Steinmann Pin Research Articles

Intramedullary nailing for concomitant extra-articular ulnar head fractures in distal radial fractures.

Four adult female patients were treated with an intramedullary Steinmann pin for an unstable extra-articular distal ulnar fracture associated with a distal radial fracture treated with plate osteosynthesis. All showed good radiographic and functional outcomes. One patient required removal of the Steinmann pin.

Utility of 2.0 mm diameter Kirschner wires assembled with Wu’s Tension Traction Bows in calcaneal skeletal traction

The 3.5 mm diameter or thicker Steinmann pins were commonly used in skeletal traction, which are so highly invasive that may result in severe complications such as pin tract infection and iatrogenic calcaneus fractures. Accordingly, Xirui Wu designed a new type of tension traction bow that can be assembled with 2.0 mm diameter Kirschner wires, but its effectiveness is unclear. We aim to evaluate the effectiveness of 2.0 mm diameter Kirschner wires assembled with Wu’s Tension Traction Bows in calcaneal skeletal traction. Data of 65 patients who were admitted to our department with tibia fractures from January 2021 to June 2022 and underwent preoperative calcaneal skeletal traction were collected retrospectively. 36 patients treated with 2.0 mm diameter Kirschner wires assembled with Wu’s Tension Traction Bows were assigned into Group 1, and 29 patients treated with 3.5 mm diameter Steinmann pins assembled with Bohler’s traction bows were assigned into Group 2. Pins loosening, breakage, and calcaneus fractures occurred in neither group. No statistical differences were observed in traction weight, swelling reduction efficacy, and traction duration (P > 0.05). Statistically significant differences were found between the two groups in term of post-traction bleeding incidence, average bleeding duration, and mean size and healing time of traction wounds (P < 0.05). Though VAS pain score before traction and on the first two days after traction in Group 1 didn't differ from Group 2 (P > 0.05), it was significantly lower in Group 1 compared to Group 2 on the third day after traction (P = 0.030). This study demonstrates that 2.0 mm diameter Kirschner wires assembled with Wu’s Tension Traction Bows produce satisfied traction outcomes with less invasion and are recommended in calcaneal skeletal traction.

Equine cheek tooth repulsion using small diameter repulsion pins: 20 cases.

Reported complication rates after dental repulsion for equine exodontia are high (up to 80%), but repulsion methods have changed notably in the last 20 years. Describe the outcome for 20 cases after dental repulsion using small diameter repulsion pins. Retrospective case series. Records of horses that underwent cheek tooth repulsion were reviewed (2014-2023). Inclusion criteria included: mandibular or maxillary cheek tooth extraction where oral extraction failed and repulsion was used to complete extraction, and where clinical follow up information was available. Repulsions were carried out under sedation with a regional nerve block or under a short general anaesthetic, using a small diameter repulsion pin (3-5 mm). Intra-operative radiographs facilitated instrument placement. The alveolus was packed with polymethyl methacrylate post-extraction. Horses were re-examined at 4-6 weeks post-operatively. Twenty cases were included. Patients had a mean age of 10.3 years old (range 5-16 years). The majority (75%) of teeth had pre-existing dental fractures. Maxillary (n = 15) and mandibular cheek teeth (n = 5) were all successfully repulsed, with 16 cases performed with the horse standing and 4 with the horse under general anaesthesia. Intra-operative complications included damage to the mandibular bone (n = 1). Short-term complications (n = 2) included superficial surgical site infection, and dehiscence of one sinus flap. Long-term complications included the recurrence of sinusitis (n = 1) and small intra-alveolar fragments causing persistent bitting problems in another patient. Retrospective study design, small number of cases. When oral extraction fails, cheek tooth repulsion using small diameter repulsion pins is an effective extraction technique. The total intra- and post-operative complication rate was 25%, which is comparable to previously published complication rates for repulsion using Steinmann pins and also those encountered after trans-buccal screw extraction.

Comparison of stereotactic brain biopsy techniques in dogs: neuronavigation, 3D-printed guides, and neuronavigation with 3D-printed guides.

