Staple Fixation Research Articles

Arthroscopic staple fixation in the management of displaced anterior cruciate ligament avulsion fractures

Introduction: Knee injuries are commonly associated with anterior cruciate ligament (ACL) avulsion fractures and its management is controversial ranging from conservative treatment to arthroscopic fixation. The purpose of our study was to assess the clinical and radiological results of arthroscopic staple fixation in the management of ACL avulsion fractures. Materials and Methods: This study included twenty-two patients (17 males and 5 females) who were analyzed after undergoing arthroscopic staple fixation for displaced ACL avulsion fractures. The mean age was 32.2 years (15-55 years. The mean follow up was of 21 months (6-36 months). The patients were assessed clinically by calculating their Lysholm and International Knee Documentation Committee (IKDC) scores. Radiological union was assessed in the follow up radiographs. Results: The mean Lysholm score was 95.4 (83-100) and the mean IKDC score was 91.1 (77-100) at the final follow up. Anterior drawer’s test was negative in 20 patients at the end of final follow up while two patients had grade I laxity. Seven cases had associated knee injuries. The final outcome was not greatly influenced by the presence of associated injuries when treated simultaneously. It was found that all the patients when examined at their final follow up were able to return to their pre-injury occupation. Conclusion: The procedure of arthroscopic staple fixation in the management of displaced ACL avulsion fractures was found to be safe and reliable method for producing clinical and radiological outcome. Keywords: ACL avulsion, Arthroscopy, Staple.

The Use of Nitinol Compression Staple Fixation and Bone Graft for Scaphoid Waist Fractures and Nonunion: A Surgical Technique

In the management of scaphoid fractures, nonunion is an important complication that can lead to carpal instability and early-onset arthritis. Various techniques have been described to treat scaphoid nonunions, yet a clear consensus on the superiority of one method is not yet established. The use of compression staple fixation has been described in the literature and may be a viable alternative to other fixation techniques. Volar Nitinol staple fixation avoids damage to the trapezium during retrograde fixation with a screw. It also avoids damage to the proximal dorsal cartilage, which occurs during anterograde screw fixation. Because of its shape and position on the volar aspect of the scaphoid, staple fixation provides compression, prevents graft extrusion, and avoids taking up space in the medullary canal of the scaphoid. Moreover, it may be technically easier than screw fixation. Despite these advantages, this technique has not been widely adopted. We describe the technique for utilizing Nitinol compression staples and bone grafting in the treatment of scaphoid nonunion.

Arthrodesis with Retrograde Intramedullary Nail for Recurrent Infected Total Knee Arthroplasty with Patellar Tendon Rupture: A Case Report and Literature Review

Patellar tendon rupture after total knee arthroplasty is a rare, but often catastrophic complication. In addition, infection is also a dreaded complication after total knee arthroplasty. We report an 84-year-old female that has late infected total knee arthroplasty with patellar tendon rupture treated with resection arthroplasty and then subsequent arthrodesis with retrograde intramedullary nail.Case Presentation:The 84-year-old female underwent left total knee arthroplasty 2 years ago and revision arthroplasty last year after trauma. She presented to the emergency department with painful disability of left knee. The septic arthritis of left knee was confirmed by bacterial culture through arthrocentesis which yielded methicillinsensitive staphylococcus aureus. Patellar tendon rupture was also noted by loss of extension mechanism and patella alta in plain films. Despite attempts on open debridement and parenteral antibiotics, the infection did not settle. Resection arthroplasty with vancomycin- impregnated cement spacer implantation was performed following by 4-week parenteral antibiotics therapy. The ESR and CRP level of serum improved gradually. Arthrodesis of left knee with retrograde locking intramedullary femoral nail through single incision of the knee was performed. Protected weight bearing was allowed in one week after arthrodesis. The patient discharged 2 weeks later without recurrent infection, but leg length discrepancy about 2cm was noted.Discussion:Patellar tendon rupture after total knee arthroplasty is a rare but disabling complication whose management is often difficult. It was reported that incidence of patellar tendon rupture in literature varies between 0.3- 12.4% for primary total knee arthroplasty and between 1-15% for revision total knee arthroplasty. Contributing factors are excessive dissection and knee manipulation, and trauma. In the literature, various different operative techniques and rehabilitation programs have been described indicating the lack of a golden standard treatment protocol. However, in patients with a total knee arthroplasty, the results have been discouraging. Reconstruction of the patellar tendon can be utilized semitendinosus-gracilis graft with an interference screw and a staple fixation in treating acute ruptures, whereas allografts and synthetic mesh are indicated for chronic cases. Nevertheless, treatment outcomes for ruptured patellar tendon are not good. Gold standard treatment of infected total knee arthroplasty was resection arthroplasty with antibiotic-impregnated bone cement spacer and parenteral antibiotics therapy and then second stage revision total knee arthroplasty until the infection is eradicated. The patella tendon repair and second revision arthroplasty were not suggested by Jake et al. Patellar tendon rupture is best treated with primary repair, but infected prosthetic knee with patellar tendon rupture seemed to be more difficult to manage. Arthrodesis but not revision arthroplasty may be the best choice after infection control to improve the patient’s level of function.

