Intraosseous Screw Research Articles

Is There Any Purpose in Routine Syndesmotic Screw Removal? Systematic Literature Review.

Introduction: The aim of this systematic review is to examine the recent evidence comparing the removal and non-removal of syndesmotic screws in tibiofibular syndesmosis injuries in terms of functional, clinical, and radiographic outcomes. Methods: A comprehensive literature review was conducted to identify clinical studies on syndesmotic screw removal and its outcomes, searching the Cochrane Library and PubMed Medline for publications from 1 January 2004 to 12 February 2024. Studies were included if they involved tibiofibular syndesmotic screw fixation, assessed screw removal or retention, described clinical outcomes, and were original research with at least fifteen patients per group. Results: Most reviewed articles (18 out of 27; 67%) found no significant differences between the routine removal and retention of syndesmotic screws post-fixation. Four retrospective studies (15%) suggested that retaining screws might result in worse outcomes compared to removal. Two studies (7%) indicated that removing screws could introduce additional risks. One study (4%) observed that post-removal, there is some fibula-tibia separation without affecting the medial clear space. Another study (4%) noted that intraosseous screw breakage might increase the need for implant removal due to pain. Additionally, no significant differences in ankle function were found among groups with varying intervals of screw removal. Conclusions: The current literature does not definitively support routine removal of syndesmotic screws. Given the potential complications and financial costs, routine removal should not be performed unless specifically indicated.

The possibilities of additive technologies for targeted tissue regeneration and implantation in a patient with a mandibular defect. A clinical case

After injury or removal of neoplasms, bone, soft tissue scar defects and deformities are formed. Methods of reconstructive bone surgery do not reliably allow to restore defects in full. The main problem is constriction, subsequent atrophy and deformation of soft tissues in the defect area. Dental implant-prosthetic rehabilitation in the area of significant bone defects requires the use of design and prototyping of the final result using computer programs and diagnostic models. The clinical experience of using an individual temporary endoprosthesis, a «tissue expander» made by layer-by-layer synthesis (3D printing) of biologically inert plastic according to CT data of the patient is presented. The expander is made in the form of a 3D element for the formation of the necessary volume of soft tissues in the patient for a period of 2–4 months, fixed under the periosteum, in the area of the lateral defect of the lower jaw with intraosseous screws. Dental implants are installed in front. Intraoperative direct prosthetics was performed. A temporary screw prosthesis is installed in the mouth. After 3 months, 3 implants were installed and bone grafting was performed. Final prosthetics 7 months after the start of treatment.

Assessment of sacral osseous fixation pathways for same-level dual transiliac-transsacral screw insertion.

The purpose of this study is to (1) describe a pre-operative planning technique using non-reformatted CT images for insertion of multiple transiliac-transsacral (TI-TS) screws at a single sacral level, (2) define the parameters of a sacral osseous fixation pathway (OFP) that will allow for insertion of two TI-TS screws at a single level, and (3) identify the incidence of sacral OFPs large enough for dual-screw insertion in a representative patient population. Retrospective review at a level-1 academic trauma center of a cohort of patients with unstable pelvic injuries treated with two TI-TS screws in the same sacral OFP, and a control cohort of patients without pelvic injuries who had CT scans for other reasons. Thirty-nine patients had two TI-TS screws at S1. Eleven patients, all with dysmorphic osteology, had two TI-TS screws at S2. The average pathway size in the sagittal plane at the level the screws were placed was 17.2mm in S1 vs 14.4mm in S2 (p = 0.02). Twenty-one patients (42%) had screws that were intraosseous and 29 (58%) had part of a screw that was juxtaforaminal. No screws were extraosseous. The average OFP size of intraosseous screws was 18.1mm vs. 15.5mm for juxtaforaminal screws (p = 0.02). Fourteen millimeters was used as a guide for the lower limit of the OFP for safe dual-screw fixation. Overall, 30% of S1 or S2 pathways were ≥ 14mm in the control group, with 58% of control patients having at least one of the S1 or S2 pathways ≥ 14mm. OFPs ≥ 7.5mm in the axial plane and 14mm in the sagittal plane on non-reformatted CT images are large enough for dual-screw fixation at a single sacral level. Overall, 30% of S1 and S2 pathways were ≥ 14mm and 58% of control patients had an available OFP in at least one sacral level.