The objective of this research was to compare two previously described stereotactic brain biopsy (SBB) techniques, three-dimensional skull contoured guides (3D-SCGs) and neuronavigation with Brainsight, to a novel SBB technique using Brainsight combined with a 3D-printed headframe (BS3D-HF) to improve the workflow of SBB in dogs. This was a prospective methods comparison with five canine cadavers of different breeds and size. Initial helical CT was performed on cadavers with fiducial markers in place. Ten different target points were randomly selected for each method. The headframe for the BS3D-HF was designed and printed. Trajectories were planned for each method. Steinmann pins (SPs) were placed into the target points using the planned trajectories for each method, and CT was repeated (post CT). Accuracy was assessed by overlaying the initial CT onto the post CT and measuring the difference of the planned target point to the SP placement. For 3D-SCG, the median deviation was 2.48 mm (0.64-4.04). With neuronavigation, the median deviation was 3.28 mm (1.04-4.64). For BS3D-HF, the median deviation was 14.8 mm (8.87-22.1). There was no significant difference between 3D-SCG and neuronavigation for the median deviation (p = 0.42). When comparing BS3D-HF to 3D-SCG, there was a significant difference in the median deviation (p < 0.0001). Additionally, when comparing BS3D-HF to neuronavigation, there was a significant difference for the median deviation (p < 0.0001). Our findings concluded that both 3D-SCGs and neuronavigation were accurate for SBB, however BS3D-HF was not. Although feasible, the current BS3D-HF technique requires further refinement before it can be recommended for use for SBB in dogs.

Complications of antibiotic cement spacers used for elbow infections

Antibiotic cement spacers have been widely used in the treatment of joint infections. There are no commercially available antibiotic spacers for the elbow. Instead, they are typically fashioned by the surgeon at the time of surgery using cement alone or a combination of cement with sutures, Steinmann pins, external fixator components, or elbow arthroplasty components. There is no consensus regarding the ideal elbow antibiotic spacer and no previous studies have examined the complications associated with these handmade implants in relation to their unique structural design. We retrospectively reviewed 55 patients who had 78 static antibiotic cement spacers implanted between January 1998 and February 2021 as part of a 2-stage treatment plan for infection of an elbow arthroplasty, other elbow surgery, or primary elbow infection. Several antibiotic spacer structures were used during the study period. For analysis purposes, the spacers were classified into linked and unlinked spacers based on whether there was a linking mechanism between the humerus and the ulna. Complications related to these spacers that occurred either during the implantation, between implantation and removal, or during removal were recorded and analyzed from chart review and follow-up x rays. Reoperations due to spacer-related complications were also recorded. Among the 55 patients (78 spacers), there were 23 complications, including 17 minor and 6 major complications. The most common complication of unlinked spacers (intramedullary [IM] dowels, beads and cap spacer) was spacer displacement. Other complications included IM dowel fracture and difficulty locating beads during spacer removal. The major complications of linked cement spacers included two periprosthetic humerus fractures after internal external fixator cement spacers and re-operation due to breakage and displacement of one bushing cement spacer. The major complications of unlinked cement spacers included two reoperations due to IM dowel displacement and one reoperation due to displacement of beads. Among patients who had removal of all components and those with native joints, there was no statistically significant difference between internal external fixator cement spacers and unlinked cement spacers in minor complication rates (30% vs. 16%, P=.16), major complication rates (7% vs. 8%, P=.85) and reoperation rates (0% vs. 8%, P=.12). Static handmade antibiotic elbow spacers have unique complications related to their structural designs. The most common complication of linked and nonlinked cement spacers were failure of the linking mechanism and displacement, respectively. Surgeons should keep in mind the possible complications of different structures of cement spacers when choosing 1 antibiotic spacer structure over another.