Akin osteotomy: Is the type of staple fixation relevant?

Although different fixation techniques for the Akin osteotomy have been described in the literature, there are no many studies trying to analyze the differences between the types of fixation available. The aim of this study is to analyze if there are any differences between three types of staple fixation available in the market. We present a retrospective study of 145 cases in which an Akin osteotomy was performed and fixed with three different kinds of implants staple A (28%), staple B (45%), and staple C (27%). Staple A is made out of stainless steel, and the surgeon mechanically controls the compression applied. Staple B increases the compression when heat is applied to it. Staple C has an intrinsic elastic memory that closes the osteotomy. In all cases, distal articular set angle, interphalangeal joint obliquity angle, and metatarsophalangeal angle were measured pre-operatively and 1.5months post-operatively on dorsoplantar weight-bearing radiographs. Other details such as post-operative complications, implant migration, osteolysis, or fracture of the lateral cortex during surgery were also recorded. Clinical and radiological results show no relevant differences between the three types of fixation. The mean angular corrections of DASA, interphalangeal joint obliquity angle, and metatarsophalangeal angle were 5, 12, and 21, respectively, for staple A; 4, 10, and 19, respectively, for staple B; and 7, 10, and 23, respectively, for staple C. The rates of intra-operative and post-operative complications were similar for all groups. There was one case of infection per group. We had five cases of delayed union two with staple A and three with staple C. In four cases, there was a loss of correction, two of them fixed with staple A and two with staple C. Seven cases developed a Südeck's syndrome, four of them fixed with staple A and three with staple C. Fifteen patients suffered an uncontrolled fracture of the lateral cortex of the phalanx when performing the osteotomy (3, 8, and 4 cases fixed with staples A, B, and C, respectively), and 87.5% of the patients that developed a plantar displacement of the osteotomy had an uncontrolled fracture of the lateral cortex (p < 0.05). All three staples achieved a rigid internal fixation and minimal periosteum damage and provided a good bone-bone contact. According to our results, the radiological differences are minimal, and although the thermal compression staple had less complication, clinical differences were also not statistically significant. This means the choice of implant could be left to the surgeon's preferences or made according to cost.

High Tibial Osteotomy for Genu Varum in Adults: Do Proprietary Implants Limit the Quality of Correction?

