Needle Breakage Research Articles

Tibiocalcaneal arthrodesis via bone transport technique for traumatic talus infection or defect

Objective To investigate the clinical efficacy of tibiocalcaneal arthrodesis using bone transport technique in the treatment of traumatic talus infection or loss. Methods A retrospective case series study was conducted to analyze the clinical data of 15 patients with talus infection or loss admitted to the provincial hospital affiliated to Shandong University from June 2011 to October 2017. There were 13 males and two females, aged from 19 to 47 years, with an average age of 27 years. Thirteen patients had talus infection and two patients had talus loss. All patients underwent tibiocalcaneal fusion with external fixator using bone transport technique, including four patients treated with annular external fixator and 11 with unilateral external fixator. Six patients with severe infection underwent debridement at stage I and osteotomy at stage II, and the other nine underwent debridement and osteotomy at the same time. The length of new bone, the fixation time of external fixator and complications were recorded. The American Orthopedic Foot and Ankle Society (AOFAS) score was used to evaluate the efficacy. Results All patients were followed up for 18-35 months, with an average of 26 months. The length of new bone in proximal tibial osteotomy area was 5-16 cm, with an average of 9 cm. The external fixators were removed after bone healing at docking site and maturation of new bone. The fixation time of external fixator ranged from 13 to 27 months, with an average of 18 months. No complications such as needle breakage, recurrence of infection and calcaneal varus occurred, and the length of both lower limbs was equal. AOFAS score was increased from preoperative (42.0±3.6)points (31-55 points) to (76.0±4.2)points (69-86 points) at the last follow-up. Conclusion Tibiocalcaneal arthrodesis using bone transport technique is proved to be effective in treating traumatic talus infection or loss, which can repair the bone defect after debridement, improve the ankle-hindfoot function and improve the quality of life. Key words: Talus; Infection; External fixators; Arthrodesis

Diamond Needles Actuating Triple-Walled Carbon Nanotube to Rotate via Thermal Vibration-Induced Collision.

A rotary nanomotor is an essential component of a nanomachine. In the present study, a rotary nanomotor from wedged diamonds and triple-walled nanotubes was proposed with the consideration of boundary effect. The outer tubes and mid-tubes were used as nanobearing to constrain the inner tube. Several wedges of the diamond were placed near the inner tube for driving the inner tube to rotate. At a temperature lower than 300 K, the inner tube as the rotor had a stable rotational frequency (SRF). It is shown that both the rotational direction and the value of SRF of the rotor depended on the temperature and thickness of the diamond wedges. The dependence was investigated via theoretical analysis of the molecular dynamics simulation results. For example, when each diamond wedge had one pair of tip atoms (unsaturated), the rotational direction of the rotor at 100 K was opposite to that at 300 K. At 500 K, the rotating rotor may stop suddenly due to breakage of the diamond needles. Some conclusions are drawn for potential application of such a nanomotor in a nanomachine.

Factors associated with needle breakage of antegrade suture passer and effect of intratendinous remnant needle tip on clinical outcomes after arthroscopic rotator cuff repair