Implant-prosthetic dental rehabilitation after autopolytrauma

With extensive damage of the facial skeleton, multiple bony and soft tissue cicatricial defects and deformations are formed. Traditional methods of reconstructive are reliably not able to restore the defects fully. Often the bony structures of the facial skeleton can’t be restored in one stage. Additional reconstructive surgeries are needed. A problematic situation is the condition after multiple surgeries in the defect area. Failure of bone grafting is associated with cicatricial deformities and lack of soft tissue, lack of gingiva, defects in the vestibule and damaged periosteum. The main problem is constriction and subsequent atrophy and deformation of the soft tissue in the area of the defect. This complicates further treatment and often it isn’t possible to restore the bone volume required for a successful dental implantation. Implant prosthetic rehabilitation in the area of extensive bone defects after a facial injury requires preparation that is more careful, design and prototyping of the outcome with the use of computer programs and diagnostic models. Biocompatible materials for dentistry and maxillofacial surgery are clinically proven and recommended for usage in patients at the treatment stages. Clinical experience with individual temporary endoprosthesis, so called «tissue expander», produced by layer-by-layer synthesis (3D-printing) from biologically inert plastic based on CT data of the patient is presented in this article. The expander is made in the form of a 3D element to form the required soft tissue volume in the patient for 4-6 months and is fixed in place subcutaneously, in the area of mandibular frontal defect, using intraosseous screws. Dental implants were placed laterally on both sides. The following was carried out intraoperative direct replacement, fabrication and placement in the mouth of a temporary screw-retained prosthesis.

RESULTS OF ORTHOPEDIC TREATMENT USING PERMANENT STRUCTURES SUPPORTED BY DENTAL IMPLANTS IN PRIVATE PRACTICE

Literary data testify to the significant prevalence of the dental implantation method to solve the problem of permanent prosthetics in partial and complete anodontia. However, a significant array of information needs systematization and generalization, taking into account the specifics of providing dental care by dental institutions in different regions. The authors conducted a retrospective study of the main statistical regularities based on the results of 32 cases of treatment of secondary anodontia by replacing bounded and finite distally unlimited defects of the lower and upper jaws with the support of dental endosseous implants as exemplified by outpatient care at a private dental office in the city of Poltava (Ukraine). Dental implantation and subsequent prosthetics were performed at one medical institution, by one doctor in cooperation with one dental laboratory in the city of Poltava (Ukraine). The term of retrospective observation was 5 years. The condition for inclusion in the study was the manufacture of a non-removable orthopedic appliance with the non-removable fixation on dismountable and full-body intraosseous screw dental implants. In all cases, metal and ceramic structures with cement fixation on intraosseous dental implants of the Implife Classic, Implife Solo (Inpride company, Ukraine) Vitaplant VK Vitaplant V2Kn (Vitadent company, Ukraine) implant systems were manufactured. Observation of the treatment outcomes was carried out an average of 32 months after the fixation of 69 orthopedic appliances. It turned out that the protocol of permanent prosthetics to replace partial defects of the dentition was implemented mainly in the middle-aged group. Periodic outpatient monitoring of orthopedic appliances with cement fixation on intraosseous implants takes place within the period from 6 to 60 months. The average observation period was 32.8 months. Characteristic statistical regularities related to the selection of individuals and the most common types of implants for solving standard clinical tasks were determined. The average number of implants per clinical case was 4 supports, and the average diameter and length of the integrated implants were 3.5 and 11 mm, respectively.

Atlas (C1) lateral mass screw placement using the intersection between lateral mass and inferomedial edge of the posterior arch: a cadaveric study.

To compare the Atlas (C1) lateral mass screw placement between screw trajectories of 0° and 15° medial angulation while using the intersection between lateral mass and inferomedial edge of the posterior arch. Forty-eight Atlas lateral masses were prepared and divided into 2 groups: Group 1; screws inserted at 3mm lateral to the reference point with screw trajectory of 0° angulation(N = 24) and Group 2; those inserted with screw trajectory of 15° medial angulation(N = 24). We evaluated the atlas anatomy, screw purchase and the presence of any breaches using CT scan. The radiographic parameters for Groups 1 and 2 were found statistically different (p-value < 0.05): bilateral intraosseous screw lengths (17.92 ± 1.47mm. vs. 20.71 ± 2.4mm.), bilateral screw length (29.92 ± 1.72mm. vs. 33.13 ± 1.78mm.), left screw medial angulation (x°) (0.67° ± 0.78° vs.14.17° ± 3.51°), right screw medial angulation (y°) (0.83° ± 1.03° vs.14.25° ± 2.53°) and bilateral screw medial angulation (0.75° ± 0.9° vs. 14.21° ± 2.99°). Twenty-two screws (91.67%) using the 0° medial angulation and nineteen screws (79.17%) using the 15° medial angulation had no cortical violations (Grade 0). However, two screws (8.33%) with 0° medial angulation and five screws (20.83%) with 15° medial angulation had breach less than 2mm (Grade 1). There were no screws with breach between 2 and 4mm (Grade 2) or greater than 4mm. (Grade 3). A starting point of 3-mm lateral to the intersection between lateral mass and inferomedial edge of the Atlas posterior arch can be safely and effectively used to insert C1 lateral mass using both 0° and 15° medial angulation.

