Steinmann Pin Research Articles

Case report: The nest technique for management of a periprosthetic patellar fracture with severe bone loss

Periprosthetic patellar fracture with marked loss of bone stock presents a significant problem in total knee arthroplasty. Treatment outcomes are often unsatisfying and may lead to disruption of the extensor mechanism of the knee. We present a patient with a Type IIIb periprosthetic patellar fracture treated by a novel approach. Three Steinmann pins were used to reduce the patella and form scaffold for bone graft and a patellar button was cemented into the construct. At 7 years followup, the patient has maintained excellent range of motion, reports no knee pain, has healed the patella fracture, and has restored patellar bone stock.

Total Hip Replacement in an Alpaca Using a Cementless Implant

To report use of a cementless total hip prosthesis in an alpaca. Case report. Alpaca (n=1) with chronic craniodorsal coxofemoral luxation. A 2.5-year-old Suri alpaca, 3 months pregnant, was admitted for evaluation of acute onset severe left hind limb lameness (grade 4/5) of 6 weeks duration. After diagnosis of craniodorsal luxation of the left femoral head, total hip replacement (THR) using a cementless implant was performed because of the poor prognosis for reduction of a chronic luxation. A press-fit prosthesis was used and the alpaca delivered a live cria 8 months later. Persistent mild mechanical lameness remained after surgery, with moderate reduction in mobility of the coxofemoral joint. The prosthesis was stable and correctly positioned at 7 weeks and at 9 months. There was mild exostosis surrounding the proximal aspect of the femur at 9 months, and Steinmann pins used to repair the trochanteric osteotomy were removed because of migration. At 1 year, the alpaca has a slight gait abnormality, remains with the herd on pasture and has been re-bred. Chronic coxofemoral luxation in an alpaca can be managed by THR. THR is a viable treatment option in alpacas with severe coxofemoral disease.

Management of equine skull fractures using fixation with polydioxanone sutures

Ten horses presented with severe distortion of the facial contour, crepitus on palpation and mild to moderate epistaxis. Individual horses also showed ocular damage, ptosis, severe dyspnoea and movement of the facial bones concurrent with respiration. The fracture fragments were exposed using a large curvilinear incision and elevated using a retractor, periosteal elevator, chisel or Steinmann pin. The fracture fragments were unstable following reduction and fixation was necessary. Stabilisation was achieved with polydioxanone sutures placed through holes drilled in opposing sides of the fracture lines. Polydioxanone sutures provided good stability and had better handling properties than wire. There was good apposition of fracture edges and minimal complications. Use of polydioxanone sutures can also avoid the expense and complexity of plate fixation in selected cases, and should be considered as an alternative to fixation with stainless steel wire in any facial fracture that adjoins stable bone.

Pronated Oblique View in Assessing Proximal Scaphoid Articular Cannulated Screw Penetration

Volar and percutaneous techniques of screw fixation for scaphoid fractures usually do not involve direct visualization of the dorsoproximal scaphoid articular surface. Intra-articular screw penetration may be overlooked if the proper fluoroscopic views are not obtained. The hypothesis of this study is that the pronated oblique fluoroscopic view of the scaphoid is the most sensitive in detecting dorsal articular screw penetration of the scaphoid when compared with other views. A 3.6-mm Steinmann pin was inserted along the central axis of the scaphoid using an open dorsal technique in 10 embalmed cadaver wrists. The pin was then withdrawn from the palmar side until it was flush with the dorsal articular surface of the scaphoid. Five fluoroscopic views of the wrist were then obtained by rotating the forearm, keeping the image beam parallel to the floor: (1) anteroposterior, (2) supinated lateral, (3) pronated lateral, (4) 60 degrees supinated oblique (60 degrees supinated from wrist neutral), and (5) 60 degrees pronated oblique (60 degrees pronated from wrist neutral). The Steinmann pin was then allowed to visually protrude proximally from the articular surface in 0.5-mm increments, and all views were repeated. The view in which articular violation was first observed was recorded, as was the corresponding amount of pin protrusion. The pronated oblique was the fluoroscopic view in which articular penetration was first observed in all 10 specimens before it was evident on the other views. The amount of pin penetrating the articular surface before it was detected on the other views was 1 mm in 6 wrists and 2 mm in 4 wrists. Statistical analysis using Fischer's exact test was performed to determine whether the radiographic projection had an effect on the determination of articular penetration. The pronated oblique view was the first view to demonstrate articular penetration, with an average radiographically measured articular penetration of 1.4 mm +/- 0.5. This study confirms our hypothesis that the pronated oblique view is the most important fluoroscopic image to obtain when evaluating penetration of the proximal scaphoid articular surface.

