Hardware Placement Research Articles

Three-Dimensional Fluoroscopic System to Assess Robotically Placed Pedicle Screws: Should We Confirm Robotic Pedicle Screw Placement With Advanced Imaging?

Retrospective cohort study. The purpose of this study is to determine the utility of advanced imaging to confirm the placement of robotic pedicle screws. With increasing robotic adoption, certain institutions and surgeons have developed protocols for obtaining 3D intraoperative imaging after robotic pedicle screw placement to ensure proper hardware placement. No studies have assessed the utility of these protocols relative to the potential risks of increased radiation exposure and operative time. The purpose of this study is to determine if we should be obtaining advanced imaging to confirm the placement of robotic pedicle screws. This is a single institution retrospective cohort study of patients from May 2022 to July 2023 who underwent lumbar spinal fusion by a high-volume orthopedic spine surgeon at a level 1 metropolitan hospital. All cases used combined robotics and navigation systems for pedicle screw placement and intraoperative 3D imaging for evaluation of screw position. Pedicle screw accuracy was assessed using the Gertzbein and Robbins system (GRS). Acceptable pedicle screw position was defined as GRS A or B. Seventy patients with 354 robotically placed pedicle screws were assessed with intraoperative 3D fluoroscopy. All pedicle screws were placed in either a GRS type A or type B position. Three hundred forty-seven were placed in a GRS A classification (99.2%, 351/354), and 3 were placed in a GRS B classification (0.08% 3/354). No patients had screw-related complications. The average radiation dosage of 3D imaging was 289.7±164.6mGy. The robotic system places pedicle screws accurately without 3D intraoperative imaging. Given the increased radiation and operative time associated with 3D imaging protocols 3D imaging scans should only be obtained in cases with heightened clinical concern. Level IV.

Diagnostic performance of digital tomosynthesis for postoperative assessment of acetabular fractures and pelvic ring injuries

IntroductionDigital tomosynthesis (DTS) has broad non-orthopaedic applications and has seen limited use within orthopaedics for imaging of the wrist. The utility of DTS for assessing reduction and hardware placement following operative treatment of pelvic ring injuries and acetabular fractures has not previously been investigated.MethodsAll operatively treated acetabular fractures and pelvic ring injuries that underwent surgical fixation within a one-year time span received both a computed tomography (CT) scan and a DTS scan as part of their routine postoperative imaging workup. Three orthopaedic traumatologists independently reviewed the images for face-value clinical utility. Radimetrics and PCXMC software were utilized on a subset of the study population's DTS and CT studies to calculate the effective and organ radiation doses delivered.Results52 patients (22 acetabular fractures, 22 pelvic ring injuries, 7 pelvic ring and acetabular fractures, 2 femoral head & acetabular fractures) were included. DTS was considered adequate to assess reduction 83% of the time, hardware position 83% of the time, and sufficient to replace the CT scan 67% of the time. DTS was associated with an 8.3 times lower effective radiation dose than CT. All organ doses were lower for DTS than CT.DiscussionDTS appears to have face-value clinical utility for assessing reduction and hardware position following surgical treatment of acetabular fractures and pelvic ring injuries. Given that DTS is associated with significantly lower radiation doses to patients, further study utilizing more objective criteria is warranted.

Fat Grafting for Forehead Contouring in Facial Feminization.

For gender-diverse individuals assigned male at birth, postpubertal estrogen and testosterone-lowering therapies alone are often inadequate to reverse the testosterone-related facial characteristics projecting a male sex identity. Facial feminization surgery significantly improves quality-of-life outcomes for gender-diverse patients by relieving this gender incongruence of the face. Because the shape of the forehead is so radically different between men and women, feminization of this area is critical for many individuals. Several techniques are typically used in combination, including hairline advancement, browlift, burring of the supraorbital rims, frontal bone contouring, and anterior table setback. This report describes the use of fat grafting as an adjuvant technique to forehead contouring as means to avoid frontal bone osteotomy, which carries a higher complication profile and often requires hardware placement.

