Steinmann Pin Research Articles

Intraoperative Fabrication of Bone Tamps for Indirect Reduction of Depressed Articular Segments

The use of bone tamps for indirect reduction of depressed articular segments is an established method of treatment for intra-articular fractures in a variety of joint injuries. Customized bone tamps can be fabricated intraoperatively using commonly available instruments and supplies consisting of Steinmann pins and T-handled chucks. The technique combines the use of bone tamps through carefully created metaphyseal windows, fluoroscopic guidance, packing with cancellous bone, and adequate fixation. This treatment methodology can allow for a minimally invasive or soft tissue preserving approach for the treatment of some intra-articular fractures while achieving anatomic reduction of the joint surface.

Intraspinal migration of a clavicular Steinmann pin: case report and management strategy

Spine injury resulting from migration of previously implanted appendicular skeleton fixation hardware is rare. We present a 41-year-old man who had Steinmann fixation pins placed for a left clavicular fracture 2 years prior. He presented with a burning sensation over his biceps bilaterally and numbness over the left anterior chest and abdomen following a significant blunt traumatic injury. A CT scan revealed migration of a fractured Steinmann pin entering the left C8 neural foramen, traversing anterior to the spinal cord. The patient underwent a left C7 hemilaminectomy, foraminal decompression, and first rib resection to identify the extraforaminal portion of the pin and remove it under direct vision. He recovered uneventfully. We conclude that a principle of safe surgical removal includes adequate exposure to allow for direct visualization of the pin and neural structures. We review the evaluation and management strategies of this unusual condition.

Anatomically safe and minimally invasive transcrestal technique for procurement of autogenous cancellous bone graft from the mid-iliac crest

Open iliac bone harvesting techniques can result in significant complications and residual morbidity. In reconstructive procedures where a small volume of autogenous cancellous bone graft is required, a minimally invasive technique for bone harvesting applied at the mid-iliac crest has been deemed satisfactory. We sought to assess the application of a well-established surgical technique to procure adequate volume of autogenous cancellous iliac bone graft with minimal trauma to adjacent structures. We retrospectively reviewed the cases of patients who underwent a minimally invasive transcrestal mid-iliac bone graft procurement technique between May 2003 and December 2007. The technique was performed using a 3.5-mm Steinmann pin as a trocar and a 4.5-mm AO drill sleeve as a trephine. We administered a questionnaire, either in the clinic or by mail, to assess a number of parameters, including postoperative pain, dysthesia, parasthesia, status of the donor site wound and patient satisfaction. Of the 37 consecutive patients who underwent the procedure, data from 26 patients were available for assessment. Donor site pain resolved within a few days of the surgery, and none of the patients experienced symptoms of chronic pain. At the final review, none of the patients reported any unpleasant signs and symptoms related to the residual scar. We recommend that the described minimally invasive trephine method be used when a small cancellous bone graft is needed. We found that patient morbidity was significantly lower with the trephine harvest technique than with open bone harvesting methods at the anterior iliac crest.

Non-invasive traction for proximal femoral fractures in amputees

Fracture reduction for fixation of proximal femoral fractures in amputees using a Steinmann pin carries the risk of infection and delayed mobilisation. The use of an arm trap used for shoulder arthroscopy provides non-invasive traction of the limb. Rotational control can be achieved using an assistant with a steady grip if required. Apply a thin layer of wool to the stump followed by the hand trap (Allen Medical Systems, Ashby de la Zouch, LE65 1JG). Wrap with a four-inch self-adhesive bandage (3M™ Coban™, 3M Health Care Ltd, Loughborough, LE11 1EP) and secure the cord to the traction table. Prepare and drape as routine. Figure 1 Use of the hand trap