The surgical technique of proximal tibial osteotomy for genu varum in adults has evolved from a procedure using closing wedges of estimated sizes with staple fixation in the 1960s to using standard trauma internal fixation implants and, more recently, to gradual correction with software-guided hexapod external fixators. In the last two decades, implant manufacturers have also produced anatomical implants specific for such corrective osteotomies. This study evaluates the limits of using such proprietary implants for proximal tibial osteotomy in genu varum.Materials and methodsScanograms (teleradiograms) of lower limbs of a patient were used to derive skiagrams (two-dimensional bony outlines of the extremities). From these, two-dimensional and three-dimensional models of varus deformities of the tibia with different values of mechanical medial proximal tibial angle (mMPTA, from 85° to 40°) were created. An analysis of the created deformity was carried out and a simulation for surgical correction was performed using an open wedge high tibial osteotomy with fixation using a proprietary (Tomofix, Synthes) implant. In addition, a 3D simulation technique was used to check the accuracy of the results obtained from the 2D simulation.ResultsIn cases of mMPTA ≥80° with localisation of the apex of varus deformity at the level of the knee joint line, the standard technique used with the proprietary medial tibial plate produces good results.In cases of mMPTA ≤70°, fixation of the osteotomised fragments by the proprietary medial plate is poor owing to the anatomical contours of the implant. In these cases, a different type of osteosynthesis is needed.In cases of mMPTA ≤70°, the distance between the lower edge of the bone plate and the medial surface of the tibia after a proximal tibial osteotomy exceeds 11 mm and will result in unacceptable soft tissue tension around the implant.Mechanical axis deviation to the Fujisawa point produces mMPTA values outside the reference range of normal values.ConclusionAn osteotomy of the proximal tibia using a prescribed technique linked to a proprietary implant achieves good results only if performed within a certain range of deformity values. Pronounced varus deformities require a fundamentally different approach. This study reveals that surgeons undertaking corrective proximal tibial osteotomies for genu varum need to perform a comprehensive analysis of the deformity to allow for appropriate selection of patients. This will enable a consideration of the size and other characteristics of the deformity that will reduce the technical complications that may arise if the correction was performed using the recommended technique linked to a proprietary implant.How to cite this articleSolomin LN, Chugaev DV, Filippova AV, et al. High Tibial Osteotomy for Genu Varum in Adults: Do Proprietary Implants Limit the Quality of Correction? Strategies Trauma Limb Reconstr 2020;15(1):13–22.

Lateral Extra-articular Tenodesis With Proximal Staple Fixation

A technique for lateral extra-articular tenodesis using proximal staple fixation is described as an adjunct to anterior cruciate ligament (ACL) reconstruction. Lateral extra-articular tenodesis has been used in an effort to decrease failure rates in ACL-deficient patients with ligamentous laxity, prior failed ACL surgery, or grade 3 pivot-shift findings. Numerous surgeons have described combining ACL reconstruction with extra-articular surgery. The approach described in this article is easy and cost-effective. Moreover, because this technique uses a staple instead of a SwiveLock (Arthrex, Naples, FL) or other suture anchor, it limits the chance of conflicting with the tunnels for the ACL because there is no need to drill or punch additional tunnels.

Long-term outcome and chronic pain in atraumatic fibrin glue versus staple fixation of extra light titanized meshes in laparoscopic inguinal hernia repair (TAPP): a single-center experience

Inguinal hernia repair belongs to the most frequently performed surgical procedures. Endoscopic techniques like TAPP and TEP have become standard of care together with the conventional open techniques. Especially in endoscopic techniques, there is a confusing amount of different meshes and fixation techniques with impact on perioperative and long-term outcome. We present the first single-center data on the use of titanized extra lightweight meshes and fibrin glue fixation compared to staple fixation regarding long-term outcome, especially chronic pain. A clinical trial with retrospective analysis of patient- and procedure-related data and questionnaire-based follow-up of TAPP procedures performed in 2012-2014 was conducted in a specialized hernia center. Standard TAPP technique was used with placement of TiMesh extra light (16g/m2) and either fibrin glue or staple fixation. Procedure- and patient-related data are compared after propensity score matching regarding perioperative complications and long-term outcome. Of 612 TAPP procedures 372 procedures were included in analysis after propensity score matching. Fibrin glue was used in n = 279 and staple fixation in n = 93 cases. There were significant differences regarding duration of the surgical procedures (p = 0.001) and distribution of mesh size. No differences were noted regarding perioperative complications such as seroma or hematoma formation and need for re-laparoscopy. During a mean follow-up of 32.1 ± 20.6month with a follow-up rate of 79%, there was no difference in long-term outcome, especially for rate of recurrence (p = 0.112) and development of chronic pain (p = 0.846). The overall rate of recurrence was 3.0% (n = 11), and in 2.4% (n = 9) patients complained of chronic pain. Inguinal hernia repair using extra lightweight titanized meshes and fibrin glue fixation is safe and feasible compared to staple fixation even in large and combined hernia defects, if mesh size is adjusted to size of hernia defect. The rate of chronic pain was extremely low at 2.4%.