Technical Considerations for the Surgical Management of a C2 Spinal Cord Hemangioblastoma and Subjacent Cervical Spondylotic Myelopathy: A 2-Dimensional Operative Video.

Hemangioblastomas are characterized as benign tumors of the central nervous system and are typically associated with von Hippel-Lindau disease in 20% to 30% of patients.1 Spinal hemangioblastomas are rare entities accounting for 2.1% of spinal cord tumors and are most frequently observed in the cervical spinal region.1-4 Treatment interventions include microsurgical resection and stereotactic radiosurgery.5 Understanding the granular detail of surgical management in these complex cases is necessary for optimal clinical outcomes. In this 2-dimensional operative video, we detail the technical nuances for resection of a World Health Organization Grade I hemangioblastoma in the upper cervical spine of a 51-year-old man. The lesion and severe adjacent canal stenosis resulted in extensive spinal cord compression, causing him to experience progressive myelopathic symptoms and neurological deficits. A C1-C7 laminectomy provided exposure of the hemangioblastoma and adequate decompression of the subjacent spondylotic disease. Intraoperative ultrasound was used to localize the tumor and perform a targeted durotomy. The sunburst-colored lesion was eccentric to the left side of C1-C2 and found in the epi-pial region, with pial thickening present in the surrounding area. The feeding vessels and deep draining vein were coagulated and cut. Low-power suction was used for traction/counter-traction dissection of the tumor planes. Owing to a multilevel laminectomy having been performed, hardware placement was performed from C2-T1. Adequate placement of all screws was confirmed with intraoperative 3-dimensional image acquisition. The patient provided informed consent for the operation and for sharing his clinical information, including digital media, for publication; Institutional Review Board not required per institutional policy.

Peroneal artery injury potential due to different syndesmosis screw placement options: a simulation study with lower extremity computed tomography angiography.

The aim of this study is to assess the risk of peroneal artery injury of hardware placement at the fixation of syndesmotic injuries. The lower extremity computed tomography angiography was used to design the study. The syndesmosis screw placement range was simulated every 0.5cm, from 0.5 to 5cm proximal to the ankle joint. The screw axes were drawn as 20°, 30° or individual angle according to the femoral epicondylar axis. The proximity between the screw axis and the peroneal artery was measured in millimeters. Potential peroneal artery injury was noted if the distance between the peroneal artery to the axis of the simulated screw was within the outer shaft radius of the simulated screw. The Pearson chi-square test was used and a p-value < 0.05 was considered significant. The potential for injury to the peroneal artery increased as the syndesmosis screw level rose proximally from the ankle joint level or as the diameter of the syndesmosis screw increasds. In terms of syndesmosis screw trajection, the lowest risk of injury was observed with the syndesmosis screw angle of 20°. Simulations with a screw diameter of 3.5mm exhibited the least potential for peroneal artery injury. Thanks to this radiological anatomy simulation study, we believe that we have increased the awareness of the peroneal artery potential in syndesmosis screw application. Each syndesmosis screw placement option may have different potential for injury to the peroneal artery. To decrease the peroneal artery injury potential, we recommend the followings. If individual syndesmosis screw angle trajection can be measured, place the screw 1.5cm proximal to the ankle joint using a 3.5mm screw shaft. If not, fix it with 30° trajection regardless of the screw diameter at the same level. If the most important issue is the peroneal artery circulation, use the screw level up to 1cm proximal to the ankle joint regardless of the screw angle trajection and screw diameter.

USE OF SEWIO REAL-TIME LOCATION SYSTEM IN PRACTICE: TECHNICAL PREPARATION OF HARDWARE, DATA COLLECTION AND ANALYSIS

Real-Time Location Systems (RTLS) technology has emerged as a transformative tool in industrial settings, offering enhanced process management and optimization capabilities. This paper presents a methodological framework for the technical preparation of RTLS hardware, aiming to provide a structured approach for its implementation in industrial environments. The framework encompasses key steps, including technical capability assessment of components, preparation of components for assembly, placement of hardware in the measured object, compliance with occupational health and safety rules, consultation with company management/process engineers, initial inspection of the established network, verification of network configuration, and validation using a tester. Through a collaborative approach involving meticulous planning, consultation, and testing, organizations can effectively deploy RTLS hardware to improve efficiency, productivity, and safety in their operations. This abstract encapsulates the essential components and insights of the paper, offering a comprehensive overview of the methodological framework for implementing RTLS hardware in industrial settings.