S203 THE EFFECTIVENESS OF BOTOX© INJECTION FOR THE TREATMENT OF INGUINAL PAIN

The main objective of this study was to investigate medial hip portals and evaluate their relation with anatomic structures in a cadaveric model.Placement of 3 medial arthroscopic portals was simulated in 10 fresh human paired cadaveric hip specimens by placing Steinmann pins into the joint under fluoroscopic control. Two portals were made at the groin, 1 anterior and 1 posterior to the adductor longus muscle, and the third portal was placed posterior to the adductor longus muscle, 5 cm distal to the groin. The specimens were then dissected, and the relation of the portals to the following structures was recorded: pectineus, adductor longus, gracilis, adductor brevis, adductor magnus, iliopsoas tendon, obturator nerve, femoral nerve, femoral artery, femoral vein, and profunda femoris artery.Regarding the anteromedial portal, the closest neurovascular structure was the profunda femoris artery, which was 10.4 ± 2.7 mm (range, 6 to 14 mm) distal to the portal. Regarding the posteromedial portal, the nearest neurovascular structure was the obturator nerve, which was 6.0 ± 3.6 mm (range, 2 to 13 mm) posterior to the portal. Regarding the distal posteromedial portal, the nearest neurovascular structures were the obturator nerve, which was 4.6 ± 3.0 mm (range, 1 to 9 mm) distal to the portal, and the profunda femoris artery, which was 10.5 ± 3.9 mm (range, 6 to 17 mm) distal to the portal.The use of the medial portals did not cause any damage to the neurovascular structures evaluated. Despite this, the portals are in close relation to the obturator nerve and profunda femoris, and care should be taken.This study investigated 3 medial hip portals in a cadaveric model and also defined safety parameters for this approach. Medial hip portals may be useful to directly approach medial hip pathologies.

Surgical reconstruction of a severely comminuted mandibular fracture in a horse

SummaryA Palomino gelding presented for evaluation of a mandibular fracture and physical examination revealed swelling and excoriation of the skin over the ventral mandible. Upon further examination, malalignment of the incisors was appreciated in addition to instability and crepitance of both the rostral aspect and vertical ramus of the mandible. Radiographic examination revealed a comminuted fracture within the interdental space and fractures of both vertical ramii of the mandible. Under general anaesthesia via tracheotomy intubation, the fractures of the vertical ramii were reduced and compression plating techniques used along the caudal‐lateral border of both ramii for stabilisation. Intraoral tension band wires were used for repair of the interdental space fracture. A type II external skeletal fixator using Steinmann pins and polymethyl methacrylate connecting bars was applied to increase stability. The horse was maintained on broad spectrum antibiotics and phenylbutazone and discharged following 6 days of hospitalisation. Radiographs were taken 10 weeks after surgery and revealed evidence of adequate healing. On follow‐up 20 months later, the horse was reported to have no difficulties eating and was maintaining its bodyweight. This case is unique due to the severity of the mandibular fracture. The authors are unaware of any previous reports of such a severely comminuted mandibular fracture and its successful reconstruction employing multiple surgical techniques.

Chondromyxoid Fibroma of the Lateral Malleolus: A Case Report

Chondromyxoid fibromas account for <1% of primary bone neoplasms. We report one such case occurring in the distal fibula of a 27-year-old woman. The patient underwent curettage, followed by phenolisation, insertion of a Steinmann pin, and cementation. This treatment reduced morbidity, restored stability, and enabled rapid functional recovery. There was no recurrence after 2 years.

Steinmann Pin Arthrodesis for Salvage of Failed Small Joint Arthroplasty

Proximal interphalangeal joint arthroplasty has been performed since the 1960s, with good short-term and medium-term results. However, despite improvements in pain, there is a considerable failure rate. Often, there is a delicate soft tissue envelope and substantial bone loss after removal of these prostheses, making salvage procedures difficult. We present an intramedullary technique of proximal interphalangeal joint arthrodesis following failed implant arthroplasty. This technique has provided reliable results in a small cohort of patients.

Treatment of intraarticular calcaneal fractures using poking reduction combined with Ilizarov method

Objective To introduce the treatment of intraarticular calcaneal fractures with poor soft tissue using poking reduction combined with Ilizarov methods. Methods From September 2007 to September 2009,11 patients with the intraarticular calcaneal fractures were treated with poking reduction combined with Ilizarov methods,including 10 males and 1 female at average age of 33.6 years(range,21-50 years).Four patients had the left calcaneal fractures and seven with the right ones.According to Sander classification,there were seven patients with type II fractures,three with type III fractures and one with type IV fracture.The various extents of heel soft tissue injury were emerged in all the patients.Before operation,B(o)hler angle was 0°-12°(average 8°)and Gissane angle 70°-95°(average 80°).According to AO classification of close soft tissue injury,there were three patients with type IC2,six with type IC3,one with type IC5 and one with open soft tissue injury.The collapse of the articular surface was recovered by Steinmann pin which passed through the lateral calcaneal tubercle.The medial and lateral fracture fragments were corrected by using the tensed olive wires.The heighat and width were maintained by using the Ilizarov external fixation. Results The mean duration of follow-up was 13.3 months (range,6-20 months).All fractures were healed after mean duration for 8.1 weeks(range,7-10weeks).The postoperative B(o)hler angle was 20°-45°(average 33°)and Gissane angle 100°-118°(average 107°).According to Maryland Foot Score system,the result of postoperative function was excellent in seven patients,good in three and fair in one,with excellence rate of 91%. Conclusions For the intraarticular calcaneal fractures,the poking reduction combined with Ilizarov method is able to recover and maintain the normal calcaneal height and width and reduce postoperative wound infections and many other complications.specially for Sanders II or III with severe soft tissue injury in the open or closed calcaneal fractures.Master of surgical indications and operating poims can attain satisfactory clinical efficacy. Key words: Foot injures; Calcaneal; Poking reduction