ObjectiveThe aim of this study was to evaluate factors associated with the needle breakage of antegrade suture passer and the effect of intratendinous remnant needle tip on clinical outcomes after rotator cuff repair. MethodsWe retrospectively reviewed 283 patients (138 men and 145 women; mean age: 59.7 ± 9.3 years) who underwent arthroscopic repair for full-thickness rotator cuff tear. We evaluated the characteristics of 16 patients in whose needle tip had been broken and embedded and remained in the rotator cuff (remnant needle group) and compared them with the remaining 267 patients (control group). Afterwards, another 64 patients were selected from control group (1:4 matching) after propensity score matching (PSM). The groups were compared anatomically with MRI or ultrasonography and functionally (serial pain VAS and ROM; ASES, Constant, UCLA and SST scores) at a minimum follow-up of 1 year. ResultsThe remnant needle group showed preoperative thicker tendon (6.72 mm vs 5.33 mm, p = 0.047), higher tendinosis (mean grade, 1.88 vs. 1.43, p = 0.029), and more frequent delaminated tears (p = 0.035) compared with control group. When we compare the clinical outcomes after PSM, the initial pain VAS of the remnant needle tip group was higher up to 3 months (pain VAS: 4.13 ± 2.07 vs 2.48 ± 1.61 (p = 0.032) at 5 weeks and 3.79 ± 2.12 vs 2.25 ± 1.76 (p = 0.044) at 3 months), however the difference disappeared after 6 months postoperatively. In final evaluation, there was no significant differences in every outcome parameters (all p > 0.05). ConclusionBreakage of the needle of the antegrade suture passer occurred more frequently in the thicker tendon, higher tendinosis, and delaminated tears. The retained broken needle tip was associated with higher pain scores during the early postoperative period, but revealed no difference in final outcomes by using PSM. Level of EvidenceLevel III, Therapeutic Study

Medical solution to needle breakage during local anesthesia

Needle breakage may be a damaging experience for both medical practitioners and patients. Medical literature provides numerous cases of dental practitioners being confronted with this problem. We have studied the clinical case of the patient L. at the Moscow State University of Medicine and Dentistry involving needle breakage during conductive anesthesia. We propose our medical approach to solving this issue alongside with a desirable course of action, providing additional recommendations and suggesting intraosseous anesthesia as a safer type of pain management.

Application of self-made mini external fixator in phalangeal fractures

Objective To explore the clinical effect of phalangeal fractures with self-made mini external fixator. Methods From June, 2014 to June, 2017, 16 cases of phalangeal fracture were treated with self-made mini external fixator. In the followed-up periods, the regulating rechecks of X-ray and measurement of interphalangeal joint activity were determined. The total active movement (TAM), numerical pain ranting scale (NPRS) and morning stiffness was used to estimate the fracture healing and the hand function recovery. Results Pain and abnormal movement around fracture was found 6 weeks after the operation in 1 case, which had been healed by removing the external fixation, open reduction and internal fixation with kirschner wire. The other 15 cases were followed-up of 48-72 (average, 58) weeks. The fracture has healed. And there was no osteomyelitis, no breakage and loosening of steel needles. The clinical healing time of the fracture was 14 to 16 weeks, with an average of 15.5 weeks. According to the TAM, NPRS and morning stiffness, there was excellent in 11 cases, and good in 4 cases. Conclusion The self-made mini external fixator can maintain the stability after fracture reduction, provide the tension required for the healing of collateral ligament and joint capsule, and meet the need of early functional exercise. It is an ideal treatment option for phalangeal fractures. Key words: Phalangeal fracture; External fixator; Self-made; Repair

Needle fracture as a complication of dental local anesthesia: recommendations for prevention and a comprehensive treatment algorithm based on literature from the past four decades

ObjectivesThe aim of this publication is to provide a concept for prevention and a standardized step-by-step clinical approach to this rare but serious and potentially preventable complication of dental local anesthesia.Materials and methodsWe collected data with a PUBMED search using the key words “local anesthesia,” “dental anesthesia/anesthesia” OR “mandibular block anesthesia,” “complication,” “hypodermic needle,” “needle breakage” OR “needle fracture,” and “foreign body AND removal” OR “retrieval.” The existing literature was systematically evaluated from 1980 to date using Microsoft Excel 2007 (Microsoft Corporation).ResultsAfter analysis of the literature, we included 36 reports documenting 59 needle breakage events and defined possible risk factors and preventive measures. All relevant reported parameters were listed in tabular form. The main result of this article is a treatment algorithm for this complication.ConclusionsPrevention of a needle fracture should be the main goal during local dental anesthesia. Use of longer hypodermic needle can obviate complex retrieval surgery. If immediate removal of the fragment fails, localization, planning, and the necessary surgical procedure should be arranged promptly.Clinical relevanceFollowing a strict algorithm, successful surgical handling of this complication will depend on minimizing risk and following treatment recommendations closely.