Designing and clinical application of caps for intramedullary pinning to manage long bone fracture in dogs

Study was carried out to design and evaluate clinical application of caps for intramedullary pinning to mange long bone fractures in dogs. Cannulated cancellous caps made of 316 L stainless steel with dimensions of 10 mm × 25 mm (length) cap for 4 mm, 4.5 mm and 5 mm steinmann pin and 8 mm × 25 mm (length) cap for 2.5 mm and 3 mm steinmann pin were designed. A total of 14 cases of dogs presented with simple transverse, short oblique fractures of long bones were equally divided into groups A and B having 7 animals in each. Simple intramedullary pinning was done in group A, whereas, in group B designed caps were fixed at entry point at trochanteric fossa after intramedullary pinning to prevent proximal migration of pins. Posture, gait, perception of pain and lameness scores were assessed during 15, 30 and 60 day, postoperatively. Caps offered rigid fixation along with intramedullary pin resulting in mild or moderate callus formation. Excellent postoperative functional recovery without any pin migration, seroma formation and valgus limb deformity were observed in group B. Results of present preliminary study suggested that designed capped intramedullary pinning offers stable internal fixation and prevented pin migration, sciatic injury and seroma formation.

Evaluation of Intraoperative Fluoroscopic Techniques to Estimate Femoral Rotation: A Cadaveric Study.

To compare three fluoroscopic methods for determining femoral rotation. Native femoral version was measured by computed tomography in 20 intact femurs from 10 cadaveric specimens. Two Steinmann pins were placed into each left femur above and below a planned transverse osteotomy which was completed through the diaphysis. Four surgeons utilized the true lateral (TL), neck-horizontal angle (NH), and lesser trochanter profile (LTP) techniques to correct the injured femur's rotation using the intact right femur as reference, yielding 120 measurements. Accuracy was assessed by comparing the angle subtended by the two Steinmann pins before and after manipulation and comparing against version measurements of the right femur. Absolute mean rotational error in the fractured femur compared to its uninjured state was 6.0° (95% CI, 4.6-7.5), 6.6° (95% CI, 5.0-8.2), and 8.5° (95% CI, 6.5-10.6) for the TL, NH, and LTP techniques, respectively, without significant difference between techniques ( p = 0.100). Compared to the right femur, absolute mean rotational error was 6.6° (95% CI, 1.0-12.2), 6.4° (95% CI, 0.1-12.6), and 8.9° (95% CI, 0.8-17.0) for the TL, NH, and LTP techniques, respectively, without significant difference ( p = 0.180). Significantly more femurs were malrotated by >15° using the LTP method compared to the TL and NH methods (20.0% vs 2.5% and 5.0%, p = 0.030). Absolute mean error in estimating femoral rotation of the intact femur using the TL and NH methods compared to CT was 6.6° (95% confidence interval [CI], 5.1-8.2) and 4.4° (95% CI, 3.4-5.4), respectively, with significant difference between the two methods ( p = 0.020). The true lateral (TL), neck-horizontal angle (NH), and the lesser trochanter profile (LTP) techniques performed similarly in correcting rotation of the fractured femur, but significantly more femurs were malrotated by >15° using the LTP technique. This supports preferential use of the TL or NH methods for determining femoral version intraoperatively.

Evaluation of external surgical approaches used for fenestration of the dorsal and ventral conchal bullae in horses: An ex vivo study

SummaryBackgroundEmpyema of the conchal bullae, which is a possible additional source of chronic unilateral nasal discharge, affects up to 56% of horses with paranasal sinus disease.ObjectivesThis study aimed to determine the external surgical approaches for the fenestration of the conchal bullae in horses.Study designExperimental study.MethodsSix heads of horses were used for external surgical approaches in the maxillary region, and the bilateral ventral and dorsal conchal bullae were fenestrated. Radiographic projections were performed preoperatively, and a further radiographic examination was performed after the surgical procedure using a Steinmann pin inserted through the surgical approach as a radiopaque marker. The approach to the bullae was also assessed by rhinoscopy. Dissection, macroscopic evaluation and digital photographic records of the surgical approaches were performed.ResultsA total of 92% (22/24 bullae) of the evaluated conchal bullae were fenestrated. The approach allowed the fenestration of 11/12 dorsal conchal bullae and 11/12 ventral conchal bullae. The postoperative radiographic evaluation allowed identification of the surgical approach and fenestration positioning by observing the location of the radiopaque pin within the conchal bullae. The dissection showed that the surgical approach to the dorsal conchal bulla was 3 cm dorsal to the infraorbital foramen and dorsal to the levator nasolabialis muscle, with no damage to the vascular or neural structures.Main limitationThe surgical approach to the ventral conchal bulla, when performed 1 cm rostral to the infraorbital foramen, was very close to the branches of the infraorbital nerve, which were identified and moved away from the trephination site. This was an ex vivo study and it is possible that nasal haemorrhage would affect the usefulness in clinical cases.ConclusionThe surgical approaches described in this study allow the fenestration of dorsal and ventral conchal bullae in adult horses in a simple way without the need for specific equipment.