Fracture shaft of humerus with anterior dislocation of shoulder treated with closed locked nailing

Correspondence: Dr. Hitesh Lal, A-1/207, Janakpuri, New Delhi – 110058. E-mail: drhiteshlall@gmail.com decided to take the patient to the operating room. The patient was taken up for surgery under general anesthesia in supine position with a sandbag below the ipsilateral shoulder. Close reduction of the dislocation was done under anesthesia with an assistant pushing manually on the head under the coracoid and another one applying traction along the axis of arm. The dislocation was surprisingly seen to reduce under radiographic control. It was decided to choose a closed interlocking nail over a plate for fixing the humerus as it is minimally invasive. But while making the entry point for the nail the head slipped again into a dislocated position even when the assistant resisted it manually with a fist pressure. A percutaneous 4 mm Steinmann pin was passed after reducing the head in an anteroposterior direction. Then 1 assistant held the head in reduced position with the help of the aforesaid pin loaded on a T handle. The operating surgeon was thus able to make an entry point with a thick Kirchner wire and the position was checked on anteroposterior and lateral views. A cannulated awl was passed over it to enlarge it and the shaft was then reamed with flexible reamer to appropriate size. A standard technique was then used to put an interlocking nail; proximal interlocking was done with the help of a targeting device and distal locking by a free hand technique. The nail of adequate length was appropriately buried in the head so as not to cause any impingement during range of motion. The rotator cuff incision at the entry site was sutured. The shoulder was then immobilized in an arm chest strapping after rechecking the position of head of humerus under C arm. Postoperative period was uneventful (Figure 2). Sutures were removed at 10 days and patient was mobilized at 15 days postoperatively. Initially pendulum exercises were started followed by shoulder range of motion and overhead abduction exercises within 10 days.

Subtrochanteric Femur Fracture after Multiple Drilling for Treatment of Nontraumatic Osteonecrosis of the Femoral Head - A Case Report -

Multiple drilling of the femoral head is a commonly-used surgical technique for the treatment of osteonecrosis. Several holes are drilled into the femoral head using a small-diameter Steinmann pin. This decompression technique promotes revascularization and regeneration of necrotic tissue in the femoral head. Known complications are heterotopic ossification and femoral subtrochanteric fractures, although these have only been rarely reported. Our case study focuses on a subtrochanteric fracture 6 weeks after a multiple drilling operation.

Pott Disease in a 13-Month-Old: Case Report

Tuberculosis (TB) is a common disease worldwide that is caused by Mycobacterium tuberculosis. TB of the spine is the most common site of bony infection and is often referred to as Pott disease. To the best of our knowledge, our case represents the youngest patient with naturally acquired Pott disease in the United States. A 13-month-old boy presented with paraplegia and a known diagnosis of TB. His evaluation revealed a kyphotic gibbus deformity in the midthoracic region associated with severe spinal cord compression. The patient underwent urgent decompressive laminectomies, T2-T4 transpedicular corpectomies, placement of an anterior tibial strut graft, and posterior instrumentation with sublaminar wires and a Steinmann pin. At his 18-month follow-up, the patient was ambulating 5 steps at a time independently, and his kyphotic deformity showed no sign of progression. Pott disease can occur in very young children and presents a unique challenge when a patient presents with a neurological deficit and unstable deformity requiring surgical intervention.