Observation of clinical effects of radiofrequency ablation in the treatment of cervical spondylotic radiculopathy

Objective To compare the clinical effects of conservative therapy and radiofrequency ablation in the treatment of cervical spondylotic radiculopathy, to analyze the reason and discuss the surgical indications. Methods Fifty-five patients with cervical spondylotic radiculopathy treated in Shijingshan Hospital from May 2013 to May 2016 were selected and retrospectively analyzed, including 30 patients received conservative treatment (conservative group), 25 patients undergone radiofrequency ablation (operation group). Visual analogue score (VAS) was used to assess the degree of pain relief in the two groups before treatment and 1 week, 1 month after treatment.The side effects in the two groups and the postoperative complications of the patients were observed. Results The VAS score of the operation group and the conservative group in 1 weeks after treatment were (3.2±0.5) points, (5.2±0.7)) points, 1 months (2.8±0.3) points, (5.8±0.4) points, respectively, the degree of pain were lower than those collected before treatment (8.0±0.9) points, (7.6±0.8) points, separately, the differences were statistically significant (P<0.05), and the degree of pain relief in the operation group was more obvious than that in the conservative group, there was significant difference between the two groups (P<0.01). Two groups of patients were treated with medication without any obvious discomfort.The surgery of the operation group was successful, and no complications such as nerve and spinal cord injury, vascular injury, local hematoma, puncture needle breakage and intervertebral space infection were found. Conclusion Radiofrequency ablation is more effective for the treatment of cervical spondylotic myelopathy in the short term than conservative treatment, and radiofrequency ablation treatment is a recommended choice for patients with no surgical contradiction. Key words: Cervical spondylosis; Minimally invasive; Radiofrequency ablation

First Case Report: Breakage of an Insulin Pen Needle in Subcutaneous Tissue

The majority of patients with type 1 diabetes (T1D) uses an insulin pen for convenience, accessibility, accuracy and reduced injection pain. We report the first case of an insulin pen needle breaking off at the base and becoming embedded in the soft tissue of the abdominal wall. The mother of a 4-year-old boy with T1D injected the boy with long acting insulin using an insulin pen while he was sleeping. He kicked his mother dislodging the needle from the pen and embedding it in the soft tissue of the abdominal wall.

Removal of a Venous Intraluminal Needle: A Case Report

In the United States, the population who report intravenous drug use is small but this behavior is associated with dangerous and costly health problems. According to the National Survey on Drug Use and Health (NSDUH) 2009 Report, data from 2006 to 2008 showed that an average of 425,000 people annually aged 12 or older (0.17 %) used a needle to inject heroin, cocaine, methamphetamine or other stimulants [1]. However, within this group, behaviors with significant medical ramifications were quite frequent. The report found that only 29 % of users reported cleaning the needle with bleach prior to their last injection and 13 % of users used a needle they knew or suspected had been used before by themselves or another person [1]. The complications from intravenous drug use and its associated high-risk behaviors can be significant and include local infection, endocarditis, sepsis, human immunodeficiency virus transmission, hepatitis C transmission, drug overdose and even death. Another complication of intravenous drug use is needle breakage with retained needle fragment(s). This is particularly concerning when the needle fragment is intravascular due to the possibility of subsequent embolization of the fragment to distant sites. We report the case of a young woman with a retained needle fragment inside the lumen of a proximal forearm vein 7 days after attempted intravenous injection with Oxycodone. To our knowledge, this is the first successful local removal of a retained intravenous needle fragment reported in the literature.

A “Needling” Complication

Intracavernosal injection therapy with vasoactive agents for treatment of erectile dysfunction has been around for more than 3 decades since its advent in the early 1980s. Common complications include ecchymosis and hematoma at the site of injection, priapism, and fibrosis. We describe a rare but potentially dangerous complication of breakage of needle during administering of injections, and discuss its successful retrieval.