The Safe Zone for Hip Arthroscopy: A Cadaveric Assessment of Central, Peripheral, and Lateral Compartment Portal Placement

This study evaluated 11 arthroscopic portals (4 central, 4 peripheral, and 3 peritrochanteric) with regard to their proximity to neurovascular structures and the extra-articular path taken before entering their intended compartments. We established 11 standard portals in 10 cadaveric hips, under arthroscopic and fluoroscopic visualization, using 3/16-inch Steinmann pins. Each hip was dissected, and the relation of the pins to the pertinent anatomy was recorded to the nearest 1 mm. Only 2 of the 11 portals, the anterior and midanterior portals, came within 2 cm of a neurovascular structure before entering their respective compartments. The anterior portal placed the lateral femoral cutaneous nerve at risk, lying at a mean of 15.4 mm (range, 1 to 28 mm) away. The midanterior portal lies a mean of 19.2 mm (range, 5 to 42 mm) from the ascending branch of the lateral circumflex femoral artery. In addition, a small terminal branch of this artery courses a mean of 14.7 mm (range, 2 to 33 mm) and 10.1 mm (range, 1 to 23 mm) from the anterior portal and midanterior portal, respectively. This study showed that 11 arthroscopic portals can be safely inserted into the central, peripheral, and peritrochanteric compartments of the hip. The midanterior and anterior portals pass in close proximity to a small terminal branch of the ascending lateral circumflex femoral artery. The greatest risk still comes from the proximity of the anterior portal to the lateral femoral cutaneous nerve. However, a slightly more lateral location seems to provide substantial benefits. This study investigated 11 arthroscopic hip portals inserted in a standardized fashion. This knowledge should help surgeons place the necessary portals both safely and accurately.

Three Lateral Divergent or Parallel Pin Fixations for the Treatment of Displaced Supracondylar Humerus Fractures in Children

To evaluate the efficacy of lateral or parallel pin fixation using 3 smooth Kirschner wires (K-wires) or smooth Steinmann pins for the operative management of displaced supracondylar humeral fracture in a consecutive series of children. Sixty-one consecutive displaced or angled supracondylar humeral fractures (Gartland type II or III) in children (mean age, 5 years 6 months) treated by 2 orthopaedic surgeons between 2001 and 2004 according to the following protocol: close reduction under general anesthesia with fluoroscopic guidance and only lateral percutaneous pinning using 3 divergent or parallel Kirschner wires or Steinmann pins. Minimum 2 years' follow-up was done in all 61 patients (range, 2.0-3.3 years). Clinical assessment was obtained at final follow-up using Flynn criteria, and radiologic assessment was obtained using the Baumann and lateral humerocapitellar angles of both arms. Statistical analysis was performed by means of the Student t test (P < 0.05). The study group consisted of 61 patients, of whom 24 (39%) presented with Gartland type II fractures, and the remaining 37 (61%) presented with a type III fracture. A comparison of perioperative and final radiographs shows no loss of reduction of any fracture. There was also no clinically evident cubitus varus, hyperextension, or loss of motion. Eight patients had preoperative nerve palsy. Five of these nerve injuries resolved immediately after surgery, and the other 3 resolved completely within 12 weeks of surgery. After an average of 28 months postoperation, 56 (91.8%) patients had achieved an excellent clinical result, and 5 (8.2%) achieved a good result. There were no iatrogenic nerve palsies, and no patient required additional surgery. One patient had a minor pin-track infection. Our series demonstrates that only 3 lateral divergent or parallel pin fixations are effective and safe for avoiding iatrogenic ulnar nerve injury and are appropriate treatment options for displaced or angled supracondylar humeral fractures in children. Therapeutic study, level III.