Functional outcome of close reduction and internal fixation by C-C screw or Steinmann pin fixation of fracture calcaneum

Abstract Background: Fracture of calcaneum results in serious and prolonging disability. Considering the high rate of malunion and severe loss of function, it will be better to choose open reduction and internal fixation as a primary mode of treatment for calcaneum fractures. Materials and Methods: This study consists of 45 fractures of calcaneum treated by using close reduction and internal fixation and subtalar arthrodesis. Of the 45 fractures, 16 (35.56%) were treated by using the C-C screw within 2 weeks of injury and 29 (64.44%) were treated by using the percutaneous k-wire or Steinmann pin or C-C screw. Results: At the final follow-up, the mean AO foot and ankle score score of the patients was 89.28 with P value ≤ 0.0001. Conclusion: Early motion prevents stiffness of subtalar joint and ankle joint and leads to early function and psychological rehabilitation. Close reduction and internal fixation by using the C-C screw or Steinmann pin is a safe and effective method for treating displaced intra-articular fracture of calcaneum.

Tibial Supra-Tubercular Deflexion Osteotomy During Revision Anterior Cruciate Ligament Reconstruction

Background: A deflexion osteotomy may reduce anterior translational forces imparted upon an anterior cruciate ligament (ACL) reconstruction (ACL-R) graft, thereby reducing risk of ACL graft failure in patients with excessive congenital posterior tibial slope. Indications: A 13-year-old female competitive soccer player with 13.7° of posterior tibial slope presented with failure of a prior ACL-R. Technique Description: A vertical incision is made along the medial border of the patellar tendon and the proximal tibia is exposed. The planned osteotomy is templated under fluoroscopic guidance by placement of 2.4-mm Steinmann pins. A supra-tubercular deflexion osteotomy is made with a sagittal saw and osteotomes, with care to maintain the posterior cortical hinge. Compression staples are utilized for fixation of the osteotomy site. Revision ACL-R is then performed. Results: There were no immediate complications following surgery. Surgical management led to radiographic improvement of the patient's posterior tibial slope and clinical resolution of anterior translational knee instability. Discussion/Conclusion: The senior author's preferred technique for a tibial supra-tubercular deflexion osteotomy in association with a revision ACL-R is presented. A deflexion osteotomy is a surgical option for patients with excessive (&gt;12°) posterior tibial slope in the setting of a prior failed ACL-R. This case demonstrates the efficacy of a tibial supra-tubercular deflexion osteotomy in the revision ACL-R setting by reducing posterior tibial slope, thereby lessening anterior translational forces on the ACL graft in a patient at high risk of graft failure. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

The Salter-Harris Type I Femur Fractur Depending on Dystocia in A Newborn Lamb

In this case report, it is aimed to inform about the results of operative treatment of Salter-Harris Type I fracture in the left femur condylar, due to dystocia in a lamb, using intramedullary pin.&#x0D; In the clinical examination of a 2 days old Akkaraman breed male lamb, which was brought with a complaint of lameness, was found unable to use left leg, only able to walk on 3 legs. When the palpation performed, a closed fracture was discovered in the left femur. Radiologic examination revealed a Salter-Harris Type I fracture in the left femur condyle.&#x0D; Under general anesthesia, Osteosynthesis was performed with intramedullary Steinmann pin to provide reduction of the fracture. On the postoperative PVC splint guided bandage was applied to the extremity. At postoperative 15 day intervals, clinical and radiological examinations were performed. On the 45th day of the controls, it was observed that the lamb was comfortably use the extremity and there was no problem in its walk.