Location Matters in Syndesmosis Screw Breakage: Interosseous Breakage and Breakage Location Within the Tibia Affect Rates of Removal Secondary to Pain

Category:Ankle; Ankle; TraumaIntroduction/Purpose:Broken or loose syndesmotic screws are typically reported to be clinically asymptomatic, however, screw breakage can lead to significant pain depending on location. Syndesmosis screws that span the incisura are particularly at an increased risk for painful outcomes. In patients with intraosseous screw breakage, normal physiologic translation where the distal convex of the fibula fits into the concave tibial incisure can lead to painful bony erosion overtime. The purpose of this investigation is to assess variables that my predict location of syndesmosis screw breakage and to also assess the effect of screw breakage location on eventual removal secondary to pain.Methods:A retrospective analysis of 1,056 patients who underwent syndesmosis fixation revealed 88 patients (121 screws) who experienced pst-operative syndesmosis screw breakage and met predetermined inclusion criteria. Patient demographic data, BMI, comorbidities, pain scores, complication rate, and revision rate were all collected. Screw length, width, number, placement height above the tibial plafond, angle, location of breakage, breakage distance location on the screw and implant removal secondary to pain were also collected. A series of binomial logistic regressions were performed to ascertain the effects of the collected variables on the likelihood of breakage location and removal secondary to pain. Regression analysis included intraosseous versus clear space breakage, tibia versus fibula breakage, and removal secondary to pain in each breakage location group (tibia, fibula, clear space).Results:Of the 121 broken screws, 91 (75.2%) broke within an intraosseous (IO) location (68 patients, 77.3%). Twenty-eight screws (23%.1) (18 patients, 20.5%) broke exclusively within the clear space (CS). Sixty screws (52 patients, 59.9%), had IO breakage within the tibia, while 29 screws (24 patients 27.7%) had breakage within the fibula. Two screws (2 patients, 2.27%) occurred within an intraosseous location and the clear space. Intraosseous screw breakage was associated with higher risk removal secondary to pain (P=.020). Multiple screw usage associated with an increased risk for CS breakage (P =.012). IO and CS screw angle and placement had no effect on screw breakage location (P =.629, P =.570). Screw breakage closer to the CS (P=.001), increased number of screws used (P=.003), and higher patient pain scores (P =.003) were associated increased risk of removal due to pain within the IO tibia breakage group.Conclusion:Syndesmotic screw breakage location plays a more important role than previously reported. When compared to clear space, intraosseous breakage is associated with increased rates of removal due to pain. Breakage location within the tibia occurring closer to the clear space is associated with higher rates of removal secondary to pain and higher patient report pain scores. Usage of multiple screws was found to be the only significant predictor of clear space vs intraosseous breakage; all other variables were found to be non-contributary, including no appreciated significance of screw placement in relation to the tibial plafond or screw angle.

Analysis of trans-sacral corridors in stabilization of fractures of the pelvic ring.

Percutaneous screw fixation combined with pelvic reduction is a surgical technique used to stabilize fractures of the posterior pelvic ring. This is the standard surgical treatment of unstable posterior pelvic ring injuries. The primary goal of this treatment is an anatomic reduction and stable fixation. This has been shown to reduce pain and improve the patients' long-term well-being. The aim of this analysis was to determine the possible screw lengths and the positioning of the screws in the S1 and S2 sacral segments. A population of 697 pelvises from the Stryker Orthopaedic Modeling and Analytics database were analyzed. The dimensions of the S1 and S2 screw corridors were determined and after assessing for sacral dysmorphism, the correct screw placement was chosen to determine the necessary screw length for surgical treatment. The measurements of the screw lengths show a Gaussian distribution for the analyzed population. The percentage of dysmorphic pelvises for the S1 screw corridor was 31.3% and for the S2 corridor 8%. Average screw length for S1 was 163.8 ± 16.2 mm and for the S2 137.3 ± 9.5 mm. The results show that the S1/S2 axis cannot be used for a trans-sacral screw placement in every patient. The study shows that intraosseous screw corridors are present in 68.7% of the patients in the S1 position and in 92% at the S2 level where an intended implant can be placed fully intraosseous.