Percutaneous Transphyseal Intramedullary Pinning for Displaced Diaphyseal Forearm Fractures in Children

Background: A prospective analysis of a case series of diaphyseal forearm fractures in children treated with percutaneous transphyseal intramedullary pinning is presented. Methods: Between 2004 and 2006, 30 children aged 9-15 years with displaced diaphyseal forearm fractures underwent percutaneous transphyseal intramedullary pinning. Both bones were fractured in 25 patients, four fractured only the radius, and one experienced ulna fracture. Eleven candidates had irreducible fractures, 13 had loss of reduction, and six had open fractures. Contoured Kirschner wires or Steinmann pins were introduced proximal to distal into the ulna and distal to proximal into the radius. All fractures were immobilized postoperatively with an above-elbow plaster cast for 4 weeks followed by a short-arm plaster cast for 2-4 weeks. Results: Closed reduction and pinning was successful in 20 cases, including 15 double-bone fractures and five single-bone fractures. Open reduction was completed in four fractures of both bones, and in six single-bone open fractures. Bone union was achieved in all patients at an average of 7 weeks. The ROM of the forearms was evaluated using the Daruwalla grading criteria. Excellent results were reported in 96% without significant complications after a mean follow-up of 20 months. Conclusion: Percutaneous transphyseal intramedullary pinning of pediatric forearm fractures revealed several advantages, including ease of application, a small incision for insertion and removal of instrumentation, a low rate of complications, unhindered bone healing, and good clinical and radiological results. This method is convenient, effective, and safe without any deleterious effects on subsequent growth of the radius and ulna.

Usefulness of the Nutrient Foramen of Lamina for Insertion of Thoracic Pedicle Screws

A cadaveric study. To determine the utility of the nutrient foramen on the lamina in thoracic pedicle screw fixation. Recent studies have examined the portal of entry for pedicle screws. Unfortunately, there is no distinct anatomic marker, and the portal of entry usually depends on the surgeon's preference. This study investigated the nutrient artery foramen on the lamina from fourth to eighth thoracic vertebrae after partial laminectomy of 7 cadaveric spines. A 2-mm Steinmann pin was inserted as follows: vertical insertion on the right nutrient foramens and a 10-degree caudal on the left nutrient foramens. Radiographs and computed tomography were obtained and the relationship between the Steinmann pin and pedicle were analyzed. There were 44 nutrient artery foramens (63%, 44/70). Among them, 31 foramens (70%, 31/44) were on the right. On the lateral radiographs, the right pins were inserted parallel within the upper end plate and the left pins were inserted within the vertebral body in T4 and T5. For T6 to T8, the right pins were inserted below the upper end plate and the left pins were inserted below the center of the vertebral body. On the computed tomography axial scan, 17 degrees of medialization for T4 to T7 and 5 degrees for T8 was possible when the size of pedicle screw for human is considered. The nutrient artery foramen on the lamina of thoracic vertebrae is useful for inserting the thoracic pedicle screw.

