Screws In Treatment Research Articles

Arthroscopic treatment of anterior cruciate ligament tibial eminence avulsion fracture with double heads compressive cannulated screw fixation in adolescents

To discuss the effectiveness of arthroscopic treatment of anterior cruciate ligament (ACL) tibial eminence avulsion fracture in adolescents by using double heads compressive cannulated screw fixation. Twenty-four patients with ACL tibial eminence avulsion fractures were treated by arthroscopic reduction and internal fixation with double heads compressive cannulated screw fixation between June 2014 and June 2017. There were 15 males and 9 females with an average age of 12.3 years (range, 5-18 years). The body mass index was 19.3-26.4 kg/m 2 (mean, 23.3 kg/m 2). The injury causes included traffic accident injury in 10 cases, sports injury in 8 cases, and falling injury in 6 cases. According to the Meyers-McKeever classification, there were 19 cases of type Ⅱ and 5 cases of type Ⅲa. All patients’ drawer test and pivot shift test were positive. The interval between injury and operation was 3-14 days (mean, 6.2 days). During the follow-up period, the fracture healing condition of patients were determined by X-ray examination; Lysholm score, International Knee literature Committee (IKDC) score, and Tegner score were used to evaluate the knee function. Primary healing of incision was obtained in all patients after operation. All the 24 patients were followed up 6-32 months (mean, 16.4 months). At 6 weeks after operation, 3 patients had difficulty in knee flexion. After the release of the knee joint by manipulation, the knee joint function recovered normally at 6 months after operation. At last follow-up, the X-ray films showed that all the fractures healed and no epiphyseal dysplasia, knee joint deformity, or leg length discrepancy occurred. The Lysholm score, IKDC score, and Tegner score were improved from preoperative 44.3±5.4, 43.7±4.4, and 3.0±1.3 to postoperative 93.1±4.3, 94.6±3.3, and 8.1±1.2, the differences were all significant ( t=25.152, P=0.000; t=28.634, P=0.000; t=13.226, P=0.000). The arthroscopic reduction and internal fixation with double heads compressive cannulated screw in treatment of ACL tibial avulsion fracture (Meyers-McKeever type Ⅱ and Ⅲ) in adolescents has so many advantages, such as minimal trauma, simple operation, firm fixation, little effect on the epiphyseal plate, and has a good joint function recovery.

Finite element analysis of occipital condylar screw in treatment of occipitocervical instability

Objective To explore the biomechanical properties of posterior occipital condyle screws compared with common occipitocervical fusion internal fixation and it's impacts upon stress of hypoglossal canals. Methods Finite element models based on the occipitocervical CT data of one 28-year-old male healthy volunteer were built, including normal model, instability model, internal fixation model by occipital condyle screws, internal fixation model by occipital plate screws, and internal fixation model by transarticular screws. Fifty N gravity and 1.5 N·m torque were exerted upon the surface of occipital bone so that the models could perform lateral bending, flexion, extension, and rotational motions. The motion range and stress distribution of internal fixation were compared under varying conditions among different occipitocervical fusion models. In addition, the impact of occipital condyle screw upon hypoglossal canals was examined. Results Compared with instability model, the motion range in the internal fixation model by occipital condyle screws declined by 96.8%, 95.6%, 95.0% and 98.5% respectively in lateral bending, flexion, extension and rotation. In the internal fixation by occipital plate screws, the motion range decreased by 96.3%, 95.7%, 98.4% and 99.6% respectively. In the internal fixation by transarticular screws, the motion range exhibited a decline of 95.7%, 94.0%, 94.3% and 98.9%, respectively. The stress peaks in the occipital condyle screw were 192.4 MPa, 201.6 MPa and 187.6 MPa under lateral bending, flexion, and rotation conditions, respectively. The stress peaks in the occipital plate screw were 279.6 MPa, 213.7 MPa, and 154.1 MPa, respectively. The stress peaks in the transarticular screw were 232.4 MPa, 220.9 MPa, and 224.5 MPa, respectively. The stress impact peak of occipital condyle screw on the hypoglossal canals wall was 12.96 MPa, and the content deformation under the hypoglossal canal was 0.64%. Conclusions The occipital condyle screw internal fixation has similar stability with common occipitocervical fusion fixations. The occipital condyle screw has more uniform stress distribution and less effect on the hypoglossal canals, and hence is safe and reliable as anchor point on the cranial side in occipitocervical fusion. Key words: Cervical vertebrae; Internal fixators; Finite element analysis; Spinal fusion