Laparoscopic Repair of Bilateral Inguinal Hernia Using Large Butterfly Mesh Without Fixation Versus Double Meshes with Stapler Fixation through TAPP Approach

Background: Inguinal hernia repair is one of the most frequent elective operations performed in general surgical practice. Approximately 20% to 30% of patients with inguinal hernia present with bilateral hernias at diagnosis. Objectives: The aim of this study was to demonstrate the outcome between using a single large butterfly mesh without fixation to Strengthen the posterior wall versus the use of two separate meshes with stapler fixation during laparoscopic repair of bilateral inguinal hernia with TAPP technique. Patients and Methods: A prospective randomized comparative study that was conducted in General Surgery Department, Al-Hussein University Hospital, Faculty of Medicine, Al-Azhar University from January 2017 to December 2018. A total of 40 patients with bilateral non-complicated inguinal hernias were included in this study. The patients were subsequently divided into two comparable groups. Group A: Twenty patients were scheduled for TAPP repair with double meshes and tacker fixation. Group B: Twenty patients were scheduled for TAPP repair with a single large mesh without fixation. Results: Average operating time was 102 minutes in group A, and 72 minutes in group B. Postoperative pain was less in group B. One patient had transient hematuria in group B. There was one recurrence in group A on the left side after 8 months and no recurrences were demonstrated in group B. Conclusion: laparoscopic TAPP using a single large butterfly mesh is safe, time saving and cost-effective approach for non-complicated bilateral inguinal hernias, especially in patients with direct hernia, large defect and low BMI.

Outcomes of posterior cruciate ligament tibial avulsion treated with staple fixation: stress TELOS X-ray evaluation.

Tibial-side avulsion injuries of the posterior cruciate ligament are rare injuries. In displaced fracture, the reduction and fixation is the treatment of choice, although the optimal surgical management has not yet been determined. The aim of this study was to evaluate the clinical, functional, and radiological outcome after an open reduction and internal fixation with staples of a posterior cruciate ligament tibial avulsion. A historical cohort of patients who underwent open reduction and internal fixation with staple due to a posterior cruciate ligament tibial avulsion were reviewed. Minimum follow-up was 2years. Demographic, clinical, and radiological data, including stress X-ray, were analyzed. Also, International Knee Documentation Committee Score, Tegner Knee Score, Lysholm Knee Score, Short-Form Health Survey, and four-point Likert scale were evaluated. Four males (57%) and 3 females (43%) were included in the final analysis. The mean age was 39years (range 27-54). All patients had a fracture union. No implant migration was observed. Postoperative posterior drawer, reverse pivot shift, and varus/valgus stress were negative. In stress TELOS X-ray, no statistically significant differences were observed between the postoperative and contralateral knee. All evaluated scores had good or excellent results. Our study provides further evidence that the use of an open reduction and internal fixation with a staple could be a simple and reliable management for posterior cruciate ligament avulsion fractures of the tibia. In our study, the postoperative stress TELOS X-ray analyze showed a correct fixation and biomechanical function of the posterior cruciate ligament.

Comparison of Direct Surgical Costs for Proximal Row Carpectomy and Four-Corner Arthrodesis.

Background Proximal row carpectomy (PRC) and four-corner arthrodesis (FCA) are common treatments for stage II scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) wrists, with similar functional and patient-reported outcomes reported in the peer-reviewed literature. Questions Study questions included (1) whether surgical encounter total direct costs (SETDCs) differ between PRC and FCA, and (2) whether SETDC differs by method of fixation for FCA. Patients and Methods Consecutive adult patients (≥ 18 years) undergoing PRC and FCA between July 2011 and May 2017 at a single tertiary care academic institution were identified. Patients undergoing additional simultaneous procedures were excluded. Using our institution's information technology value tools, we extracted prospectively collected cost data for each surgical encounter. SETDCs were compared between PRC and FCA, and between FCA subgroups (screws, plating, or staples). Results Of 42 included patients, mean age was similar between the 23 PRC and 19 FCA patients (51.2 vs. 54.5 years, respectively). SETDCs were significantly greater for FCA than PRC by 425%. FCA involved significantly greater facility costs (2.3-fold), supply costs (10-fold), and operative time (121 vs. 57 minutes). Implant costs were absent for PRC, which were responsible for 55% of the SETDC for FCA. Compared with compression screws, plating and staple fixation were significantly more costly (70% and 240% greater, respectively). Conclusion SETDCs were 425% greater for FCA than PRC. Implant costs for FCA alone were 130% greater than the entire surgical encounter for PRC. For FCA, SETDC varied depending on the method of fixation. Level of Evidence This is a level III, cost analysis study.