Complications of Ankle Fracture in Patients With Diabetes

Ankle fractures in patients with diabetes mellitus have long been recognized as a challenge to practicing clinicians. Complications of impaired wound healing, infection, malunion, delayed union, nonunion, and Charcot arthropathy are prevalent in this patient population. Controversy exists as to whether diabetic ankle fractures are best treated noninvasively or by open reduction and internal fixation. Patients with diabetes are at significant risk for soft-tissue complications. In addition, diabetic ankle fractures heal, but significant delays in bone healing exist. Also, Charcot ankle arthropathy occurs more commonly in patients who were initially undiagnosed and had a delay in immobilization and in patients treated nonsurgically for displaced ankle fractures. Several techniques have been described to minimize complications associated with diabetic ankle fractures (eg, rigid external fixation, use of Kirschner wires or Steinmann pins to increase rigidity). Regardless of the specifics of treatment, adherence to the basic principles of preoperative planning, meticulous soft-tissue management, and attention to stable, rigid fixation with prolonged, protected immobilization are paramount in minimizing problems and yielding good functional outcomes.

Removal of Broken Hardware

Despite advances in metallurgy, fatigue failure of hardware is common when a fracture fails to heal. Revision procedures can be difficult, usually requiring removal of intact or broken hardware. Several different methods may need to be attempted to successfully remove intact or broken hardware. Broken intramedullary nail cross-locking screws may be advanced out by impacting with a Steinmann pin. Broken open-section (Küntscher type) intramedullary nails may be removed using a hook. Closed-section cannulated intramedullary nails require additional techniques, such as the use of guidewires or commercially available extraction tools. Removal of broken solid nails requires use of a commercial ratchet grip extractor or a bone window to directly impact the broken segment. Screw extractors, trephines, and extraction bolts are useful for removing stripped or broken screws. Cold-welded screws and plates can complicate removal of locked implants and require the use of carbide drills or high-speed metal cutting tools. Hardware removal can be a time-consuming process, and no single technique is uniformly successful.

Distal Locking Screws: The Easy Way

BACKGROUND Distal locking in intramedullary nails can be technically demanding, using either a radiolucent drill or freehand technique. We describe a tried and tested technique which makes a difficult job easier. METHOD Pre-operative planning is the key. The image intensifier is positioned as close as possible and at right angles to the limb to get a magnified circle on the screen. After a stab incision and blunt dissected, a Steinmann pin is placed on the bone. The pin is held with two Cockers Forceps to prevent the surgeon's hand being under the image intensifier (Figure 1). The tip of the pin is then aligned with the hole of the nail with the image intensifier. Moving only the proximal end of the pin, the position is adjusted so it is in line with the circle (Figure 2). Figure 1 Figure 1 Figure 2 Figure 2 With the pin then aligned with the image intensifier it is tapped to leave a groove in the proximal cortex (Figure 3). The drill piece then replaces the pin in the groove and is advanced with the drill aligned with the image intensifier. With the set up correct, the drill advances through the proximal cortex, the nail and the distal cortex. The drill hole is then measured, tapped and the screw inserted to finish the distal locking of an intramedullary nail (Figure 4.) Distal Locking Screws: The Easy Way 2 of 3 Figure 3 Figure 3 Figure 4 Figure 4 DISCUSSION This technique is quick and easy to follow. Multiple drill holes are not made in the proximal cortex and the drill does not skid off the bone. A disadvantage occurs when the bone is soft. The pin can be driven through the bone and nail and can fracture the distal cortex. The intramedullary nail can also be damaged causing a stress riser and potential for nail breakage. Therefore care is needed when tapping the pin on the proximal cortex to leave a groove only. We feel that this is a simple technique which, if followed correctly, can make free hand distal locking easier. References Distal Locking Screws: The Easy Way 3 of 3 Author Information D.T. Loveday, MRC Addenbrookes Hospital A. Carroll, FRCS Arrowe Park Hospital

Occurrence and Pattern of Long Bone Fractures in Growing Dogs with Normal and Osteopenic Bones