A comparative study of short proximal femoral nail and dynamic hip screw in treatment of intertrochanteric fractures

Background: Incidence of intertrochanteric fractures has increased significantly during recent years due to rising age of population and sedentary life style. They are one of the most frequently operated fracture types. Intertrochanteric fractures occur predominantly in elderly patients with osteoporosis. Operative fixation is the treatment of choice. It can be extra medullary implant like dynamic hip screw (DHS) or intramedullary implant like proximal femoral nail (PFN). Objectives • Evaluation of effectiveness of PFN and DHS in the management of intertrochanteric fractures. • The advantages and disadvantages of the PFN and DHS in intertrochanteric fractures Materials and methods: These is a prospective study which was carried out from Feb 2015 to Feb 2016 in Government Medical College Kozhikode. In this study period 48 cases of intertrochanteric fractures were studied, out of which 24 cases were operated with PFN and 24 cases were operated with DHS. The results were evaluated and compared. Results: Most of the patients were between 50 to 80 years of age. Most common mode of injury was domestic fall. The mean time of fracture union was 16 weeks. 54.2% patients operated by PFN were unstable fractures and 58.3% patients operated by DHS were stable fractures. The functional outcome was calculated by Harris hip score during follow up in 2 week, 6 weeks.3 months 6 Months and 1 year. By 1 year follow up of operated patients 96% of patients with PFN had good to excellent results 4% had fair results. 88% patients with DHS had good to excellent results and 12% patient had fair results. Conclusion: There is not much difference in functional outcome of intertrochanteric fractures treated by DHS and PFN in our settings. PFN is used mainly in unstable fracture and DHS in stable intertrochanteric fractures. Surgical exposure is minimal in PFN so minimal blood loss and wound complication. Early mobilization is an advantage with PFN. PFN needed better operative skill than DHS.

Pauwels cannulated screws versus DHS-blade plus anti-rotation screw for treatment of Pauwels type III femoral neck fractures

Objective To compare the curative effects of Pauwels cannulated screws (PCS) and DHS-blade plus anti-rotation screw +anti-rotation screw(DHSA+AS) in the treatment of Pauwels type Ⅲ femoral neck fractures. Methods From December 2013 to December 2015, 46 patients with fresh Pauwels type Ⅲ femoral neck fracture were treated with internal fixation at our department. They were divided into 2 groups according to different fixation methods. In the DHSA+AS group of 25 patients, 13 were male and 12 female, with an average age of 49.2±8.2 years, and there were 3 cases of Garden type Ⅱ, 4 cases of Garden type Ⅲ and 18 cases of Garden type Ⅳ. In the PCS Group of 21 patients, 11 were male and 10 fe-male, with an average age of 48.7±6.2 years, and there were 2 cases of Garden type Ⅱ, 6 cases of Garden type Ⅲ and 13 cases of Garden type Ⅳ. The 2 groups were compared in terms of operation time, intraoper-ative blood loss, reduction quality, hospital stay, union time, postoperative complications and Harris hip score. Results DHSA+AS group needed significantly longer operation time (54.0±7.3 minutes) and incurred significantly more intraoperative blood loss (102.3±10.5 mL) than PCS group (46.3±5.4 minutes & 77.4±9.1 mL, respectively) (P 0.05). DHSA+AS group and PCS group obtained an average follow-up of 14.1±1.6 months and 13.7±1.2 months, respectively. For DHSA+AS group and PCS group, the rate of postoperative complications was respectively 12.0%(3/25) versus 4.8%(1/21), and the Harris hip score at the last follow-up respectively 83.6±5.4 versus 85.1±5.5, showing no significant dif-ferences between the 2 groups (P >0.05). Conclusions DHSA+AS and PCS are both suitable in-ternal fixation options for patients with Pauwels type Ⅲ femoral neck fracture when reduction is fine. Com-pared with DHSA+AS, PCS may need less operation time and incur less intraoperative blood loss. Key words: Femoral neck fractures; Fracture fixation, internal; Bone nails; Pauwels’ angle