Three-dimensional morphometry of the first two sacral segments and its impact on safe transiliac-transsacral screw placement

IntroductionPercutaneous screw fixation of the posterior pelvic ring is a popular technique to treat unstable pelvic ring lesions. This technique is practicable in both, the high-energy pelvic ring fractures, mostly in the young population as well as the osteoporotic fractures in the elderly. Risk of the transiliac-transsacral screw positioning is that the critical area of nerve root exit has to be passed twice. For secure screw placement, without causing iatrogenic neurovascular injuries, the knowledge of distances to the narrowest areas is essential. Purpose of this anatomical study was to examine the optimal intraosseous screw placement for the first two sacral segments. Material/methodsImages of uninjured pelves from 50 patients (64-line CT scanner) were evaluated. Then virtual transiliac-transsacral srews were positioned into the first two sacral segments. The distance from the screws’ entrance points at the ilium's alar bone to the narrowest portion of the whole pedicle as well as the height and width in this area were measured. Descriptive statistics were used and gender related differences were evaluated using student T-test. ResultsFor the first sacral segment the distance to the narrowest zone amounted in mean 62.75 mm, respectively 63.31 mm, depending on the selected way of measurement. For the second segment the mean distance to the neuroforamina was on average 50.61 mm, respectively 51.54 mm. The average height in S1 measured 25.88 mm and the average width 25.49 mm. The average height for S2 was 17.54 mm and the average width 17.61 mm. We could not find any statistically significant gender correlation for the measured distances. ConclusionResults of this anatomical study may help in performing a safe surgical procedure.

ТЕРМОГРАФИЧЕСКИЙ КОНТРОЛЬ ТЕЧЕНИЯ ПОСЛЕОПЕРАЦИОННОГО ПЕРИОДА У ПАЦИЕНТОВ С ДЕНТАЛЬНОЙ ИМПЛАНТАЦИЕЙ

Subject. Thermal imaging provides an objective measurement of temperature changes that are clinically relevant for the detection of local inflammatory processes. The article examines the infrared radiation of the facial skin, its quantitative and qualitative characteristics, to predict the course of the postoperative period after dental implant placement. The aim is to evaluate changes in the parameters of contactless infrared thermography (CIT) of the facial skin before and after operation. Methods. A prospective randomized study was conducted in 17 patients aged 30 to 65 years (12 women, 5 men) who underwent surgery to install intraosseous screw dental implants (DI) under local anesthesia on one side of the jaw according to the delayed implantation technique. Before and after operation, as well as on the 1st, 3rd and 7th days of the postoperative period, patients underwent facial skin CIT using the FLIR One Pro device. Blood pressure, heart rate and body temperature were also monitored. The maximum and minimum temperature (T) of the facial skin on the side of the installed implant and the opposite side were compared. Results. The mean values of blood pressure and heart rate in the studied patients did not show deviations from the normal values before and after the operation of DI placement. The average values of body temperature were almost the same before and after the operation. In two patients, the body temperature was 37 °C during the day after the operation. The difference between average values of the skin temperature of the right and left half of the face did not exceed 0.6 °C, that is acceptable in the norm. Conclusions. The temperature relief of the facial skin after surgery changes in comparison with the preoperative values with a tendency to increase the average values of the maximum T. In the postoperative period, there is an increase in the average values of the maximum T on the side of the operation in comparison with the opposite side.

Syndesmotic Screw Breakage May Be More Problematic Than Previously Reported: Increased Rates of Hardware Removal Secondary to Pain With Intraosseous Screw Breakage.

The majority of retained syndesmotic screws will either loosen or break once the patient resumes weight-bearing. While evidence is limited, anecdotal experience suggests that intraosseous screw breakage may be problematic for some patients due to painful bony erosion. This study seeks to identify the incidence of intraosseous screw breakage, variables that may predict intraosseous screw breakage, and whether intraosseous screw breakage is associated with higher rates of implant removal secondary to pain. Five hundred thirty-one patients undergoing syndesmotic stabilization were screened, of which 43 patients (with 58 screws) experiencing postoperative screw breakage met inclusion criteria. Patient charts were retrospectively reviewed for demographic data, comorbidities, time to screw breakage, location of screw breakage, and implant removal. Several radiographic parameters were evaluated for their potential to influence the site of screw breakage. Intraosseous screw breakage occurred in 32 patients (74.4%). Screw breakage occurred exclusively in the tibiofibular clear space in the remaining 11 instances (25.6%). Intraosseous screw breakage was significantly associated with eventual implant removal after breakage (P = .034). Screws placed further from the tibiotalar joint were at less risk for intraosseous breakage (odds ratio 0.818, P = .002). Screws placed at a threshold height of 20 mm or greater were more likely to break in the clear space (odds ratio 12.1, P = .002). Syndesmotic screw breakage may be more problematic than previously described. Intraosseous breakage was associated with higher rates of implant removal secondary to pain in this study. Placement of screws 20 mm or higher from the tibiotalar joint may decrease risk of intraosseous breakage.Levels of Evidence: Level III: Retrospective study.