A retrospective study was undertaken to record the occurrence and pattern of long bone fractures, and the efficacy of Intramedullary (IM) Steinmann pin fixing in growing dogs. All the records of growing dogs during a 10-year-period were screened to record the cause of trauma, the age and sex of the animal, the bone involved, the type and location of the fracture, the status of fixation, alignment, maintenance of fixation and fracture healing. The results were analysed and comparisons were made between growing dogs with normal and osteopenic bones. Among the 310 cases of fractures recorded, the bones were osteopenic in 91 cases (29%). Minor trauma was the principal cause of fracture in dogs with osteopenia (25%), and indigenous breeds were most commonly affected (38%). Fractures in dogs with osteopenic bones were most commonly recorded in the age group of 2-4 months (53%), whereas fractures in normal dogs were almost equally distributed between 2 and 8 months of age. Male dogs were affected significantly more often in both groups. In osteopenic bones, most fractures were recorded in the femur (56%), and they were distributed equally along the length of the bone. Whereas in normal bones, fractures were almost equally distributed in radius/ulna, femur and tibia, and were more often recorded at the middle and distal third of long bones. Oblique fractures were most common in both groups; however, comminuted fractures were more frequent in normal bones, whereas incomplete fractures were more common in osteopenic bones. Ninety-nine fracture cases treated with IM pinning (66 normal, 33 osteopenic) were evaluated for the status of fracture reduction and healing. In a majority of the cases (61%) with osteopenic bones, the diameter of the pin was relatively smaller than the diameter of the medullary cavity (<70-75%), whereas in 68% of the cases in normal bones the pin diameter was optimum. The status of fracture fixing was satisfactory to good in significantly more osteonormal (59%) than osteopenic dogs (42%). Fracture healing, however, was satisfactory in significantly more cases with osteopenic than normal bones. The appearance of callus was relatively early and the amount of bridging callus was relatively large in greater number of osteopenic bone fractures. Mal-union and non-union were recorded more often in osteopenic cases than in normal cases. However, the incidence of bone shortening and osteomyelitis was significantly higher in normal bones than in osteopenic bones.

Arthroscopic-Assisted Treatment of Coronoid Fractures

Little information exists regarding arthroscopic treatment of coronoid fractures; this study reports outcomes in a series of patients. Forty-one coronoid fractures were identified by retrospective chart review; 7 were treated arthroscopically; 6 with >12 months of available follow-up. Regan-Morrey fracture types were II (n = 4) and III (n = 3). The age of the patients averaged 37 years; the mechanism of injury was a fall in 6 patients and a motocross accident in 1 patient. Fracture fixation included: plate-and-screws following arthroscopic reduction (1); screws (2) and threaded Steinmann pins (2); 2 fractures were debrided. Three patients had immediate (2) or delayed (1) lateral ulnar collateral ligament repair. Follow-up averaged 31.8 months. The range of motion averaged 9 degrees to 133 degrees in flexion-extension and 87 degrees/79 degrees in prono-supination. Mayo Elbow Performance scores were 100 in 5 of 6 patients and unavailable in 1 patient. Complications included asymptomatic heterotopic ossification (1) and delayed ulnar neuropathy (1). In our series of coronoid fractures treated with arthroscopic means, all patients had a functional, pain-free result. All patients returned to preoperative avocations and occupations. Level IV, therapeutic case series.

Clinical evaluation of small diameter decompression and arthroscopy in the treatment of early avascular necrosis of femoral head