A Comparative Study of Short Proximal Femoral Nail and Dynamic Hip Screw in Treatment of Intertrochanteric Fractures

A Comparative Study of Short Proximal Femoral Nail and Dynamic Hip Screw in Treatment of Intertrochanteric Fractures

Buttress plate fixation alone or combined with hollow screws for treatment of posterior tibial pilon fractures

Objective To study the effect of buttress plate fixation alone or combined with hollow screw fixation of posterior tibial pilon fractures. Methods A retrospective case series analysis was made on 28 cases of posterior tibial pilon fractures admitted from February 2010 to February 2015. There were 18 males and 10 females, aged from 20 to 65 years (mean, 40.5 years). Klammer classification was type 1 in 10 cases, type 2 in 12 and type 3 in 6. Denis-Weber classification was type B in 26 cases and type C in 2 cases. Fourteen cases had buttress plate fixation, 4 hollow screw fixation through posterior-anterior approach, and 10 buttress plate fixation combined with hollow screws. Fracture reduction, function recovery, incidence of complications, and range of motion of ankle joint were detected after operation. American orthopedic foot and ankle society (AOFAS) ankle-hindfoot scale, Kellgren-Lawrence grading for osteoarthritis and visual analogue scale (VAS) were applied to evaluate clinical efficacy at the final follow-up. Results Operation incision healed by first intention. Anatomic reduction and rigid stabilization were noted in all, except that two cases presented one millimeter gap in the posterior articular surface. Duration of follow-up was 13 to 36 months (mean, 20.6 months). Time to fracture healing was 6 to 10 weeks after operation (mean, 7.5 weeks). No deep incision infection or lower extremity deep venous thrombosis occurred after operation. One case developed epidermal necrosis, and resulted in scar healing by strengthening the dressing. One case developed fibula tendon irritation symptom, and disappeared after the removal of internal fixation. One case developed skin irritation symptom because of the overlong screw, and disappeared after the removal of the screw. One case developed osteoarthritis because of the mild displacement of fracture bone in the process of fixation. One case developed toe flexion deformity two months after operation. AOFAS scale was (88.6±6.4)points at the final follow-up, and differed significantly from that before operation [(32.2±1.3)points] (P<0.05). Kellgren-Lawrence grading zero was noted in 24 cases, grading Ⅰ in 2, grading Ⅱ in 1, and grading in 1. VAS was (0.8±0.3)points at the final follow-up, and differed significantly from that before and after operation [(8.5±1.5)points and (6.3±1.0)points, respectively] (P<0.05). Conclusion Anatomical reduction of posterior tibial pilon fractures can be received by buttress plate fixation alone or combined with hollow screws, which can reduce the complications and attain excellent clinical outcomes. Key words: Tibial fractures; Ankle; Fracture fixation, internal

Evaluation of Stainless Steel Intermaxillary Fixation Screws in Treatment of Favorable Mandibular Fractures