Reasons for Removal of Rigid Internal Fixation Devices in Craniofacial Surgery: A 20-year Update.

The hardware utilized for rigid internal fixation of the craniofacial skeleton has evolved over time. Thus, the reasons for the unplanned removal of hardware continue to change. The purpose of this study is to compare past (1989-1995) and present (2000-2020) patient cohorts to establish trends related to unplanned removal of craniofacial hardware. A retrospective review study was designed. Data from our institution's original publication describing the unplanned removal of craniofacial hardware (1989-1995) was obtained. Data related to patients who underwent unplanned removal of hardware from 2000 to 2020 was collected from the electronic medical record. A descriptive statistical analysis was performed to compare demographics, reasons for hardware placement, and reasons for unplanned hardware removal between cohorts. This study includes 55 patients treated from 1989 to 1995 and 184 patients treated from 2000 to 2020. The average age at hardware placement decreased from 32 years (1989-1995) to 28 years (2000-2020). The most common reason for hardware placement changed from motor vehicle accident (1989-1995) to congenital deformity (2000-2020). The length of time with hardware in situ increased from 13 months (1989-1995) to 25 months (2000-2020). The most common reason for hardware removal changed from prominent hardware (1989-1995) to hardware exposure (2000-2020). In summary, patients who underwent rigid internal fixation of the craniofacial skeleton from 2000 to 2020 retained their hardware 2 times longer than patients treated from 1989 to 1995. Factors potentially contributing to increased retention include improved surgical technique, decreased profile of hardware, and increased surgeon experience. Further studies are warranted to define preoperative risk factors for unplanned hardware removal.

Automated traffic monitoring of neurosurgical operating room

Operating room (OR) traffic disrupts airflow and increases particle count, which predisposes patients to surgical site infections, particularly in longer surgeries with hardware placement. The aim of this study is to evaluate the rate of traffic during neurosurgical procedures, as well as reasons for and perceptions of OR traffic. This is a single-center, multimethod study monitoring neurosurgical OR traffic through direct observation, automated monitoring, and interviews. Traffic was observed between the skin incision and closure. Personal interviews with OR teams including surgeons, anesthesia, and nurses were conducted to evaluate their perceptions of the frequency of OR traffic and reasons for OR traffic. Direct observation reported OR door opening an average of 18 times, with 20 people entering or exiting per hour. The exact reason for traffic was not verified in all traffic cases and was able to be confirmed in only a third of the cases. Automated monitoring resulted in an average of 31 people entering or exiting the OR per hour. The procedure length was significantly associated with the number of people entering or exiting the OR per hour (P<.0001). Interviews highlighted that OR teams reported traffic to be significantly lower than observed and automated monitoring results, with approximately <6 people entering or exiting per hour. OR traffic is higher than staff expected, and updated processes are required to reduce the number of times the OR door opens. Implementing automated observation of OR traffic could reduce the OR traffic and the risk for surgical site infection.

Case Report: Management of pediatric Le Fort and mandibular fracture with a modified cap splint