External supervesical hernia. A case report

The paper presents a case report of diagnosis and treatment of external supravesicalis hernia after operation on the inguinal hernia in the volume of laparoscopic transabdominal preperitoneal plastic. A man, 49 years old, re-enrolled by recommendation from the polyclinic with a diagnosis of the inguinal hernia on the right. Ten months before the patient had undergone laparoscopic transabdominal preperitoneal plastic surgery on the right inguinal hernia. Due to the high BMI (34.5 kg/m 2 ) and objective doubts about the relapse, computed tomography of the abdominal cavity with intravenous contrasting was performed, which revealed a hernial protrusion in the suprapubic region. There was no intraoperative defect detected in the area of previously performed hernioplasty, but the test confirmed peritoneal protrusion medially to the lateral umbilical fold. After mobilization of the peritoneum of this region, a hernial defect was found about 2.5 cm in diameter, formed by the medially pyramidal muscle, from below the pubic bone and laterally by the rectus abdominal muscle. The contents of the hernia was urine fat. A mesh (5 x 7 cm) denture was installed with stapler fixation. The patient was discharged on the third day after the surgery. The follow-up period was about 12 months. Data for recurrence of hernia or dysuric phenomena were not found.

Is there difference in chronic pain after Suture and Stapler fixation method of mesh in Ventral Hernia? Is stapler fixation method quicker? A randomized controlled trial.

Background & Objective:Chronic pain occurs in 20–30% of patients after hernia surgery. As a consequence of this chronic pain, almost one third of patients have limitations in daily activities. Frequency and severity of this pain varies with different techniques of hernia repair. The objective of this study was to compare polypropylene suture and skin staples for securing mesh in uncomplicated ventral hernioplasty in terms of acute and chronic postoperative pain and to compare the time taken for mesh fixation between polypropylene sutures and skin stapler in ventral hernioplasty.Methods:This study was conducted in Surgery Department of Dow University Hospital, Dow University of Health Sciences, Ojha Campus and included 53 patients from Jan 2015 to Dec 2016, after taking informed consent. All patients were operated under general anesthesia by the same surgical team. Patients were randomized into two groups; in one group mesh fixed with 2/0 polypropylene suture while in other group mesh stapler was used. Time taken to apply mesh was noted in minutes from laying the mesh over anterior rectus sheath to completion of fixation by either method. The severity of post-operative pain was measured with VAS (1-10) after one week, one month and after one year after surgery. Data was analysed using SPSS version 17.Results:Patient characteristics and operative outcome were similar in the two groups and statistically non-significant in both. Early postoperative pain was more after suture fixation but it was not statistically significant. Mean ± SD pain score was after one week 3.47±2.7 after sutures while 2.91±1.88 after stapler. After four weeks, 0.40±0.49 after suture while 0.35±0.48 after stapler fixation. In both study groups 30–34% of the patients felt some pain in follow-up after one year. Severity of pain was 0.60±0.62 after suture while 1.65±1.94 after stapler fixation which is statistically significant as well (p<0.007). Mean operative time was 15.33±6.33 minutes for suture fixation while 1.56±0.41 minutes for fixation by staples, p-value < 0.001.Conclusion:The method of fixation does not appear to cause significant difference in early post-operative pain but chronic pain is more after stapler fixation of mesh. However, operative time was reduced significantly in staple fixation group as compared to suture fixation group

Radiographic Results of Nitinol Compression Staples for Hindfoot and Midfoot Arthrodeses.

The purpose of this study was to determine the radiographic union rate after midfoot and hindfoot arthrodeses using a new generation of nitinol staples, and to compare outcomes between a nitinol staple construct and a nitinol staple and threaded compression screw construct. A retrospective chart review was performed to identify patients who underwent hindfoot or midfoot arthrodesis using a new generation of nitinol compression staples with or without a partially threaded cannulated screw with minimum 3-month radiographic follow-up. The primary outcome variable was radiographic evidence of arthrodesis on radiographs and, when available, computed tomographic scan in patients who underwent midfoot or hindfoot arthrodesis using nitinol staples. Ninety-six patients and 149 joints were eligible for analysis. Median radiographic follow-up was 5.7 months. Radiographic union was seen in 93.8% (60/64) of patients and 95.1% (98/103) of joints using the nitinol staple construct. Radiographic union was seen in 90.6% (29/32) of patients and 95.7% (44/46) of joints using the nitinol combined staple and screw construct. There was no significant difference in radiographic union rate or revision surgery between the 2 groups. Seven patients developed nonunion, 4 in the nitinol staple construct group and 3 in the staple and screw group. New-generation nitinol staples were safe and effective for hindfoot and midfoot arthrodeses, with a high radiographic union rate. The use of a partially threaded screw for additional fixation was not found to either significantly increase or decrease radiographic fusion with nitinol staple fixation. Level III, comparative cohort study.