Background: Numerous methods have been described for achievement of Intermaxillary fixation in the treatment of fractures of facial skeleton. Conventional methods like Erich arch bars and eyelet wires are currently the most common methods for achieving intermaxillary fixation (IMF), however, they have their own disadvantages. Since 1989, IMF using intraoral self-tapping IMF screws has been introduced for treatment of mandibular fractures. The aim of this study was to evaluate the efficacy, advantages, disadvantages and potential complications associated with using of self-tapping IMF screws in the treatment of mandibular fractures. Material and Methods: Twenty patients with favorable mandibular fractures, attended to Oral and Maxillofacial Surgery unit, AL-yarmuk Teaching Hospital between November 2014 and October 2015, they were treated with IMF screws. The parameters considered were duration of the procedure, perforations in the gloves, patient acceptance, oral hygiene, iatrogenic dental injuries, mouth opening, healing outcome, occlusal discrepancy and needle stick injuries during IMF. Results: The patients included in this study were 20 (17 males and 3 females). The extremes of age in this study ranged from 12 to 37 years. Three patients had 2 fracture lines. Assault was the most common cause of fractures. The most common site of fracture was the body and parasymphysis regions. Two screws (2.5%) from 80 screws became loosened. One patient (5%) ended with malunion and malocclusion. One patient (5%) developed infection at screw site. Three patients (15%) developed screws soft tissue burying. Conclusion: IMF screws considered to be a useful modality of treatment to establish maxillomandibular fixation. It is safe, and time-sparing technique; however, it is not without limitations or potential consequences in which the surgeon must be aware of in order to provide safe and effective treatment.

ИСПОЛЬЗОВАНИЕ БИОДЕГРАДИРУЕМЫХ ВИНТОВ ПРИ ЛЕЧЕНИИ ПАЦИЕНТОВ С HALLUX VALGUS

The aim of the research was to assess using biodegradable screws in treatment of hallux valgus. We managed 40female patients (average age 50±2.51) with hallux valgus who where admitted to the orthopedic unit of Irkutsk Scientific Center of Surgery and Traumatology for operative treatment.All patients had X-ray, MRI and intraoperational examination of affected foot before the surgery and in postoperative period. All patients were operated using own surgical technique.Patients were divided into two groups: group1 (22patients) – osteosynthesis using biodegradable (PLGA) screws; group2 (18patients) – osteosynthesis using metal cannulated screws.In group1 postoperative values of M1P1 angle were within normal range (9.67±0.78°). According to MRI, proximal articular set angle (PASA) was corrected from 21.5±0.35 to 4.17±0.09°. 6patients of the group1 were complaining of pain and discomfort in the area of screw-head contacting soft tissues. The result of operative treatment in the group2 resulted in the correction of M1P1 angle from 34±1.63 to 7.67±0.75°. After the surgery intraoperative PASA was back to the normal range (4.33±0.34°).The comparison of the results of treatment of patients of groups1 and 2 didn’t reveal any statistically significant dif-ferences in the values of М1Р1, М1М2, М1М5 angles and PASA.The advantage of using biodegradable screws, compared to the metal ones, in the treatment of hallux valgus is the possibility of postoperative MRI of the foot with calculation of PASA to evaluate treatment results. The disadvantage of using biodegradable screws is engineering deficiency preventing screw-head from dipping into bone tissue and causing soft tissue traumatizing. Biodegradable and metal screws allow to obtain similar results of hallux valgus treatment.

External fixation versus dynamic hip screw in treatment of elderly intertrochanteric hip fractures: A systematic review and meta-analysis.