Application of three-level navigation template in surgery for hemivertebrae in adolescents

Objective . To assess efficacy and safety of using a three-level navigation template in the surgical treatment of congenital spinal deformities. Material and Methods . Three-level navigation templates were used in surgical treatment of four consecutively operated 10–17-year-old patients with congenital scoliosis associated with thoracic hemivertebrae. The correctness of screw position was evaluated according to CT data using a 2-mm increment method: class 0 – intraosseous screw position; class 1 – the screw extends beyond the pedicle cortex by less than 2 mm; class 2 – by 2–4 mm; and class 3 – by more than 4 mm. Preoperative DICOM data were processed with free software. The model of target zone and navigation template were 3D printed and used in surgery. Results . Four of 16 (25 %) pedicles were narrower than 4.35 mm and were estimated as difficult for implantation with a planned violation of the integrity of the endplate. Perforation of the outer cortical layer took place in all these cases, and screw position corresponded to class 2 only in pedicle width of 1.9 mm. In pedicles wider than 4.35 mm, 11 of 12 (91.7 %) screws were implanted intraosseously. One screw extended beyond the pedicle cortex by 0.8 mm (class 1). Conclusion . Three-level navigation template can be considered as an effective means of positioning transpedicular screws in secondarily changed segments adjacent to anomalous one and confounding implantation. Free software is sufficient for preparing 3D-model of target zone and navigation template, and such a model is a highly informative reference object that is convenient to use during the operation. A navigation template made using 3D printing does not require the use of expensive equipment, which can make surgery for congenital scoliosis more accessible.

The sacral screw placement depending on morphological and anatomical peculiarities.

Various pathologies of the lumbosacral junction require fusion of the L5/S1 segment. However, pseudarthroses, which often come along with sacral screw loosening, are problematic. The aim of the present investigation was to elaborate the morphological features of the L5/S1 segment to define a so-called "safe zone" for bi- or tricortical screw placement without risking a damage of the iliac vessels. A total of one hundred computed tomographies of the pelvis were included in this investigation. On axial and sagittal slices, pedicle morphologies, the prevertebral position of the iliac vessels, the spinal canal and the area with the largest bone density were analyzed. Beginning from the entry point of S1-srews iliac vessels were located at an average angle of 7° convergence, the spinal canal at 38°. Bone density was significantly higher centrally with a mean value of 276 Hounsfield Units compared to the area of the Ala ossis sacri. The largest intraosseous screw length could be achieved at an angle of 25°. The average pedicle width was 20mm and the pedicle height 13mm. A "safe-zone" for bicortical screw placement at S1 with regard to the course of the iliac vessels could be defined between 7° and 38° convergence. Regarding the area offering the largest bone density and the maximal possible screw length, a convergence of 25° is recommended at S1 to reduce the incidence of screw loosening. Screw diameter, as a further influence factor on screw holding, is limited by pedicle height not pedicle width.

P156. Update on percutaneous lumbopelvic fixation for unstable sacral fractures with spinopelvic dissociation patterns: two-year follow up

BACKGROUND CONTEXT Sacral fractures with spinopelvic dissociation patterns (“H” or “U”-type sacral fractures) are highly unstable injuries that often require surgical treatment. In an effort to minimize surgical morbidity while achieving stable fixation, we modified the typical open surgical approach into a percutaneous lumbopelvic fixation technique. PURPOSE To report the outcomes and complications of a prospectively acquired consecutive case series of 19 patients with unstable sacral fractures with spinopelvic dissociation treated with percutaneous lumbopelvic fixation. STUDY DESIGN/SETTING Retrospective review of a prospectively acquired database. PATIENT SAMPLE Nineteen consecutive patients with unstable sacral fractures causing spinopelvic dissociation treated with percutaneous lumbopelvic fixation. OUTCOME MEASURES Blood loss, surgical time, fluoroscopy time, post-operative complications, Short Form Survery (SF-12v2), Oswestry Disability Index (ODI), and World Health Organization Wellbeing Index (WHO-5). METHODS Nineteen consecutive patients with unstable sacral fractures treated with percutaneous lumbopelvic fixation were prospectively enrolled into a database Intraoperative and postoperative data were reviewed, including blood loss, surgical time, fluoroscopy time and postoperative complications including infection. Postoperative follow-up included outcome measures including the Short Form Survey (SF-12v2), Oswestry Disability Index (ODI), and the World Health Organization Wellbeing Index (WHO-5). Screw accuracy, fracture reduction, fracture healing and implant integrity were evaluated on pre- and postoperative radiographs and CT scans. RESULTS Clinical follow-up in 19 patients who had surgery more than one year prior to this report averaged 2.1 years. Radiographic follow-up averaged 1.7 years. Operative time averaged 2 hours 25 minutes (105 – 215 minutes), fluoroscopy time averaged 141 seconds (68–225 seconds), and blood loss averaged 200 mL (75–400 mL). There was 1 deep wound infection. Postoperative CT scans in 17 patients showed a 3 mm lateral pedicle breach and a 2 mm iliac screw cortical breech (both asymptomatic) but otherwise accurate intraosseous pedicle screw (n=79) and iliac screw placement (n=37), for an overall accuracy of 98.3%. Sacral fracture kyphosis reduction was shown to be achievable. All but two patients maintained or regained full neurological function, and all patients healed their fractures. CONCLUSIONS Sacral fractures with spinopelvic dissociation patterns are severe injuries that have traditionally been treated with open lumbopelvic fixation, which is a surgery that carries substantial morbidity. Percutaneous techniques have been reported over the past several years. This is the largest case series, now with 2-year follow-up. Nineteen patients were treated with percutaneous lumbopelvic instrumentation with minimal blood loss and within a reasonable surgical duration, theoretically minimizing the physiological burden of surgery in these severely injured patients. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Distal Biceps Tendon Repair Using A Single-incision Approach With Unicortical Intramedullary Button Fixation: Report Early Post-operative Outcomes And Complications