Pediatric facial fractures are rare and make up 5–15% of all facial fractures. The low incidence of facial fractures among children is due to physiological and environmental factors such as greater resilience of the pediatric skeleton, higher bone to tooth ratio, direct parental supervision and limited outdoor activity.1 In children of 5–10 years of age nasal fractures are by far the most frequent (58.6%), followed by mandibular fractures (21.5%). Orbital (9.5%), frontal (5.1%), and midfacial (3.8%) fractures are next in frequency2. Le Fort fractures are very rare in children, and there is a paucity of literature presenting their frequency and characteristics. In the mandible condylar fracture is the most common (38.9%) followed by angle (20.6%), parasymphysis (18.3%), body (15.3%) and symphysis (5.3%).3 Facial fractures are more common in boys, though this varies greatly from 1.1:1 to 8.5:1.4 The majority of facial fractures in children result from falls (7.8–48%) and sports-related injuries (4.4–42%).5 In primary or mixed dentition, the placement of internal fixation hardware is challenging due to the risk of injuring unerupted permanent tooth follicles. The use of resorbable plates and screws offer a potential solution to the growing pediatric facial bone as the standard titanium fixation systems carry the risk of translocation, growth restriction, and dental injury. Dental splinting or suspension wires can also be used in place of direct plating. Fortunately, mild malocclusion at this age has the potential to be improved through bony remodeling, the eruption of permanent dentition, compensation of the mastication mechanism, and posttraumatic orthodontia.6 Accordingly, the goal of treatment is to restore the underlying bony architecture to its preinjury position in a stable fashion with minimal residual functional and esthetic impairment.

Minimally Invasive Chevron Akin Osteotomy for Hallux Valgus Correction.

Minimally Invasive Chevron Akin Osteotomy for Hallux Valgus Correction.

Sacrolumbar Interbody Fusion (SLIF): Feasibility, Technical Nuances, Biomechanical Assessment, and Clinical Outcomes.

S1-L5 transdiscal screw fixation is a direct stabilization technique used for surgical treatment of high-grade (III-IV) L5-S1 spondylolisthesis. It has not been used for nonspondylolisthetic cases or in combination with an interbody cage (IC). This study aimed to develop a novel, direct S1-L5 sacrolumbar interbody fusion (SLIF) technique, a combination of IC and sacrolumbar transdiscal screw. SLIF was tested in cadaveric, clinical, and finite element analysis settings. Three cadaveric lumbar spines were used to test the SLIF procedure before clinical application. Eight patients underwent the SLIF procedure. Clinical outcomes were evaluated by visual analog score for leg and back pain, short form 36, Oswestry disability index, and neurological examination. CT scans of the lumbar spine were used to assess the hardware placement and subsequent fusion. Finite element analysis was performed on a healthy human CT-based L5-S1 model. Intact segment, unilateral facetectomy and discectomy, SLIF, and transforaminal lumbar interbody fusion (TLIF) procedures were compared in terms of the range of motion (ROM), von Mises stress on hardware, and shear-induced directional deformity. Additionally, the same set of tests were conducted in an osteoporotic model. Excellent hardware placement was feasible in three cadavers and eight patients. Preoperative neurological deficits improved in all patients. Statistically significant improvements were obtained on all self-reported questionnaire scores. All patients developed solid, Bridwell grade I fusions. Biomechanical testing revealed similar outcomes for TLIF and SLIF regarding the ROM. However, the screw's von Mises stress and shear-induced directional deformity were low for SLIF of healthy and osteoporotic bone. SLIF is a feasible, safe, and effective L5-S1 fusion option suitable for all clinical scenarios. It provides several biomechanical advantages, yielding excellent clinical outcomes.

Virtual Reality–Enabled Resident Education of Lateral-Access Spine Surgery

OBJECTIVELateral access spine surgery has many benefits, but adoption has been limited by a steep learning curve. Virtual reality (VR) is gaining popularity and lends itself as a useful tool in enhancing neurosurgical resident education. We thus sought to assess if VR-based simulation could enhance the training of neurosurgery residents in lateral spine surgery. METHODSNeurosurgery residents completed a VR-based lateral spine module on lateral patient positioning and performing lateral lumbar interbody fusion (LLIF) using the PrecisionOS VR system on the Meta Quest 2 headset. Simulation occurred 1x/week every other week for a total of 3 simulations over 6 weeks. Pre- and post-intervention surveys as well as intra-simulation performance metrics were assessed over time. RESULTSThe majority of resident participants showed improvement in performance scores, including an automated PrecisionOS precision score, number of X-rays used within the simulation, and time to completion. All participants showed improvement in comfort with anatomic landmarks for lateral access surgery, confidence performing lateral surgery without direct supervision, and assessing fluoroscopy in spine surgery for hardware placement and image interpretation. Participant perception on the utility of VR as an educational tool also improved. CONCLUSIONVR-based simulation enhanced neurosurgical residents’ ability to understand lateral access surgery. Immersive surgical simulation resulted in improved resident confidence with surgical technique and workflow, perceived improvement in anatomical knowledge, and simulation performance scores. Trainee perceptions on virtual simulation and training as a curriculum supplement also improved following completion of VR training.