To evaluate the effect of external fixation compared with dynamic hip screw (DHS) for the treatment of elderly intertrochanteric hip fractures. We searched Pubmed, Embase, Cochrane central database (All to December 19th, 2015) for comparative studies relevant to external fixation versus DHS for the management of intertrochanteric hip fractures. Only randomized controlled trial (RCT) were included. We extracted the trial characteristics, intervention details, primary and secondary outcomes. Risk of bias was assessed. Fixed/random effect model was adapted according to the heterogeneity tested by I2 statistic. Sensitivity analysis was conducted and publication bias was assessed. A total of 4 RCTs were retrieved involving 260 patients. Pooled results showed for the primary outcomes of Harris hip score and final mortality, no significant difference was found between external fixation and DHS, however, for the secondary outcomes, external fixation had advantages in the aspects of length of surgery, operative blood loss, blood transfusion and hospital stay while shortcomings in pin-track infection. For other secondary outcomes such as fracture reduction, cut out and varus malunion, no significant difference could be found. While there was no conclusive evidence, as external fixation with less surgery time, less blood loss and less post-operative pain while no compromise in final functional outcome and mortality compared with DHS, it could be considered as an alternative for the elderly intertrochanteric hip fractures, especially in highrisk patients who could not tolerate routine spinal anesthesia and open surgery.

An Outcome Analysis to Determine the Uses of Poller Screw in Treatment of Displaced Proximal and Distal Shaft Metadiaphyseal Fractures of Tibia Treated With Intramedullary Nailing

An Outcome Analysis to Determine the Uses of Poller Screw in Treatment of Displaced Proximal and Distal Shaft Metadiaphyseal Fractures of Tibia Treated With Intramedullary Nailing

Biomechanical stability of combined use of multiaxial and monoaxial screws in fixation of thoracolumbar burst fractures

Objective To investigate the biomechanical stability of general pedicle screw (monoaxial screw) and multixial screws in treatment of thoracolumbar burst fractures.Methods Six calf fresh-frozen lumbar spines (L1-L5) were selected to produce models of L3 burst fractures.The specimens were assigned to none fracture fixation group,multiaxial screw group (fixation of the fractured vertebra and upper and lower adjacent vertebral bodies with monoaxial screws,) and combined screw group (fixation of the upper adjacent vertebral body with monoaxial screws and of the fractured vertebra and lower adjacent vertebral body with multiaxia[screw).Differences in range of motion and neutral zone at level of L2-L4 at six movement directions were compared between groups.Results Range of motion and neutral zone had insignificant differences between the two groups under anterior flexion,posterior extension,lateral bending,and rotation (P ＞ 0.05),but significant difference in comparison with none fracture fixation group (P ＜ 0.01).Conclusions Combined use of multixial and monoaxial screws produces no effect on biomechanical stability of the internal fixation.Multiaxial plus monoaxial screw fixation and monoaxial screw fixation can both provide reliable biomechanical stability. Key words: Spinal fractures ; Internal fixators ; Joint instability

Deflective placement of anterior odontoid cannulated screw for treatment of odontoid fracture combined with atlantoaxial posterior dislocation

Objective To investigate deflective placement of anterior odontoid cannulated screw for treatment of odontoid fracture combined with atlantoaxial posterior dislocation.Method From August 2002 to December 2011,18 cases of fresh odontoid fracture combined with atlantoaxial posterior dislocation were treated with deflective placement of anterior odontoid cannulated screw in our hospital.They were 10 males and 8 females,aged from 20 to 50 years (mean,41 years).According to the classification of Anderson-D'Alonzon,12 cases were type Ⅱ and 6 type Ⅲ; according to the classification of American Spinal Injury Association (ASIA),3 cases were grade C,10 grade D and 5 grade E.All patients underwent skull traction pre-operation to reduce dislocation.During the operation,the head was bent close to the chest in order to maintain atlantoaxial restoration and odontoid reduction.Because in this posture the jawbone blocked Kirschner wire and made the placement challenging,the anterior odontoid cannulated screw was deflected in all cases.Results In this series,the operation time ranged from 1.0 to 1.5 hours and the blood loss 50 to 100 mL (mean,75 mL).The mean time of follow-up was 15 months (range,12 to 18 months).All cases got bony union 3 to 4 months postoperation without screw failure.According to the ASIA grading for neural function,one case improved from grade C to grade E,one from grade C to grade D,9 cases from grade D to grade E,and no improvement was noted in the other cases.The difference in atlantoaxial shift distance between preoperation and postoperation was statistically significant (P ＜ 0.05).Conclusion In the treatment of odontoid fracture combined with atlantoaxial posterior dislocation,deflective placement of anterior odontoid cannulated screw may preserve the rotation function of the atlas and axis and lead to positive outcomes. Key words: Fascia dentate; Atlanto-axial joint; Fracture, bone; Dislocation ; Fracture fixation, internal