Objectives: While various techniques for distal biceps repair have been described, biomechanical studies have shown cortical button fixation to outperform bone tunnels, intraosseous screws, and suture anchors. Furthermore, numerous studies have shown no difference in complication rate between single- and dual-incision approaches. Thus, it follows that a single-incision approach with cortical button fixation may provide superior clinical outcomes with minimal complications. The purpose of this study is first to investigate intra-operative and short-term complications of distal biceps tendon repair through a single-incision approach using unicortical button fixation, and secondly to assess clinical outcomes. Methods: 52 patients who underwent distal biceps repair with unicortical button fixation (Figure 1) at a single institution from 2014 to 2017 were identified. Exclusion criteria included age less than 18 or greater than 75 years, prior ipsilateral biceps repair, concomitant ipsilateral surgical procedure, and most recent follow-up less than 2 months. Postoperative nerve deficits, flexion and supination strength by manual testing, range of motion, Mayo Elbow Performance Score (MEPS) and radiographs for identification of heterotopic ossification (HO) were obtained and analyzed retrospectively. Results: Fifty-two patients with 53 distal biceps ruptures were included, with mean age 48 years (range 25-71 years). Median time from injury to surgery was 2 weeks (range 1 day to 16 weeks), with 15 patients being treated at greater than 3 weeks from injury. Forty-four patients (83%) had complete tears. Following surgery, average time to final follow-up was 22.8 weeks (range 8-65 weeks). Postoperatively, 49 patients (92.5%) had full range of motion, 48 patients (90.6%) had return of full supination and flexion strength by manual muscle testing (the remaining patients had strength graded as 5-/5). There was no difference in outcomes between those patients treated &lt; 3 weeks from injury compared to those treated &gt; 3 weeks from injury. Two patients (3.8%) initially reported sensory deficit in the lateral antebrachial cutaneous nerve distribution, both cases of which fully resolved by 7 and 11 weeks postoperative. Two patients (3.8%) displayed radiographic evidence of heterotopic ossification, Hastings and Graham class I (Figure 2). One of these was an incidental finding without any clinical symptoms, the other had mild pain but normal strength and neurovascular function. Mean postoperative MEPS was 93.9 (range 60-100), corresponding to “excellent” function (MEPS&gt;90). Conclusion: Distal biceps repair using single incision, unicortical button fixation yields a low rate of complications with good clinical results compared to other techniques reported in the literature. The single incision approach in patients treated between 3 and 16 weeks from injury is safe and resulted in outcomes no different than in those patients treated &lt;3 weeks from injury. Further investigation is warranted in the form of larger, comparative studies with more robust outcome measures and longer term follow up. [Figure: see text][Figure: see text]

Safe Supra-Acetabular Pin Insertion in Relation to Intraosseous Depth.