Four-Corner Fusion in SLAC &amp; SNAC Wrist: Does Method of Fixation Really Make A Difference?

There is no financial information to disclose. Four-corner fusion (4CF) has traditionally been reported to have a higher complication rate with similar functional outcomes as the PRC. To date, there have been limited comparisons that specifically focus on whether the fusion method utilized in 4CF affects functional outcomes and complication rates. In this study, we explored the differences in outcomes of two different fixation methods in 4CF and how these compare to traditionally reported 4CF outcomes in the literature. A retrospective chart review was conducted to compare headless compression screw (HCSF) versus staple fixation (SF) in four-corner fusion for SLAC or SNAC wrist in a single surgeon’s practice over a ten-year period. Primary functional outcomes included pre- versus post-operative flexion-extension arc and grip strength, complication rate and time to fusion. Two-tailed T-tests were used to compare the outcomes of HCSF and SF methods. The Chi-squared test was used to evaluate the complication rates associated with each method. Sixty-four patients were identified; 38 patients were treated with HCSF and 26 with SF. The majority of patients were male (84%) with an average age of 60.2 years and 52.9 in the HCSF & SF groups, respectively. Patients were followed on average for a 10-month period. HCSF patients had improved flexion arc post-operatively (108% of pre-operative arc), whereas SF patients lost an average of 30.4% of their pre-operative range (P-value: 0.00003). Grip-strength was improved in both groups. A statistically significant higher complication rate was associated with SF (50%) versus HCSF (13.2%). Hardware irritation/pain (6), delayed union (4) and nonunion (1) were the most common complications of SF, where as neuropraxia (2) and hardware failure (2) were the most common complications associated with HCSF. The higher complication rate and equivocal functional outcomes traditionally reported for 4CF may be associated with specific fixation methods such as the SF. •4CF patients treated with headless compression screw fixation have better arc of motion and a lower complication rate than those treated with staple fixation.•Various fixation methods are available for 4CF, however functional outcomes and complication rates are inconsistent among these methods.•Although 4CF is reported to have a higher complication rate than PRC in the literature, various fixation options are available and may be a key factor contributing to this discrepancy.

Biomechanical assessment of an alternative method of staple fixation for anchoring the Bone Patellar Tendon Bone graft to the tibia

IntroductionThe Anterior cruciate ligament (ACL) is the most commonly injured ligament around the knee and is best reconstructed with a biological graft. For ideal graft fixation, there should be sufficient initial strength to avoid failure of fixation and sufficient stiffness to restore the stability of the knee and to avoid gradual loosening in the post-operative period.When considering fixation of Bone Patellar Tendon Bone (BPTB) grafts to the tibia, the interference screw is considered to be the gold standard. As an alternative, we have used of staples and stainless steel (SS) wire to anchor the BPTB graft to the tibia and femur. The aim of this study was to assess the biomechanical efficacy of this fixation technique for anchoring the BPTB graft to the proximal tibia. We used a bovine model to compare three fixation techniques −interference screw, braided polyester sutures tied to a screw post and SS wire tied to a staple. Materials and methodsFifteen fresh bovine knees specimens were used for the study. The patella was fixed to a load cell and the construct was pre-tensioned to 40N to allow for creep of the tendon. The BPTB graft was fixed to the tibia using the three fixation techniques − the interference screw, polyester suture tied to a post, and SS wire anchored to a staple. After fixation, the graft was subjected to a single load to failure test, and the forces generated were recorded. The ultimate failure load (the pullout strength), stiffness, and mode of failure were noted. ResultsIn the single load-to-failure biomechanical testing, the ultimate failure load and stiffness for Staple with SS wire were 726.40N and 61.9N/mm respectively. For the screw post and polyester suture, it was 733.20N and 53.22N/mm, and for Interference screw − 594.00N and 79.50N/mm respectively. There was no statistically significant difference in the stiffness or ultimate failure load between the three fixation techniques. The graft fixation using interference screws failed at the bone- tunnel interface by slippage of the bone block from the tunnel in all 5 specimens. In all 5 of the specimens fixed with polyester suture and the screw post, the fixation failed when the polyester suture snapped. When the SS wire and staple construct was stressed, the graft failed as the SS wire cut through the graft in 4 specimens, and in the fifth construct, the knot over the staple unraveled as the load was applied. ConclusionThe biomechanical properties of BPTB graft fixation with SS wire tied to a staple is similar to that of other fixation devices like the interference screw and suture post. This technique provides a simple, yet effective fixation for the graft − but needs further clinical assessment.