Effectiveness of Percutaneous Screws for Treatment of Degenerative Lumbar Low Back Pain

The purpose of this retrospective observational study was to demonstrate the efficacy of a percutaneous screws system in the treatment of lumbar pain caused by high-level disc degeneration combined with facet joint hypertrophy and canal stenosis especially in the L5-S1 levels. Thirty-eight patients (25 males, 13 females, mean age 63 years) with lumbar pain and/or neuralgia-claudication were treated with interpeduncular dynamic screws. Diagnosis was based on clinical\medical history evaluation and X-ray, CT, and MR examinations. All patients completed the visual analogic scale (VAS) for evaluation of clinical efficacy and pain measurement both before and after (1 month and after 2 years) the procedure. Patients also were given the Oswestry disability index (ODI) before and after treatment. The area of the neuroforamina also was measured. Thirty-eight intervertebral spaces were treated. The VAS pain scale showed a reduction of pain symptoms at 1 month and after 2 years (VAS pre 8.7 ± 1.1; after 1 month 5.1 ± 2.2; after 2 years 6.5 ± 2.1; p = 0.001). ODI also showed improvement (pre 56.7 ± 18.6 %; after 1 month: 31.9 ± 26.3%; after 2 years: 42 ± 24.2 %, p = 0.001). The study showed a widening of the neuroforaminal area of 15.5 % in the right neuroforamen and 17 % in the left ones (right foraminal area pre 0.94 mm(2), post 1.08 mm(2); left foramina area pre 0.95 mm(2), post 1.11 mm(2)). In addition, the spinal canal area displayed a statistically significant reduction (pre = 1.97 and post = 2.23; p < 0.0001). Our study indicates that patients treated with dynamic screws have VAS pain reduction as well as ODI improvement. Moreover, we found a statistically significant widening of the neuroforaminal area.

Changing ways of orthopaedic knowledge sharing!

Changing ways of orthopaedic knowledge sharing!

Sa1.10 Precise placement of lag screws in treatment of trochanteric femoral fractures with a new guide system and trochanteric nail

Sa1.10 Precise placement of lag screws in treatment of trochanteric femoral fractures with a new guide system and trochanteric nail

Use of the Schanz screw as a joystick and the Poller screw in intramedullary nailing for subtrochanteric or proximal femoral fracture