In pelvic fractures, dysfunction of the pelvic ring is often stabilized with supra-acetabular pin insertion. In existing literature, there are heterogeneous indications on proper pins selection and inclinations. Therefore, this study aimed to quantify the narrowing of safe pin corridors in the transverse and sagittal planes with increments of intraosseous screw depths. A computer algorithm created cross-sections over three-dimensional pelvic reconstructions at sagittal inclinations from 45° cranial to 45° caudal in 5° increments. Templates of screw depths spanning 60-120 mm in 15 mm increments were disposed in the transverse plane from 45° medial to 45° lateral. Each intraosseous screw depth and transverse angle were evaluated for intraosseous containment to evaluate ranges narrowing with increasing screw depths. The 60-mm depth resulted in the largest sagittal range (60.9° ± 6.9°) and transverse range (27.5° ± 4.1°) at 30° caudal. Increasing depths by 15 mm resulted in ranges being significantly different from one another (p < 0.01). The sagittal plane of 20° cranial had the highest frequency of insertion for all depths, while transverse ranges were narrowed (p < 0.01). Bisecting angles were similar for sagittal planes 20° cranial to 30° caudal with an average of 27.9° ± 1.2° (p ≥ 0.115). In conclusion, while 60 mm depths can be inserted with the highest discretion, 15 mm increments in depth significantly reduce safe ranges. Screws depths above 90 mm have low frequencies of insertion, should be inserted more cranially and must be considered prone to breaching. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:1790-1797, 2019.

Intraosseous Screw and Post versus Traditional Screw Fixation for Talonavicular Arthrodesis

Category: Midfoot/Forefoot Introduction/Purpose: Talnonavicular (TN) arthrodesis historically has high rates of non-union and complications including prominent hardware. Traditional constructs include screw fixation and can be limited by the geometry of the midfoot. Screw and post devices utilize a post implanted into the navicular and either fixed or variable angle compression screws inserted through the post into the talus. This creates a fixed angle intraosseous construct. Reported advantages include increased axial compression strength, low profile, and greater multi-plane stability during healing than traditional methods. Few comparison studies exist in the literature. We present our experience with TN arthrodesis using a screw and post device compared to traditional fixation at an average 13.7 month follow up. Methods: A retrospective chart review identified consecutive midfoot fusion procedures at our institution performed by fellowship trained orthopaedic Foot and Ankle surgeons. Arthrodesis of the TN joint was the primary inclusion criteria. Prior infection and prior surgical procedures to the midfoot were excluded. Our cohorts were divided into traditional screw fixation and arthrodesis performed with the IO Fix (Extremity Medical, Parsippany, NJ) screw and post device. Primary endpoints were union rate, time to clinical and radiographic healing, and complications requiring return to operating room. Post-op rehab protocols were at the discretion of the surgeon and involved short leg cast or CAM boot immobilization with no weight bearing until clinical indicators of healing were present. Statistical analysis was performed with STATSPACK. Results: Twenty-one consecutive patients were reviewed. One was excluded for prior procedures. Seven patients had IOFix and 13 patients had screw constructs. One patient was lost to all follow up. No statistical difference in demographics such as age, gender, BMI, or smoking existed (Figure 1). Primary fusion rate was 89% (17/19 patients). Average follow up was 13.7 months. Time to clinical healing was 9.9 weeks with screw fixation and 8.2 weeks with IOFix (p=0.11). Time to radiographic healing was 18.8 weeks with screw fixation and 13.5 weeks with IOFix (p=0.01). Three of 10 patients in the screw construct group had complications. One non-union was present in each group; both underwent revision fusion with IOFix and ultimately fused radiographically at average 16.2 weeks following revision. Conclusion: Prior laboratory study has suggested screw and post constructs for talo-navicular arthrodesis have improved mechanical properties compared with traditional techniques. In our clinical comparison with screw fixation, we demonstrate a trend towards faster clinical healing and statistically significant faster radiographic healing with the IO Fix screw and post construct. Both non-unions in our cohort ultimately fused with use of the IO Fix device during the revision procedure. Additional study examining the cost of a commercial device may guide the surgeon in both primary and revision T-N fusion procedures.

Secure corridor for infraacetabular screws in acetabular fracture fixation\u2014a 3-D radiomorphometric analysis of 124 pelvic CT datasets

BackgroundAcetabular fracture surgery is directed toward anatomical reduction and stable fixation to allow for the early functional rehabilitation of an injured hip joint. Recent biomechanical investigations have shown the superiority of using an additional screw in the infraacetabular (IA) region, thereby transfixing the separated columns to strengthen the construct by closing the periacetabular fixation frame. However, the inter-individual existence and variance concerning secure IA screw corridors are poorly understood.MethodsThis computer-aided 3-D radiomorphometric study examined 124 CT Digital Imaging and Communications in Medicine (DICOM) datasets of intact human pelves (248 acetabula) to visualize the spatial IA corridors as the sum of all intraosseous screw positions. DICOM files were pre-processed using the Amira® 4.2 visualization software. Final corridor computation was accomplished using a custom-made software algorithm. The volumetric measurement data of each corridor were calculated for further statistical analyses. Correlations between the volumetric values and the biometric data were investigated. Furthermore, the influence of hip dysplasia on the IA corridor configuration was analyzed.ResultsThe IA corridors consistently showed a double-cone shape with the isthmus located at the acetabular fovea. In 97% of male and 91% of female acetabula, a corridor for a 3.5-mm screw could be found. The number of IA corridors was significantly lower in females for screw diameters ≥ 4.5 mm. The mean 3.5-mm screw corridor volume was 16 cm3 in males and 9.2 cm3 in female pelves. Corridor volumes were significantly positively correlated with body height and weight and with the diameter of Köhler’s teardrop on standard AP pelvic X-rays. No correlation was observed between hip dysplasia and the IA corridor extent.ConclusionIA corridors are consistently smaller in females. However, 3.5-mm small fragment screws may still be used as the standard implant because sex-specific differences are significant only with screw diameters ≥ 4.5 mm. Congenital hip dysplasia does not affect secure IA screw insertion. The described method allows 3-D shape analyses with highly reliable results. The visualization of secure IA corridors may support the spatial awareness of surgeons. Volumetric data allow the reliable assessment of individual IA corridors using standard AP X-ray views, which aids preoperative planning.