To investigate the therapeutic effect of small diameter, multiple porous, low drill velocity decompression and hip arthroscopy in treatment of early avascular necrosis of femoral head (ANFH). 226 ANFH patients (383 hips), 169 males (296 hips) and 57 females (87 hips), aged 36.5 (14 - 64), underwent drilling decompression with 3.5 mm Steinmann pin at a low velocity under the C-arm X-ray monitoring, all the 383 hips were decompressed with Steinmann pin, small diameter, multiple porous, low drill velocity. Synovectomy and cartilage trimming were performed through hip arthroscopy at the same time on the 209 hips combined with hip arthrosynovitis or cartilage trauma. 164 cases were followed up for 35 months (3 - 60 months). The Harris score was increased from 68 (56 - 78) pre-operatively to 79 (58 - 92) post-operatively. Excellent curative effect was found in 198 of the 383 hips (69.5%) with a Harris score > 80, medium curative effect was found in 70 hips (24.5%) with a Harris score between 70 and 79; and bad effect found in 17 hips (6.0%) with a Harris score < 69. During the follow-up, these 17 hips presented progress in staging of clinical course and collapse of femoral head. 139 hips with hydrops articuli were treated with arthroscopy, and 87 of the 139 hips underwent hip MRI during the follow-up. It was found that the hydrops articuli decreased in 59 hips and increased in 10 hips. Complications were found in 10 cases and all of them were recovered after treatment. The effect of small diameter, multiple porous and low drill velocity decompression is equal to or surpasses traditional core decompression. Small diameter decompression has the advantage of less osseous destruction of femoral head, delaying femoral head collapse and improving blood circulation in the necrosis zone of femoral head. Hip arthroscopy can greatly improve the therapeutic effect of ANFH through scavenging pain-producing substance, removing the cartilage chips caused by isolation or undermining dissection, and correcting internal environment disorder.

Migration of a broken Kirschner wire from an acromioclavicular joint into the neck: a case report

Migration of Kirschner wires and Steinmann pins when they are used for internal fixation of the shoulder girdle is a known complication, which could sometimes result in life threatening situations. A case of pin breakage used for fixation of an acromioclavicular joint dislocation with subsequent migration of its medial end into the neck is presented emphasizing the fact that bending the outer end of the wire doesn’t guarantee safety and wire migration is possible after its breakage. It seems that the most reliable way to avoid this complication is close radiographic follow up of the patient and removal of wire or pin at an appropriate time.

Reconstruction of Noncontained Proximal Tibial Defects with Divergent Screws and Cement

Postoperative fracture is a well described complication following curettage and cementation of aggressive benign bone tumors. We asked whether: (1) the addition of diverging screws that engage the opposite cortex increase the strength and rigidity of the construct in the proximal tibia compared with (a) cement alone and (b) would cement with intramedullary Steinmann pins; and (2) the modes of failure be different for those constructs. The average load to failure for tibias reconstructed with cement augmented with diverging screws (6321 +/- 681 N) was higher than for tibias reconstructed with cement alone (2343 +/- 222 N). The average load to failure for tibias reconstructed with cement augmented with diverging screws (6885 +/- 445 N) was higher than for tibias reconstructed with cement and intramedullary Steinmann pins (5218 +/- 941 N). Furthermore, constructs with cement augmented with diverging screws were less likely to fail by an intraarticular fracture than other types of constructs. Our data support the use of diverging screws that engage the opposite cortex to augment the strength of the construct when using acrylic cement to fill noncontained defects after curettage of the proximal tibia. This more stable, stronger construct might allow earlier mobilization and rehabilitation after curettage, with a decreased risk of fracture.

Circumferential stabilization with ghost screwing after posterior resection of spinal metastases via transpedicular route