Efficacy of Modified Toggle Splint with Nylon Suture for ‎‎Stabilization of Coxofemoral ‎Luxation in Dogs

Coxofemoral luxation is a common orthopedic lesion in dogs. This study aimed to evaluate ‎the effectiveness of a modified toggle splint with nylon suture as a prosthetic teres ligament ‎for reducing and fixing coxofemoral luxation in dogs. Five adult mongrel dogs weighing ‎‎15±2 kg were used in this experimental study. The toggle splint was fabricated from a ‎Steinmann pin (1cm length, 2mm diameter) by drilling 0.5 mm hole in the center. ‎Stabilization of coxofemoral joint was performed by a modified Toggle splint technique. A ‎tunnel, from the major trochanter through the fovea capitis to the acetabulum, was ‎performed in which the toggle splint was passed through, and nylon suture was used for ‎fixation. Dogs were scored for lameness severity at 0-, 14-and 42-day post-operation using a ‎numerical rating scale (NRS) with 5 levels, and reductions were assessed radiographically ‎at three-time points the day of operation, day 28th, and day 42nd. The results showed that the ‎treatment splint was effective in achieving good reduction and fixation in four out of five ‎‎(80%) dogs at all time points. Reluxation was observed only in one dog (20%) up to week 6 ‎post-operation. The mean lameness score on day 14 (2.0±0.87) and 42 (0.60±0.60) were ‎significantly lower (P&lt;0.001) compared to day 0. These results indicate that the modified ‎toggle splint with nylon suture is a promising treatment option for canine coxofemoral ‎luxation.

ORTHOPAEDIC TRAUMA EMERGENCIES DONE AFTER HOURS

In 2019, the incidence of fractures were 178 million globally, South Africa accounting for close to 600 000 of these fractures, an 18.53% increase since 1990. South Africa does not have the public infrastructure to adequately facilitate the optimal surgical management of this burden. This forces intensive labour practices among orthopaedic surgeons, often performing complex surgeries throughout the night. There is a direct correlation between “after-hour”operations and the increase in morbidities.A retrospective review of the orthopaedic surgical cases and orthopaedic surgical emergencies done at a tertiary institution in Johannesburg between 8th of August 2021 to 12th December 2022. The nature of the orthopaedic interventions, the date of booking of the surgical procedures, date of surgical procedures, as well as start and end time of the orthopaedic interventions were analysed.“After-Hours” orthopaedic interventions were defined as interventions done between 16:00 and 07:00. Orthopaedic emergencies were defined as: Open fracture debridements, external Fixator insertion, arthrotomies, fasciotomies and the insertion of steinmann pins. 1483 (27.92%) of 5310 operative cases done on the emergency board were orthopaedic cases. 1098 (74.04%) hardware-related cases and 535 (36.08%) orthopaedic emergencies were done. 854 (57.58%) cases were done “After-Hours” of which 433 (29.20%) cases were done during “Dead-Hours” (23:00–07:00). Of these 433 cases, only 173 (39.95%) were true orthopaedic emergencies.Although the proportion of emergencies done after hours were greater than during working hours, there is still a large proportion of intricate orthopaedic cases done between 16:00– 07:00 that should not be prioritized, due to an associated higher morbidity. Enhanced strategic planning is advisable in future in order to prioritize complex hardware cases during working hours, and due to the burden, prioritize minor relooks and simple skin- grafts for the latter aspects of the night. A dedicated Orthopaedic Trauma theatre is recommended.

Intra-operative Safety of an Autonomous Robotic System for Total Knee Replacement: A Review of 500 Cases in India.

Manual total knee arthroplasty (TKA) has been documented several times for their safety and complications data. In contrast, there is a limited evidence-based analysis for safety and complications of autonomous robotic-assisted (RA)-TKA. This study aimed to evaluate the safety features and intra-operative surgical complications associated with the use of Cuvis Joint™ autonomous robotic system for TKA. The study included 500 consecutive patients who underwent TKA using the Cuvis Joint™ autonomous robotic system from November 2020 to November 2021. All surgeries were performed by a senior surgeon. Patients in whom the surgery was abandoned midway due to technical errors, were excluded from the analysis. In case of unilateral abandonment of the robotic arm during a bilateral RA-TKA, data of the side on which the surgery was completed with robotic assistance was recorded. There was no incidence of neurological injury, vascular injury, extensor mechanism disruption, or medial collateral ligament injury. There was one case of superficial abrasion of the patellar tendon; however, it did not require any intervention. There were no cases of midway abandonment due to threatened soft tissue injury. There was no intra-operative pin loosening or stress-related fractures at the pin sites. There was one case of Steinmann pin breakage and another case of drill bit breakage, which were removed without any damage to the bone. The Cuvis Joint™ autonomous robotic system for TKA is safe with no significant intra-operative complications.

