine sulphate was used as preanaesthetic and anticholinergic agent. TIVA found suitable for orthopaedic surgeries in this study. Intramedullary pinning, bone-plating (Dynamic compression plating and Reconstruction plating), external skeletal fixation system (using jess clamps and epoxy) or combination of two different fracture fixation techniques were performed for surgical management of presented fracture cases. For combination of two orthopaedic techniques, either bone plating with supplementary IM-pinning or ESF with IM-pinning were used in this study. All cases were evaluated by radiographs as well as clinical performance of operated limbs. Radiographs were taken at regular interval for assessment of radiographic bone healing and in those cases where radiographs were not possible owner contacted telephonically.

Surgical correction of a complete diaphyseal humeral fracture of Brahminy kite -a case report

A young Brahminy kite (Haliastur indus) weighing 600g was presented to the Shahedul Alam Quadary Teaching Veterinary Hospital, at Chattogram Veterinary and Animal Sciences University, with a history of trauma due to collision with electric wire, which was unable to fly. Physical examination revealed temperature106ºF, depressed bird with bluish discoloration of subcutaneous tissue from shoulder to elbow joint of right wing and radiographic examination showed complete transverse diaphyseal right humeral fracture. Retrograde intramedullary pinning was done under general anesthesia with diazepam and ketamine combination. Post-operative radiograph confirmed the implant was in position. The total anesthetic period of the surgery was 60 minutes. The present study suggests that, intramedullary pinning can be successfully used for humeral fracture management in kite with proper anesthetic protocol. Postoperative care is very important for a successful outcome in avian orthopedics.

Assessment of 2 Treatment Methods for Ulna Fractures With an Intact Radius in Raptors: Conservative Management and Surgical Fixation With a Type I External Skeletal Fixator Intramedullary Pin Tie-in.

Several methods have been reported for treating avian antebrachial fractures, yet the quantitative information regarding their success is limited. This retrospective study applied data from raptors admitted to a wildlife rehabilitation center to provide metrics associated with the treatment of ulna fractures with an intact radius by either conservative management or a single surgical method: a type I external skeletal fixator tied in to an intramedullary pin (ESF IMP tie-in). Postfledging wild raptors with an ulna fracture admitted to The Raptor Center at the University of Minnesota College of Veterinary Medicine (St Paul, MN, USA) between January 1, 2007, and December 31, 2017, that survived for at least 7 days after admission were included in the study. Information regarding signalment, fracture characteristics, treatment method, outcome, and complications were recorded. The study included 110 raptors representing 15 species. The majority of birds (69%, 76/110) were treated with conservative management. Conservative management was used more often in cases of chronic (P = .02) and closed (P = .02) fractures, whereas fractures with poor alignment at the time of admission were frequently treated through surgical means (P=.001). Alignment was more likely to improve with an ESF IMP tie-in (P=1.01 ×10-9). The majority of cases (65%, 72/110) had a successful outcome. Birds with closed fractures were more likely to have a successful outcome (P=.03). Birds in which fracture alignment became exacerbated with either treatment method were more likely to have a poor outcome (P=.002). The results of this retrospective study found that conservative management and surgical fixation by the ESF IMP tie-in technique are both viable treatment options for ulna fractures with an intact radius in raptors. The choice of treatment method is dependent on the clinician's assessment of the fracture characteristics and individual patient.

Type II Monteggia Lesion with Complete Elbow Dislocation in a Cat

AbstractA 2-year-old neutered male cat was presented for right forelimb non-weight-bearing lameness. A fracture of the proximal third of the ulna (associated with a caudal radio-humeral and humero-ulnar dislocations and a radio-ulnar dislocation) was radiographically identified, leading to a diagnosis of type II Monteggia lesion with complete elbow joint dislocation. The ulnar fracture was reduced and stabilized using an intramedullary pin. During surgery, the lateral collateral ligament and the annular ligament appeared disrupted. The radio-ulnar dislocation was reduced and stabilized, using a double-loop suture prosthesis passing through the metaphysis of the ulna and around the radial head. The radio-humeral dislocation was reduced and stabilized using a lateral collateral suture prosthesis. No postoperative complications were observed and the patient regained good elbow joint range of motion, with no significant lameness at 8 postoperative months.

Сравнение вариантов хирургического лечения перелома проксимального отдела бедренной кости у пациентов пожилого возраста при ожирении

The purpose — to investigate the efficiency of surgical treatment of proximal femur fractures in obese elderly patients. Material and methods. We conducted a prospective analysis of the treatment outcomes of 230 patients aged 60 to 93 years between 2016 and 2019. 115 patients with proximal trochanteric fractures underwent arthroplasty and 115 patients with similar fractures were treated with the method of intramedullary blocked osteosynthesis. Conclusion. As shown by our experience in the treatment of trochanter femoral fractures using intramedullary pin and arthroplasty in obese patients, at the inpatient stage of treatment there are no fundamental differences (limitations) with patients with normal body weight. We believe that the use of both methods can improve the postoperative function of the hip joint. However, the overall positive outcome of the treatment of obese patients leaves no doubt about the need for joint replacement in case of indications in this group, taking into account the increased risk of complications in the studied group of patients and provided that possible intra- and postoperative risks are prevented.

Балалардағы жетілмеген остеогенезді хирургиялық емдеудің заманауи тәсілдері: Әдеби шолу

Osteogenesis imperfecta is a widespread hereditary dysplasia of connective tissue, characterized by changes in the bone structure, frequent fractures, manifestations of disorders in other organs and systems. This is a genetically determined disease, characterized by a violation of the production of collagen type 1, for which a specific treatment algorithm has not yet been developed.The article presents scientific data on modern methods of surgical treatment of osteogenesis imperfecta in children using non-telescopic and telescopic intramedullary pins (Rusch nail, titanium elastic rods (TEN), etc.). The article also describes the shortcomings and expected complications after surgical treatment using these metal structures.Key words: incomplete osteogenesis, children, surgical treatment, osteosynthesis, osteotomy, rods.

Open reduction and internal fixation by intramedullary pinning of humerus fracture in a house sparrow (Passer domesticus) and subsequent release: A case report

Open reduction and internal fixation by intramedullary pinning of humerus fracture in a house sparrow (Passer domesticus) and subsequent release: A case report

An Unusual Complication of Intramedullary Pin Migration during Total Knee Arthroplasty - A Case Report.

Total knee arthroplasty (TKA) is one of the most effective operations to relieve pain and improve function in the end stage of osteoarthritis (when bone on bone contact occurs). The intraoperative complications of TKA include fracture, tendon or ligament injury, and nerve or vascular complications. We herein describe an unusual complication of intramedullary pin migration within the femoral canal during TKA. A 72-year-old male patient underwent TKA with a posterior stabilization system with sacrifice of the posterior cruciate ligament. The distal femur was sectioned and balance was checked in extension. Then to make anterior, posterior, chamfer and notch cuts, the five-in-one anteroposterior (AP) cutting block was placed on the distal femur and the cuts were initiated. As there was a medial overhang of the cutting block, it was shifted laterally. While doing so, the pins had to be shifted too, and one of them was inadvertently hammered into the previously-created medullary canal opening of the femur. As usual orthopedic instruments, like the long straight artery forceps and pituitary rongeurs, failed to remove the migrated pin, an extralong laparoscopic grasper was used under fluoroscopy control to locate, grasp, and remove the migrated pin.