Novel use of interosseous absorbable mattress sutures for secondary sternal fixation: A case series

There is currently no consensus on the treatment of median sternotomy patients presenting secondarily with deep sternal wound infection or symptomatic sternal nonunion. We have developed a novel approach to sternal bone fixation when concerns for open wounds or microbial colonization preclude the use of permanent hardware placement: (1) sternal closure with absorbable interosseous monocortical horizontal mattress sutures followed by (2) multilayered soft tissue closure with pectoralis major advancement or turnover flaps. Benefits of this technique include: closure of retrosternal dead-space, tension offloading of the soft tissue closure, repair of transverse sternal fractures, and preservation of internal mammary artery (IMA) perforators for potential pectoralis turnover flaps. In our early experience, this technique has been successful at promoting functional sternal union - even in secondary closure of high-risk patients contraindicated for permanent hardware placement.

Techniques and Tips to Arthroscopically Remove Prominent and Loose Shoulder Joint Hardware

The number of arthroscopic shoulder operations has continued to steadily increase in recent years, with a projection of over 500,000 rotator cuff operations in 2023. Although the incidence of anchor pullout, hardware failure, and aberrant hardware placement is relatively low, this increased volume of shoulder operations has inevitably resulted in a consequent increase in the number of patients who experience such hardware complications. These hardware issues can cause significant pain, limit shoulder function, and cause permanent damage to the shoulder articular cartilage. The described arthroscopic techniques are presented to provide tools and strategies to safely and effectively remove prominent and loose shoulder joint hardware.

Novel Standalone Motion-Sparing Pelvic Fixation Prevents Short-Term Insufficiency Fractures After Midsacrectomies Without Sacrificing Normal, Mobile Lumbar Segments Traditionally Used for Stabilization.

Sacrectomy is often the treatment of choice to provide the greatest chance of progression-free and overall survival for patients with primary malignant bone tumors of the sacrum. After midsacrectomy, the stability of the sacropelvic interface is diminished, resulting in insufficiency fractures. Traditional stabilization involves lumbopelvic fixation but subjects normal mobile segments to fusion. The purpose of this study was to determine whether standalone intrapelvic fixation is a safe adjunct to midsacrectomy, avoiding both sacral insufficiency fractures and the morbidity of instrumenting into the mobile spine. A retrospective study identified all patients who underwent resection of sacral tumors at 2 comprehensive cancer centers between June 2020 and July 2022. Demographic, tumor-specific, operative characteristics and outcome data were collected. The primary outcome was presence of sacral insufficiency fractures. A retrospective data set of patients undergoing midsacrectomy without hardware placement was collected as a control. Nine patients (5 male, 4 female), median age 59 years, underwent midsacrectomy with concomitant placement of standalone pelvic fixation. No patients developed insufficiency fractures during the 216 days of clinical and 207 days of radiographic follow-up. There were no adverse events attributable to the addition of standalone pelvic fixation. In our historical cohort of partial sacrectomies without stabilization, there were 4/25 patients (16%) with sacral insufficiency fractures. These fractures appeared between 0 and 5 months postoperatively. A novel standalone intrapelvic fixation after partial sacrectomy is a safe adjunct to prevent postoperative sacral insufficiency fractures in patients undergoing midsacrectomy for tumor. Such a technique may allow for long-term sacropelvic stability without sacrificing mobile lumbar segments.