Comparative Distalization Effects Of Conventional Pendulum Appliance And Bone Anchored Pendulum Appliance

Abstract Introduction: The introduction of intraosseous screws as temporary orthodontic anchorage devices has proved successful in achieving sufficient molar distalization without major anchorage loss in Class II malocclusions. Bone-anchored pendulum appliance is used to obtain an effective and compliance-free molar distalization without anchorage loss. Aims And Objectives: This prospective study was designed to evaluate and compare the skeletal and dentoalveolar effects produced by 2 types of pendulum appliance with different anchorage modalities - the Bone anchored pendulum appliance (BAPA) and Conventional pendulum appliance (CPA) in subjects with Angle's ClassII malocclusion. Materials and Methods: BAPA group consisted of 5 patients with mean age, 16.4±1.5 years. The CPA group consisted of 5 patients with mean age, 16.6±1.1 years. Lateral cephalograms &amp; dental casts were obtained at pre-treatment stage &amp; after achieving Class I molar relation. Dentoalveolar, skeletal, soft tissue measurements and dental cast measurement were recorded &amp; compared between the groups. Results and Conclusions: Successful distalization was achieved in both groups in a mean period of 6.2 months for BAPA and 5.2 months for CPA. It was concluded that, both theBAPA and CPA were effective for the distalization of maxillary molars. Though the distal molar movements obtained were similar between the BAPA and the CPA groups, anchorage loss was observed with the CPA in the form of premolar mesialization &amp; incisor proclination, whereas absence of anchorage loss, significant spontaneous distal premolar movement, and distal incisor movement was observed with the BAPA, making it a viable choice compared to the CPA.

Percutaneous screw fixation of the iliosacral joint: A case-based preoperative planning approach reduces operating time and radiation exposure

IntroductionA preoperative planning approach for percutaneous screw fixation of the iliosacral joint provides specific entry points (EPs) and aiming points (APs) of intraosseous screw pathways (as defined by CT scans) for lateral fluoroscopic projections used intraoperatively. The potential to achieve the recommended EPs and APs, to obtain an ideal screw position (perpendicular to the iliosacral joint), to avoid occurrence of extraosseous screw misplacement, to reduce the operating time and the radiation exposure by utilizing this planning approach have not been described yet. MethodsOn preoperative CT scans of eight human cadaveric specimen individual EPs and APs were identified and transferred to the lateral fluoroscopic projection using a coordinate system with the zero-point in the center of the posterior cortex of the S1 vertebral body (x-axis parallel to upper S1 endplate). Distances were expressed in relation to the anteroposterior distance of the S1 upper endplate (in%). In each specimen on one side a screw was placed with provided EP and AP (New Technique) whereas at the contralateral side a screw was placed without given EP and AP (Conventional Technique). Both techniques were compared using postoperative CT scans to assess distances between predefined EPs and APs and the actually obtained EPs and APs, screw angulations in relation to the iliosacral joint in coronal and axial planes and the occurrence of any extraosseous screw misplacement. The “operating time (OT)” and the “time under fluoroscopy (TUF)” were recorded. Statistical analysis was performed by the Wilcoxon signed-rank test. ResultsEPs were realized significantly more accurate using the new technique in vertical direction. The screw positions in relation to the iliosacral joint showed no significant difference between both techniques. Both techniques had one aberrantly placed screw outside the safe corridor. The (mean±SD) “OT” and the (mean±SD) “TUF” were significantly decreased using the new technique compared to the conventional technique (OT: 7.6±2min versus 13.1±5.8min, p=0.012; TUF: 1.5±0.8min versus 2.2±1.1min). ConclusionThe presented preoperative planning approach increases the accuracy in percutaneous screw fixation of the iliosacral joint, reduces operating time and minimizes radiation exposure to patient and staff.