Simple Minimally Invasive Method to Reduce Valgus-Impacted and Tilted Femoral Neck Fractures without Soft Tissue or Cartilage Injury: Radiological and Clinical Results.

This is a rare study comparing the radiological and functional outcomes of fixation after reduction with in situ fixation group using Femoral Neck System (FNS). The aim of this study was to introduce a simple, innovative, minimally invasive method to reduce valgus-impacted and tilted femoral neck fractures without soft tissue or cartilage injury. A retrospective comparative analysis of 46 patients between May 2020 and February 2022 was performed. In the control group, 23 patients underwent in situ fixation without reduction. In the study group, another 23 patients were managed by fixation after reduction using a percutaneous pull-out technique with a full threaded Steinmann pin. Caput-collum-diaphysis (CCD) angle, tilt, and femoral neck shortenings were compared between the two groups. In addition, Harris Hip Score (HHS) was evaluated and compared at 1 year after surgery. Basically, independent samples t-test was used to compare radiological and functional results. Patients' initial valgus and tilt angles were not significantly different between the groups (n.s.). However, the CCD and tilt angles measured immediately and at one year postoperatively were significantly different between the groups (p < 0.05). Regarding femoral neck shortening, shortening in the three directions, the x, y, and z vectors, was significantly less in the reduction group immediately postoperatively and at 1 year post-surgery (p < 0.05). The mean HHS at 1 year postoperatively was 79.7 ± 8.4 in the in situ fixation group and 87.9 ± 6.6 in the reduction groups, and there was a significant difference (p < 0.05). The pull-out method with a threaded Steinmann pin to reduce valgus-impacted and tilted femoral neck fracture is safe and effective for accomplishing anatomical restoration. This may achieve successful bone union and maintain the femoral neck length and original tilt without nearby soft tissue or cartilage injury.

A PROSPECTIVE OBSERVATIONAL STUDY OF THE FUNCTIONAL OUTCOME OF SURGICAL MANAGEMENT OF INTRA-ARTICULAR CALCANEUM FRACTURE BY CLOSED REDUCTION WITH PERCUTANEOUS PINNINGS

The calcaneum is the greatest bone of the foot and is the major weight-bearing structure of the foot and the most common tarsal bone to fracture. Many treatment techniques are described in the literature but indications for specic techniques are undened. This study analyzes the outcome of the treatment of intra-articular tonguetype calcaneum fractures treated by Essex-leproesti technique. Methods- This prospective observational study aimed to evaluate the functional outcome of tongue-type intra-articular fracture by closed reduction with a percutaneous Steinmann pin. 16 patients with intra-articular tongue-type fracture were treated in Indra Gandhi government medical college and hospital, Nagpur from December 2020 to December 2022 with a minimum follow-up of 6 months. the functional outcome was assessed by the AOFAS Score. Most common cause for injury is fall from height. All patients were managed surgically and out of 16 patients, 4 cases(25%) had excellent, 9 cases (56%) had good and 5 cases (19%) had fair results. None of the patients in this series had poor results. As per our experience, the time for surgery is short and it can easily be performed even in the presence of swelling in the period immediately after injury also the risk of infection is very low.

Prebent Steinmann Pin to Remove the Broken Retrograde Intramedullary Nail After Tibiotalocalcaneal Arthrodesis

A retrograde intramedullary nail is an implant option for tibiotalocalcaneal arthrodesis because it provides mechanical strength and compression at the fusion site, while being less invasive to soft tissue. However, some fusion failures result in implant overloading, resulting in implant failure. The accumulated stress at the level of the subtalar joint will most likely cause implant breakage. It is challenging to remove the broken tibiotalocalcaneal nail’s proximal part. Several surgical procedures for removing the broken tibiotalocalcaneal nail have been reported. In this article, we present a surgical technique for removing a broken tibiotalocalcaneal nail by punching out the proximal part of the broken nail using a prebent Steinmann pin. It has the advantage of being less invasive and not requiring any specific tools to punch out the nail.