Various surgical methods have been described for treating spinal metastases, namely, en bloc spondylectomy, minimally invasive techniques, and anterior and posterior approaches. The main goals in surgical intervention for these lesions are tumor removal and establishment of strong, durable stabilization. The least invasive method is always preferred. Posterior transpedicular spondylectomy meets all these needs, as this method achieves tumor excision and stabilization of the anterior and posterior spine through one posterior incision and in the same surgical session. The surgeon circumferentially excises a spinal metastasis and then achieves circumferential stabilization in the same session. Numerous circumferential stabilization methods have been used to date, including placement of free bone grafts or cages or acrylic grafts, or insertion of an acrylic graft supported by a Steinmann pin anteriorly and by posterior transpedicular fixators or a Luque rectangle posteriorly. This article describes seven cases of spinal metastasis in which an alternative circumferential stabilization technique known as "ghost screwing" was performed. The first step in this method is circumferential decompression, achieved with laminectomy followed by eggshell corpectomy via the transpedicular route. Then a short segmental transpedicular stabilization system is fixed to the vertebrae cranial and caudal to the laminectomy/corpectomy defect. Prior to fixing the rods in place, an additional screw is mounted on each rod such that the screw shaft protrudes into the defect space. Once the rods are fixed and the two extra screws are optimally positioned, acrylic bone cement is introduced into the defect site, encasing the ghost screws and forming an anterior graft upon hardening. The outcomes in our cases were excellent. All seven patients had uneventful postoperative periods and all experienced pain relief and were able to mobilize early. Direct connection of the anterior acrylic graft to the posterior fixation system via ghost screws makes this system strong and durable, and prevents subsidence or horizontal displacement of the graft. Such complications can be serious issues with other circumferential systems that use independent anterior and posterior fixators.

Retroarticular Drilling and Bone Grafting of Juvenile Osteochondritis Dissecans of the Knee

We present an effective technique for retroarticular drilling and bone grafting of juvenile osteochondritis dissecans (OCD). A radiolucent bolster is used to flex the knee at 45°, allowing adequate C-arm visualization. A 2-cm incision is made over the iliac spine, and soft tissue is dissected with the use of electrocautery. A 3.5-mm Steinmann pin is driven ∼5 cm into the iliac crest. With a mallet, the 3.5-mm-long drill sleeve from the Synthes External Fixator Set (Part #395.913; Synthes, Paoli, PA) is tamped over and 1 cm past the guide pin, while cores of autograft cancellous bone are harvested. The same Steinmann pin is inserted over the corresponding aspect of the knee. The Steinmann pin is advanced to approximately 1 cm above the lesion, and the drill guide is once again tapped over the pin. With use of the C-arm, the pin is removed, and a 3.5-mm bit is used to drill the remaining distance into the lesion. The graft is tamped through the drill guide and into position with the reverse end of the bit. This technique may be repeated according to the size of the lesion. Major advantages of this technique include the ease of harvest/transfer of autograft, readily available instrumentation to perform the procedure, and the ability to avoid violation of stable articular cartilage.

Comparison of Results in Two Operative Treatments for Clavicle Shaft Fractures in Adult: Comparison of Results between Open Reduction and Internal Fixation with the Plate and Percutaneous Reduction by Towel Clip and Intramedullary Fixation with Steinmann Pin

Comparison of Results in Two Operative Treatments for Clavicle Shaft Fractures in Adult: Comparison of Results between Open Reduction and Internal Fixation with the Plate and Percutaneous Reduction by Towel Clip and Intramedullary Fixation with Steinmann Pin

Results of Multiple Drilling Compared with Those of Conventional Methods of Core Decompression

We performed multiple drilling as a femoral head-preserving procedure for osteonecrosis of the femoral head thinking the therapeutic effects of core decompression could be achieved by this simpler procedure than core decompression. We retrospectively reviewed 136 patients (163 hips) who had multiple drilling using 9/64-inch Steinmann pins for treatment of nontraumatic osteonecrosis of the femoral head. The mean followup for patients who did not require additional surgery (113 hips) was 87 months (range, 60-134 months). We defined failure as the need for additional surgery or a Harris hip score less than 75. After a minimum 5-year followup, 79% (31/39) of patients with Stage I disease and 77% (62/81) of patients with Stage II disease had no additional surgery. All (15/15) small lesions (<25% involvement) and 84% (37/44) of medium-sized lesions (25-50% involvement) were considered successful. Survival rates of patients with Ficat Stages I or II lesions were greater than survival rates for patients with Stage III lesions. Hips with a large necrotic area had poor results. We had one instance of subtrochanteric fracture through drill entry holes. Multiple drilling is straightforward with few complications and produces results comparable to results of other core decompression techniques.