Toward Self-Powered Wearable Adhesive Skin Patch with Bendable Microneedle Array for Transdermal Drug Delivery.

A wearable adhesive skin patch for transdermal drug delivery is developed with bendable microneedles, dry adhesive and triboelectric energy harvester (TEH). The bendable microneedle array can overcome the needle breakage issue. The dry adhesive can realize a conformal attachment. The TEH can generate power when attached on flat skin or joint to power active components to be integrated in the future.

Migration of a broken dental needle into the posterior cervical space

AbstractAimThe purpose of the present study was to report a rare case in which a broken needle migrated to the posterior cervical space.Case reportA 52‐year‐old male was referred to the Oral and Maxillofacial Surgery Department of the Marcílio Dias navy Hospital in order to assess a broken needle in the mandible. The patient was submitted to a dental procedure on the right side of the mandible and the breakage occurred during the inferior alveolar nerve block. The dentist requested a panoramic radiograph and cone beam computed tomography (CBCT) and referred the case to the hospital immediately. The needle fragment was found in the pterygomandibular space. Conservative management with a systematic follow‐up was applied. The patient returned after 7 days and did not exhibit any signs or symptoms. In consultations after 14, 30 and 60 days, the clinical condition remained the same. CBCT was requested 180 days after the needle breakage and the posterior‐medial migration of the needle fragment to the posterior cervical space was confirmed, close to the first cervical vertebra (1.81 mm). In the follow‐up after 1 year, the patient still did not exhibit any signs or symptoms.ConclusionsThe decision to not retrieve the needle fragment was taken with the patient. The patient is being monitored. Appropriate measures should be taken in order to prevent this mishap from occurring.

Evaluation of Sewability of Nappa Leathers

This paper focuses on determining the standard threshold value of needle penetration force and sewability of garment leathers using sewability tester whose design has been modified exclusively for leathers. Two different types of apparel leathers sheep and goat nappa leathers were chosen for the study. A nominal value of threshold was initially set based on mass per unit area of samples and tests were carried out at different threshold settings. The appropriate threshold level was determined based on the actual performance of the fabric/leather with respect to needle breakage, seam performance etc. It has also been observed that there is a correlation between weight/thickness and threshold value of needle penetration force which is well explained on the basis of the fact that as the weight/thickness increases, the resistance to sewing increases and thereby sewability value increases. The sewability values of goat nappa leathers are on the higher side compared to sheep nappa leathers because of the dense and compact triple helical fibre structure.

Feasibility study of a novel intraosseous device in adult human cadavers

Background & objectives:Intraosseous (IO) access is an alternative to difficult intravenous (iv) access during emergency clinical situations. Existing IO solutions are expensive, require power supply and trained manpower; limiting their use in resource constrained settings. To address these limitations, a novel IO device has been developed. The objectives of this study were to evaluate functionality and safety of this device in adult human cadavers.Methods:The ability of the IO device to penetrate the proximal and/or distal tibia was evaluated in three adult cadavers. Subjective parameters of loss of resistance, stable needle hold, easy needle withdrawal and any damage to the device were evaluated during the study. The insertion time was the objective parameter measured. Four sets of radiographs per insertion confirmed the position of the needle and identified complications.Results:A single physician performed 12 IO access procedures using the same device. Penetration of proximal and/or distal tibia was achieved in all instances. It was successful in the first attempt in eight (66.7%) and during second attempt in the remaining. The mean time to insertion was 4.1 ± 3.1 sec. Appropriate insertion of needle in the intra-medullary space of bone was confirmed with radiological examination in 10 (83.3%) insertions. In two occasions after penetrating the cortical layer of bone, the device overshot the intra-medullary space, as detected by radiological examination. Device got bent during insertion in one instance. There was no evidence of needle breakage or bone fracture. The needle could be withdrawn effortlessly in all instances.Interpretation & conclusions:The novel IO device could successfully penetrate the adult cadaver bones in most cases. Further studies are needed to confirm these results on a large sample.