Proximal endoscopic repair of the hamstring tendons: a cadaveric anatomical study of posterior hip portals.

Arthroscopy and endoscopic hip surgery have attracted increasing attention in the orthopedic field. In the case of arthroscopy, portals and their relationships with neurovascular bundle structures at risk are well established. However, studies on endoscopic portals used for the repair of hamstring tendon injuries are insufficient. Hamstring injuries are the most common muscle injury in sports medicine, and up to 12% can present as a tendon rupture. Endoscopic surgery is advantageous because it has a lower rate of bleeding and avoids excessive handling of the gluteal muscles. The objective of this study is to perform an anatomical evaluation of endoscopic portals for hamstring repair and measure their distance to neurovascular structures-mainly sciatic nerve and posterior femoral cutaneous nerve (PFCN). Fifteen hips from frozen and formalized cadavers were evaluated. Specimens that showed any modification in their anatomy were excluded. Portals were simulated using Steinmann pins, and anatomical dissection was performed. Distances from neurovascular structures were measured using a digital caliper. Four male cadaver hips (26%) and eleven female cadaver hips (74%) were included. Two dissected hips presented PFCN injury through the posterolateral portal- mean 20.28 mm (±8.14), and one through the distal accessory portal- 21.87 mm (±12.03). The injury rate for PFCN was 3/15 or 20%. None of the portals presented sciatic nerve injury. Conclusion: There is an imminent risk of nerve injury to the PFCN by performing the lateral portals for hamstring repair. To avoid this, we recommend starting the procedure through the most medial (posteromedial) portal, and the other portals must be performed under direct visualization.

Application of an Intraoperative Limb Positioner for Adjustable Traction in Both-Column Fractures of the Acetabulum: A Technical Note with Clinical Outcome

Traction of the ipsilateral leg is usually required to facilitate fracture reduction while operating both-column acetabular fractures. However, it is challenging to maintain constant traction manually during the operation. Herein, we surgically treated such injuries while maintaining traction using an intraoperative limb positioner and investigated the outcomes. This study included 19 patients with both-column acetabular fractures. Surgery was performed after the patient's condition had stabilized, at an average of 10.4 days after injury. The Steinmann pin was transfixed to the distal femur and connected to a traction stirrup; subsequently, the construct was affixed to the limb positioner. A manual traction force was applied through the stirrup and maintained with the limb positioner. Using a modified Stoppa approach combined with the lateral window of the ilioinguinal approach, the fracture was reduced, and plates were applied. Primary union was achieved in all cases at an average of 17.3 weeks. The quality of reduction at the final follow-up was found to be excellent, good, and poor in 10, 8, and 1 patients, respectively. The average Merle d'Aubigné score at the final follow-up was 16.6. Surgical treatment of both-column acetabular fracture using intraoperative traction with a limb positioner yields satisfactory radiological and clinical outcomes.

Diagnosis and Treatment of Neuropathic Ankle Fractures.

Standard 3-view ankle radiographs are the first-line imaging modality for suspected neuropathic ankle fractures. Computed tomography is helpful to evaluate for concomitant osseous changes and soft-tissue infection. Nonoperative management may be considered for low-demand, elderly, or comorbid patients for whom surgery and anesthesia are contraindicated. However, the presence of comorbidities alone should not necessarily preclude operative intervention. Given the overall poor results of nonoperative treatment in the neuropathic ankle fracture population, operative intervention may in fact be less risky to the patient. The authors have 2 preferred treatment techniques. For cases in which the vascular supply and bone stock are adequate, open reduction and internal fixation (ORIF) with locking fixation for the fibula, a medial buttress/hook plate with lag screws for the medial malleolus, multiple syndesmotic screws for additional fixation even in the absence of a syndesmotic injury, and temporary transfixation Steinmann pins from the calcaneus into the tibia are used. For cases in which there is a concern for wound healing or previously failed ORIF, minimally invasive surgical tibiotalocalcaneal arthrodesis with a retrograde locked intramedullary nail is used.