Long-term results and comparison of the three different high tibial osteotomy and fixation techniques in medial compartment arthrosis

BackgroundThe purpose of this study is to report and analyze the long-term outcomes of the patients who underwent high tibial osteotomy (HTO) with three different techniques for the treatment of medial compartment arthrosis.MethodsA total of 187 patients (195 knees) who underwent HTO between 1990 and 2010 were retrospectively evaluated. Eighty-eight knees, opening-wedge osteotomy with Puddu plate (group A); 51 knees, transverse osteotomy below the tubercle with external fixator (group B); and 29 knees, closing-wedge osteotomy with staple fixation (group C) were included in the study. The patients (mean age 44.9 ± 10.6 years, mean follow-up of 12.4 ± 3.2 years) were called for final controls and survival rates of the knees, and functional evaluations of the patients were performed using Knee Society Score (KSS) and Hospital for Special Surgery (HSS) knee score assessments.ResultsIn the comparison of the three groups, there were no differences regarding the mean age, preoperative arthrosis levels, or preoperative deformity analyses (n.s.). The main finding of these comparisons showed that the closing-wedge osteotomy has the greatest lateralization effect on mechanical axis deviation (MAD) (p = 0.024), the greatest valgization effect on medial proximal tibial angles (MPTA) (p = 0.026), and the lowest posterior tibial slope (PTS) angles (p = 0.032) in comparison to the other groups. There were no functional differences between the three groups in the long-term assessment of patients with KSS and HSS knee scores. According to the Kaplan–Meier survival analysis, the probability of the survival of the native knee joint after HTO was 93.4% in 5 years and 71.2% in 10 years in our study group. During the follow-up of the 168 knees, revision surgery with total knee replacement was needed in 27 knees (16%). The mean time from HTO to total knee replacement was 8.9 years in these patients.ConclusionsHTO has acceptable long-term clinical and functional results that should not be underestimated by orthopedic surgeons under pressure to perform arthroplasty operations.

The biomechanical study of the influence to the forefoot plantar pressure of the first tarsometatarsal joint fracture-dislocation fixed by three different implants.

Objectives:To study the influence of forefoot plantar pressure of the first tarsometatarsal joint fracture-dislocation by three different implants to provide experimental reference in selecting implants.Methods:Eight fresh foot specimens were made into the models of the first tarsometatarsal joint fracture-dislocation, which were fixed with 3.5 mm cortical screw, 1/4 tubular plate and compressive staple in turn. After the loading of 600N, the changes of the plantar pressure in forefoot were measured by the method of the F-scan plantar pressure system.Results:After first tarsometatarsal joint fracture-dislocation, the peak pressure under the first metatarsal head would decrease, while the pressure under the second metatarsal head would increase(P<0.05). When the first tarsometatarsal joint was fixed with screw or plate respectively; the peak pressure under the two metatarsal heads would tend to be normal. However, the staple fixation would show the statistical significant difference, although the peak pressure under the first and second metatarsal heads were recovered in some extent(P<0.05).Conclusions:After the first tarsometatarsal joint fracture-dislocation, the plantar pressure might be compensated partly by the adjacent metatarsal heads. While the first tarsometatarsal joint fracture-dislocation was fixed by screw or plate, the plantar pressure of the forefoot would return to the normal state. However, if the joint was fixed by the staple, it would still be difficult to return the plantar pressure to be normal.

Tibial fixation in anterior cruciate ligament reconstruction.