We read with great interest the article titled ‘‘Use of blocking screws in intramedullary fixation of subtrochanteric fractures’’ by Amin et al. [1]. We congratulate the authors on their success in using intramedullary nailing in conjunction with the placement of blocking screws to treat six patients with subtrochanteric fractures. All their patients demonstrated satisfactory results, with alignment and bony union maintained at the final radiographic followup. These types of fractures present with characteristic musculature-induced difficulties to control reduction. The abductors and short external rotators insert over the greater trochanter, and the lesser trochanter is the insertion site for the iliacus and psoas hip flexors. These muscles cause the proximal fragment to develop a flexed, abducted and externally rotated position after a fracture [2]. This deformity cannot be resolved with traction on the fracture table with traction, and it is difficult to find a precise point of entry and achieve excellent reduction. Sadighi et al. [3] reported that percutaneously placed Schanz screws used as joysticks could facilitate closed reduction. Kim et al. [4] described a procedure in which they reamed the proximal fragment progressively up to 13 mm, selected a nail that was 2–3 mm smaller than the estimated diameter of the isthmic portion, and inserted the nail into the proximal fragment and manipulated it in an extended, adducted, and internally rotated direction to achieve good reduction and cross the fracture site. Otherwise, the proximal fragment would have a larger canal diameter compared with the distal fragment, and inadequate alignment with translation would be noted if the proximal reamed canal deviated toward the medial or lateral cortex. Krettek et al. [5] described the clinical application of Poller screws to prevent axial deformities during intramedullary nailing for proximal and distal tibial fractures during intramedullary nailing. Amin et al. [1] termed these screws ‘‘blocking screws’’ and applied them to the proximal femoral fragment, separately targeting the medial one-third and posterior one-third. We developed a simple synthesized technique using the Schanz screw as a joystick and the Poller screw for treatment of subtrochanteric or proximal femoral fractures. With the injured limb under traction on the fracture table, one Schanz screw is inserted over the proximal fragment under fluoroscopic guidance and pushed to cause proximal fragment adduction. It is convenient to find a precise entry point for the nail. A ball-tip guide wire is inserted into the proximal canal after using an awl to create the entry point. The Shanz screw is unscrewed until the lateral third of the canal is occupied as Poller screw. The Schanz screw is maintained in position to keep the make medial cortex contact (extended, adducted, and internally rotated), and the guide wire is progressed across the fracture site. This is C.-Y. Chen K.-C. Lin (&) S.-W. Yang Y.-W. Tarng C.-J. Hsu J.-H. Renn Department of Orthopaedics, Kaohsiung Veterans General Hospital, 386 Ta-Chung 1st Road, Kaohsiung, Taiwan e-mail: orthokcl@gmail.com

Treatment of unstable posterior pelvic ring fracture with percutaneous reconstruction plate and percutaneous sacroiliac screws: a comparative study

ObjectiveThe aim of this study is to compare the clinical effects of percutaneous reconstruction plate and percutaneous sacroiliac screws in treatment of unstable posterior pelvic ring fracture. MethodsFifty-eight patients with unstable posterior pelvic ring fracture treated with two methods from March 2002 to October 2007 were enrolled in the study and divided into two groups according to two kinds of internal fixation: percutaneous reconstruction plate (20 males and 9 females, at mean age 37.3 ± 11.3years) and percutaneous sacroiliac screws (21 males and 8 females, at mean age 39.3 ± 10.4years). Causes of injury included traffic accident in 38 patients, fall from height in 17, and crush in 3. The correlative data of operation duration, number of X-ray exposures, intraoperative bleeding volume, length of incision, Majeed postoperative functional evaluation, and postoperative complications were analyzed statistically. ResultsAll 58 patients were followed up for 12–36months (mean duration 21.3months). There was statistical difference for operation duration, number of X-ray exposures, size of incision, and intraoperative bleeding volume between the two groups. Majeed postoperative functional evaluation indicated excellent and good rates of 86.1 % for percutaneous reconstruction plate and 88.2 % for percutaneous sacroiliac screws. ConclusionsThe clinical effect of the two methods is similar in treatment of Tile C pattern posterior pelvic ring fracture. However, the percutaneous reconstruction plate has lower risk of damaging nerves and blood vessels than the percutaneous sacroiliac screws. Moreover, intraoperative fluoroscopy is rarely performed.

Comparative prospective study of proximal femoral nail and dynamic hip screw in treatment of intertrochanteric fracture femur.