The role of intravenous drug use in venous leg ulceration.

V enous leg ulceration is thought to be a disease of old age and prevalence is around 1% of the adult population. However, as many as 46% of sufferers may develop their ulceration before the age of 50 (Mackenzie et al, 2003) and, increasingly, venous leg ulcers are occurring in younger people as a result of intravenous injecting. A recent study showed a high leg-ulcer prevalence of 15% in a sample of 200 people (aged under 44) who had injected drugs (Coull et al, 2014). The assessment process is important in the care of patients with leg ulceration. However, many leg ulcer assessments do not include a question about intravenous (IV) drug use, and IV drug use is rarely mentioned as a risk factor in literature about venous leg ulceration. Chronic venous disorders (CVDs) are classified in a staging system that ranges from no visible or palpable signs of venous disease through the signs of chronic venous insufficiency (CVI), varicose veins, oedema, skin changes, to ulceration as end-stage venous disease (EklOf et al, 2004). CVI commonly occurs in the sixth or seventh decade of life, but occurs in the third or fourth decade for people who inject drugs (PWID) (Pieper, 1996). It is important to recognise that prevalence is higher than expected, and be aware of key contributing factors that might cause leg ulceration in PWID, especially as ulceration may occur long after injecting has ceased (Pieper, 1996). Most significant is injecting in the femoral vein or the legs, and the presence of deep vein thrombosis (DVT). PWID may use the femoral vein as a site to inject into (groin injecting). This site can be used for many years and is associated with a lack of alternative access, easier technique, improved drug effect, and the fact that the site is easily hidden (Williams and Abbey, 2006). Femoral injecting is risky, with many reported problems. Repeated puncturing of the femoral vein may result in a noticeable dimples in the skin and eventually a sinus may form in some individuals (Maliphant and Scott, 2005). Swellings or aneurysms can occur in the groin area and there is a risk of inadvertent arterial injection, venous insufficiency, infection and pain (Gan et al, 2000; Senbajo et al, 2012). Scarring or thickening of the femoral vein can occur causing difficulty with injecting, such as needle breakage and a requirement to use longer, thicker needles. Swelling or thickening can lead to a narrowing of the lumen causing a slowing in venous blood flow, resultant back pressure and venous hypertension. Consequently, as the blood flow becomes sluggish, a DVT may form (MacKenzie et al, 2000). Injecting directly into the legs increases the likelihood of skin breakdown and ulceration. This is partly owing to the venous damage inflicted by repeated needle punctures and increased risk of infection and DVT in the lower legs (Pieper et al, 2009). DVT is a risk factor in the development of venous ulceration, and, although DVT is relatively common in PWID, there is a lack of awareness of the long-term consequences on the lower limb (Williams and Abbey, 2006). A clot in the leg, especially proximal to the knee, also increases the likelihood of post–thrombotic syndrome (PTS), which is characterised by signs of venous insufficiency with limb swelling, pain, skin changes, difficulty in walking and venous ulceration (Kahn and Ginsberg, 2004). PTS has been known about for many years (Linton, 1953) but little is known about the risk factors or why it occurs in some and not others. Despite this, it is possible that the PTS sequelae, including ulceration that follows DVT, could be prevented in up to 50% of sufferers by using compression hosiery (Prandoni et al, 2004). However, a study by Kahn et al (2014) contradicted earlier results and showed elastic compression stockings did not prevent PTS. Further trials are needed, but hosiery may offer symptomatic relief and would be advised for those with a proximal DVT at or above the popliteal vein (Arumugaswamy and Tran, 2014). Other guidelines suggest that those with PTS should wear compression hosiery constantly and forever, to minimise the extension of disease and venous ulcer formation (Robson et al, 2008). Compression can also have a dramatic effect on reducing pain (Ettridge, 2011). Health professionals caring for PWID should be aware of the high prevalence of leg ulceration in this group, and consider their role in the prevention of ulceration following DVT and in PTS. Early recognition of PTS may help reduce the prevalence of leg ulceration. Educating this group about the long-term consequences is also worthy of consideration. BJN

Where Is The Rest of That Needle? Needle Breakage: A Rare Complication of EBUS-TBNA

Where Is The Rest of That Needle? Needle Breakage: A Rare Complication of EBUS-TBNA

Management of Foreign Object Migration and Surgical Removal with C-Arm Fluoroscopy.