To determine whether supplementary tibial graft fixation with a staple is routinely necessary for anterior cruciate ligament (ACL) reconstructions. We retrospectively reviewed a series of consecutive patients who underwent ACL reconstruction at our institution from April 2012 to July 2013. Patients who fulfilled the inclusion and exclusion criteria were divided into two groups, of which one with tibial fixation of the graft with a biointerference screw alone (biointerference screw group) and the other with tibial fixation of the graft with a biointerference screw and supplementary extra tunnel staple fixation (biointerference screw and staple group). All the surgeries were performed by a single fellowship-trained sports surgeon, using a standardized transportal technique and rehabilitation protocol. Both well-matched groups were evaluated at 1-year follow-up objectively for ligament laxity using instrumented testing with KT-2000 arthrometer and clinical tests as well as subjectively with the validated International Knee Documentation Committee 2000 (IKDC) and Lysholm knee score. All complications were reported. A total of 64 patients (31 in the only biointerference screw group and 33 in the biointerference screw and staple group) were included in the study. At 1 year, there was no significant difference in the objective and subjective outcome assessments between the two groups. However, four patients from the group with supplementary staple experienced symptomatic hardware on kneeling of which two necessitated removal of hardware. Our study showed that supplementary tibial graft fixation with a staple is not routinely necessary for ACL reconstructions. It confers no additional benefits when compared with the use of biointerference screw alone for tibial graft fixation but may increase the risks of symptomatic hardware.

Staged management of missed lisfranc injuries: A report of short-term results

Objective To analyze the clinical and radiographic outcomes of staged reduction and fixation in a consecutive series of patients with the old Lisfranc injuries. Methods Fifty patients (16 feet) with Lisfranc injuries were treated with staged reduction. Mean duration between injury and surgery was 4.8month (3 to 8 month). In first stage an external fixator was applied across the Lisfranc joint and distraction was done at 1 milliliter per day to 2 milliliter per day. In the second staged the ORIF (open reduction and internal fixation) was doneand we were able to reduce all the fractures and dislocations. Extra-Articular screws and staple fixation were used for fixation. We compared categorical variables using Fisher’s exact test and continuous variables using paired t-test or Wilcoxon signed-rank test. Results All patients were followed up 1 to 3 years (mean 2.2 years) in the clinic. The visual analogue scale score averaged 3.1 points at the final follow-up, the average AOFAS scores for these patients were 55.8 points (range, 43 to 98 points), with a significant increase than before surgery (P=0.001). The mean duration between two surgeries was 3.2 weeks (range 2.5-4.5 weeks). Anatomic reduction was obtained in all 15 patients. At the last follow-up, 2 patients had lost reduction. Posttraumatic osteoarthritis was observed in 5 patients, and all of them were scheduled for arthrodesis because of persistent pain. Conclusions The study have displayed that staged reduction and Extra-Articular fixation should be considered for old Lisfranc injuries with a good reduction, the firm stability, low risk of intraoperative fracture.The short-term effectiveness is good, but the long-term effectiveness needs further follow-up. Key words: Missed lisfranc injury; Staged management; Extra-articular fixation; Fractures; Treatment outcome; Joint

Laparoscopic Sleeve Gastrectomy With or Without Staple Line Inversion and Distal Fixation to the Transverse Mesocolon: Impact on Early Postoperative Outcomes

Staple line complications and axial rotation of the gastric tube after sleeve gastrectomy are well-recognized complications of the procedure. The present study aims to investigate the role of staple line inversion and distal fixation to the transverse mesocolon in reducing these complications. This is a retrospective analysis of prospectively collected data of 252 patients with morbid obesity who underwent laparoscopic sleeve gastrectomy (LSG). Patients were subdivided into two groups: group I comprising 124 patients did not have distal sleeve fixation and group II comprising 128 patients underwent staple line inversion and distal fixation. Patients were 171 females and 81 males with a mean age of 33.2±8.7years and a mean preoperative body mass index (BMI) of 50.9±8.6 Kg/m2. The mean operating time was 103.9±26.9min and the median hospital stay was 1day. Major complications were detected in 15 (5.9%) patients, who were all in group I. Group I had significantly shorter operative time and significantly higher rates of staple line bleeding (4% in group I versus 0 in group II) and gastric axial rotation (5.6% in group I versus 0 in group II). There were no significant differences between the two groups regarding early postoperative vomiting (21.7% versus 26.5%) and staple line leak (2.4% versus 0). Staple line inversion and distal fixation to the transverse mesocolon can be a simple, effective strategy to prevent staple line bleeding, and gastric axial rotation, though it prolonged the operative time of LSG.