The aim of this study was to compare the outcome of intertrochanteric fractures treated with Dynamic Hip Screw and Proximal Femoral nail. This study was conducted on 50 cases of Intertrochanteric fractures of femur treated by a dynamic hip screw and proximal femoral nail. Patients were operated on standard fracture table under image intensifier control. The average age of the patient was 62.3 years. Most common mechanism of fracture was domestic fall. Twenty percent four percent had stable, 58% unstable and 18% reverse oblique pattern of fracture. The unstable pattern was more common in old aged patients with higher grade of osteoporosis. The average blood loss was 100 and 250 ml in PFN and DHS group respectively. In PFN there were more no. of radiation exposure intraoperatively. The average operating time for the patients treated with PFN was 55min as compared to 87min in patients treated with DHS. Total complications were 15% with implant failure 6%, infection 4%, nonunion 2% and greater trochanter splintering 4%. In the PFN group the amount of sliding on X-rays was less as compared to DHS. The patients treated with PFN started early ambulation as they had better Harris Hip Score in the early period (at 1 and 3 month). In the long term both the implant had almost similar functional outcomes. The DHS was tolerated better by young patients with stable fracture while PFN had a better outcome with osteoporotic patients and weak bone mass and reverse oblique fractures.

Comparative analysis of adjacent levels of degeneration and clinical outcomes between conventional pedicle screws and percutaneous pedicle screws in treatment of degenerative disease at l3-5; a preliminary report.

ObjectiveThis study was conducted to compare radiologic changes and clinical outcomes in adjacent level of percutaneous pedicle screws with those of conventional (open) pedicle screws.MethodsFrom January 2007 to December 2009, 51 patients underwent L3-5 decompression and spinal fusion. Percutaneous pedicle screws were used in 22 patients, and open pedicle screws were used in the remaining patients. For estimation of instability, we performed measurements of change in the lordotic and adjacent segment angles. A retrospective evaluation of the patients' data and several assessment scales was conducted for determination of clinical outcomes.ResultsThe radiological examinations revealed no significant differences, except the L2-3 sagittal angle change. The upper adjacent level angle change in the open group was larger than that in the percutaneous group. In the percutaneous group, the sagittal angle changed from 9.7±3.0° to 11.25±3.6° during the follow-up periods, and in the open group, the sagittal angle changed from 10.8±4.1° to 13.6±4.5°. Radiological instability was observed in 5 patients (17%) in the open group and in 2 patients (9%) in the percutaneous group. Both groups showed similar clinical outcomes.ConclusionWe suggest that open screws have a greater tendency to cause degenerative change in the upper segment than percutaneous screws. This may be because percutaneous screw fixation causes minimal injury to supporting structures and preserves adjacent facet joints.

Self-designed adjustable titanium screw in treatment of unilateral vocal cord paralysis:an observation of curative effects

Objective:To observe the curative effects of self-designed adjustable titanium screw in treatment of unilateral vocal cord paralysis in dogs.Methods:We designed and prepared an adjustable titanium screw.The beagle dogs were divided into an experimental group and a control group (n=3) at random.Animals in the experimental group had their left recurrent laryngeal nerve resected and received implantation of adjustable titanium screw.The left arytenoid cartilage was adjusted to allow the left vocal cord in the middle,so as to achieve glottis closure when making a sound.The dogs in the control group only received recurrent laryngeal nerve resection.Observation with electron fibrolaryngoscope and CT was done immediately,1,2,and 4 months after operation; electron fibrolaryngoscope was also used before operation.The curative effects and the prognoses of dogs were observed.Results:Four months after operation electron fibrolaryngoscope found that the adjustable screw in the experimental group could make the left arytenoid cartilage move inwardly,benefiting glottis closure and improving the voice quality.Animals in the control group had their left vocal cord located in the paramedina position,and there was cleft during glottis closure.CT image indicated that the adjustable screw was in a good position,and there was no breaking off.Local slight inflammation was seen in both groups 1,2,and 4 moths after operation.Tntrinsic laryngeal muscle atrophy aggravated as time passing by.There was no severe inflammation around the implants or implants excretion.Conclusion:Our adjustable screw is easy to perform in surgical treatment of unilateral vocal cord paralysis; it can be adjusted during operation and the outcome can be observed in time.The short-time effect is confirmed and the method is worth popularizing.