ID: 217156 Lumbar-Sacral Transforaminal Nerve Root Stimulation: Applying Peripheral Nerve Stimulation Technology to Spinal Neurostimulation

The rationale and efficacy of spinal neurostimulation for treatment of neuropathic pain pathologies in lower extremities is well established. However, the presence of treatment failures, especially evident in long term follow up, justifies continued search for other ways of applying neuromodulation in spinal neurostimulation. Peripheral neurostimulation presents the advantages of increased specificity of stimulation targets and decreased risks of hardware implantation as it is performed outside the spinal axis. Lumbar-sacral transforaminal nerve root stimulation utilizes familiar transforaminal approach for placement of stimulation hardware directly inside the neural foramen, minimizing operative risks and allowing for immediate use and ease of programming of the implanted system. This approach is technically easier than the DRG stimulation placement technique previously described, as it utilizes the familiar transforaminal approach used in routine interventional pain treatment practice.

Nonunion in Orthognathic Surgery: A Case-Series of 15 Patients

Bone nonunion is extensively studied in the orthopedic literature, but the knowledge in oral and maxillofacial surgery, specifically orthognathic surgery, is scarce. Since this complication has a significant negative impact on postoperative management of patients, more studies are needed. To report the characteristics of patients presenting with bone nonunion after orthognathic surgery. This is a retrospective case-series study on subjects who underwent orthognathic surgery between 2011 and 2021 and developed nonunion. Inclusion criteria were mobility at the site of the osteotomy and the need for a second surgical intervention. Exclusion criteria were an incomplete medical chart; the absence of nonunion upon surgical exploration, or radiological evidence of nonunion; cleft lip/palate; or syndromic patients. The outcome variable was bone healing after nonunion care. Demographics (age, sex), medical/dental comorbidities, type of surgery (type of fixation, bone grafts, Botox injection), amplitude of movements, nonunion treatment. Descriptive statistics were computed for each study variable. The sample was composed of 15 patients (11 females, mean age 40.4 years old) with nonunion (maxilla: 8 cases, mandible: 7 cases) out of 2036 patients who underwent orthognathic surgery during the period studied (incidence 0.74%). Nine (60%) were bruxers, three were smokers (20%) and one had diabetes. Mean forward movement of the maxilla was 6.55mm (4-9mm) and 7.71mm (4.8-12mm) for the mandible. All patients but one (who refused surgery) were treated by curettage of fibrous tissue and new hardware placement. In addition, 11 received a bone graft, and 4 had Botox injections. All osteotomies healed after the second surgical intervention. Curettage with or without grafting appears to be a good strategy for the cure of nonunion. Bruxism may be a risk factor (60% of patients were bruxers in this study).

108 A Novel Robotic-Assisted Platform for Spinal Decompression Procedures

INTRODUCTION: Removal of pathologic tissue during degenerative spinal surgery cases near a bone-nerve interface presents a challenge during spinal decompression, especially in minimally invasive procedures. Robotic systems for spinal surgeries can potentially offer greater accuracy than manual operations. However, today’s robotic systems are designed only for placement of fusion hardware and lack the ability to work in-situ and in proximity to neural structures. METHODS: In the proposed approach, the surgeon utilizes a 6-degrees-of-freedom joystick to control an industrial grade robotic arm connected to curved-at-the-tip high-speed, shielded drilling end-effectors to perform various bone removal tasks. Live visual feedback is displayed from top-view and endoscopic camera views. Force readouts, correlated to the force exerted on the end-effector through tissue contact, provide real time visual feedback. Additional safety restrictions are designed into the system to prevent excessive force. System orientation training was conducted on vertebral models. Initially, three spine surgeons used the system to perform ipsilateral decompression and foraminotomy in four surgeries in a live pig model. Next, six surgeons used the system to perform ipsilateral decompression on two human cadavers. All surgeons completed questionnaires assessing procedure efficacy and system usability. RESULTS: Animal studies: Required decompression was achieved in all cases, with no complications and minimum-to-moderate bleeding. Intuitive usability and acceptable kinematic range of motion of the robotic system was confirmed. Cadaver study: Questionnaire results demonstrated high scores of confidence in the technique (4.7/5), overall satisfaction (4.4/5) and achievement of adequate decompression (3.9/5). All neural structures remained intact. CONCLUSIONS: This preliminary data indicates that the proposed robotic system can facilitate safe and precise decompression through removal of sufficient tissue removal at the bone/nerve interface. Further studies with a medical grade robotic arm are planned.