Management of Foreign Object Migration and Surgical Removal with C-Arm Fluoroscopy.

Tissue concentrations of sulfamethazine and tetracycline hydrochloride of swine (Sus scrofa domestica) as it relates to withdrawal methods for international export

The use of water medications is a common practice in the US swine industry to treat and prevent infections in swine herds with minimal labor and without risk of needle breakage. There are concerns that FDA-approved withdrawal times (WDT) may be inadequate for several water medications when exporting pork products to countries where MRLs (maximum residue limits) are lower than US tolerance levels. In this study, withdrawal intervals (WDI) were estimated for pigs when dosed with tetracycline and sulfamethazine in water. The WDI were calculated using the FDA tolerance method (TLM) and a population-based pharmacokinetic method (PopPK). The estimated WDIs (14–16days using TLM) were similar to the approved WDT of 15days for sulfamethazine. However, the PopPK method extended WDIs for both sulfamethazine (19–20days) and tetracycline (12days) compared to the currently approved WDTs in the U.S. This study also identified potential differences in WDI between weanling and finisher pigs. In conclusion, the TLM may not always provide adequate WDT for foreign export markets especially when MRLs differ from tolerance levels approved for US markets. However, PopPK methods can provide conservative WDIs in situations with considerable variability in medication exposure such as with administration in water.

Efficiency Losses Calculation and Identify Causes of Losses of Circular Knitting Machine during Knit Fabric Production

This thesis deals with a major problem of production loss of a knitting industry. The knitting machine has to stop when defects occurred and then faults are corrected, which results in time loss and efficiency loss. Not only that the knitted fabric may be rejected if quality requirements are not met. An effective monitoring is required to avoid defects and to avoid productivity and quality losses. The study identifies two main categories of defects (average time required for correcting defects and machine down time) are responsible for reducing productivity. The thesis reflects that due to yarn breakage machine stopped for seen minutes per days, for maintaining machine stopped for two hours per month, for needle breakage six minutes per day and for technical problem machine stopped for several times.

Computed tomography-guided percutaneous biopsy of bone lesions: rate of diagnostic success and complications.

ObjectiveTo determine the rates of diagnostic success and complications of computed tomography (CT)-guided percutaneous biopsy of bone lesions suspected for malignancy.Materials and MethodsRetrospective study including 186 cases of CT-guided percutaneous biopsies of bone lesions in the period from January, 2010 to December, 2012. All the specimens were obtained with 8-10 gauge needles. The following data were collected: demographics, previous history of malignancy, data related to the lesion, to the procedure, and to histological results.ResultsMost patients were women (57%), and the mean age was 53.0 ± 16.4 years. In 139 cases (74.6%), there was diagnostic suspicion of metastasis and the most common primary tumors were breast (32.1%) and prostate (11.8%). The bones most commonly involved were spine (36.0%), hip (32.8%) and long bones (18.3%). Complications occurred in only three cases (1.6%) including bone fracture, paresthesia with functional impairment, and needle breakage requiring surgical removal. The specimens collected from 183 lesions (98.4%) were considered appropriate for diagnosis. Malignant results were more frequently found in patients who had a suspected secondary lesion and history of known malignancy (p < 0.001), and in patients who underwent PET/CT-guided procedures (p = 0.011).ConclusionCT-guided percutaneous biopsy is a safe and effective procedure for the diagnosis of suspicious bone lesions.