660 Intraoperative O-C2 and O-EA Angular Measurements for Achieving Optimal Alignment During Posterior Fossa Decompression and Occipitocervical Fusion for Complex Chiari Malformation

INTRODUCTION: Excess flexion or extension during occipitocervical fusion (OCF) can lead to postoperative complications such as dysphagia and neck pain. Achieving neutral craniocervical alignment intraoperatively can be challenging in patients with Chiari malformation (CM) with craniocervical instability (CCI) undergoing posterior fossa decompression (PFD) and OCF because the head must be flexed for optimal PFD and subsequently extended to neutral for OCF. METHODS: We retrospectively reviewed patients with CM 1 and 1.5 who underwent PFD and OCF. Patient demographics, preoperative presentation, XR morphometrics, operative details, postoperative complications, and clinical outcomes were analyzed. RESULTS: Out of 39 patients (mean age 24.6 years, range 3-51, 76.9% female), 37 patients did not require revision surgery after PFD and OCF. In this non-revision cohort, O-C2a (13.5 ± 10.4° vs. 17.5 ± 10.1°, P = .047) and nPAS (10.9 ± 3.4 mm vs. 13.1 ± 4.8 mm, P = .007) increased significantly after surgery. In 2 patients who required revision due to postoperative dysphagia, these measurements acutely decreased after initial surgery (mean difference -16.6° in O-C2a and -12.8° in O-EAa), and revision surgery restored the morphometrics back to baseline. Applying these observations, we now intraoperatively measure these fluoroscopic morphometrics and ensure neutral craniocervical alignment using the Mayfield head clamp locking mechanism prior to hardware placement. CONCLUSIONS: Utilizing fluoroscopic morphometrics pre- and intra-operatively can guide surgeons in appropriate positioning during combined PFD and OCF. With neutral rotatory fixation, single-axis flexion/extension of the head during each stage of the surgery with the Mayfield head clamp locking mechanism facilitates positioning in conjunction with these fluoroscopic-based measurements.

Routine postoperative computed tomography (CT) scans following acetabulum open reduction internal fixation (ORIF): A survey of orthopaedic traumatologists

ObjectiveThe purpose of this study was to assess the practices related to obtaining postoperative pelvic CT scans following acetabular ORIF and revision surgery rates. DesignA 20-question survey published on the Orthopaedic Trauma Association (OTA) website assessed each surgeon's preference and rationale for or against the routine use of postoperative CT scans for acetabular fractures. ParticipantsFellowship-trained orthopaedic traumatologists. Main outcome measurementsWe examined the percentage of surgeons ordering routine postoperative CT scans, surgeon demographics, and revision surgery rates based on these routine CT scan results. ResultsResponses were received from 57 surgeons. Practices varied regarding postoperative CT scans, with 16 surgeons (28%, Group A) routinely ordering them and 41 surgeons (72%, Group B) not ordering them on all patients. No significant difference in surgeon demographics were found between the groups. Majority of Group A report a revision surgery rate of <1% based on the results of the postoperative CT.Group A report routine postoperative scans were obtained to assess reduction, hardware placement, identify intra-articular fragments, and for educational purposes. Group B did not obtain routine postoperative CTs due to the following: unlikely to change postoperative treatment, adequate reduction and instrumentation placement assessed intraoperatively and by postoperative radiographs, and increased radiation exposure and cost to patients. Group B did report obtaining postop CT scans on select patients, with inadequate intraoperative imaging and postoperative neurological changes being the most common indications. ConclusionThe routine use of postoperative CTs following open reduction internal fixation of acetabular fractures is a controversial topic. While we recognize the role for postoperative CT scans in select patients, our study questions the clinical utility of these scans in all patients and in conclusion do not recommend this protocol.