In situ fixation of slipped capital femoral epiphysis with Steinmann pins

Background and purpose Slipped capital femoral epiphysis (SCFE) is often treated by surgical fixation; however, no agreement exists regarding technique. We analyzed the outcome of in situ fixation with Steinmann pins.Patients and methods All 67 subjects operated for slipped capital femoral epiphysis at Haukeland University Hospital during the period 1990–2007 were included. All were treated by in situ fixation with 2 or 3 parallel Steinmann pins (8 mm threads at the medial end). The follow-up evaluation consisted of clinical examination and hip radiographs. Radiographic outcome was based on measurements of slip progression, growth of the femoral neck, leg length discrepancy, and signs of avascular necrosis and chondrolysis.Results 67 subjects (41 males) were operated due to unilateral slips (n = 47) or bilateral slips (n = 20). Mean age at time of diagnosis was 13 (7.2–16) years. Mean age at follow-up was 19 (14–30) years, with a mean postoperative interval of 6.0 (2–16) years. The operated femoral neck was 9% longer at skeletal maturity than at surgery, indicating continued growth of the femoral neck. At skeletal maturity, 12 subjects had radiographic features suggestive of a previous asymptomatic slip of the contralateral hip. The total number of bilateral cases of SCFE was 32, i.e half of the children had bilateral SCFE. 3 subjects required additional surgery and mild avascular necrosis of the femoral head was seen in 1 patient. None had slip progression or chondrolysis.Interpretation In situ pinning of SCFE with partly threaded Steinmann pins appears to be a feasible and safe method, with few complications. The technique allows further growth of the femoral neck.

Intrathoracic Migration of Large-Fragment Screws After Failed Shoulder Arthrodesis

Orthopaedic implants used during upper-extremity surgery have been discovered in many locations. Kirschner wires and Steinmann pins have migrated into the thorax or mediastinum from local sites1-5 and from distant sites such as the phalanx6, patella7, and hip8. Although there are well-documented case reports on the migration of smooth and threaded Kirschner wires and Steinmann pins from the sternoclavicular and acromioclavicular joints into the thorax, the migration of large-fragment screws from the shoulder into the thorax has not been reported, to our knowledge. Screws are less likely to migrate because of their larger size and irregular shape. We present a case of intrathoracic migration of large-fragment screws after a failed shoulder arthrodesis. In accordance with the medical center institutional review board policy, the patient was informed about, and consented to, case publication. A sixty-three-year-old woman with oxygen-dependent obstructive pulmonary disease presented with right-sided pleuritic chest pain. Her surgical history included multiple surgical procedures in the right shoulder due to instability and rotator cuff arthropathy. An arthroscopic rotator cuff repair in the right shoulder, done in 1989, had failed, and a shoulder arthrodesis was subsequently attempted. Shoulder implants were removed in 1992. Although the patient was asymptomatic, she was noted to have a fibrous nonunion of the right shoulder and had a revision arthrodesis in May 1996. This arthrodesis was unsuccessful, and there was subsequent failure of the implants. The patient was not a candidate for repeat revision arthrodesis because of inadequate bone stock and medical comorbidities. A routine chest radiograph made in 2003 showed a broken plate with screws remaining in the right shoulder region as well as a large-fragment screw on the left side of the thorax, which was from a failed left glenoid reconstruction performed in 1995 at the …

Pseudoaneurysm of the anterior tibial artery: A rare complication of proximal tibial steinman pin insertion.

An anterior tibial artery pseudoaneurysm is a rare and unexpected complication of Steinmann pin insertion. We describe the case of an 18-year-old boy, who sustained such an injury to the anterior tibial artery during this procedure. Diagnosis was confirmed on a magnetic resonance (MR) angiogram. Aneurysmal sac excision with lateral repair of the vessel wall was performed. Postoperatively, a good flow was documented on a follow-up MR angiogram. This case highlights a major and unexpected complication of a so-called minor procedure. Too posterior a pin placement in the proximal tibia should be avoided to prevent such injuries.

A 17-Year Follow-Up of Modified “Harrington” Reconstruction After Acetabular Resection

Acetabular reconstruction after resection of advanced periacetabular metastatic lesion is a complex undertaking. Harrington ( J Bone Joint Surg [Am]. 1981;63-653) described a reconstructive technique in class III- and IV-type resections using threaded Steinmann pins and acrylic cement. This technique, although effective for pain relief and restoration of function, is traditionally considered when patient's life expectancy is short because of its questionable durability. A 17-year follow-up of our patient with plasma cell cytoma of the ilium and acetabulum, treated with a modification of the above technique after intralesional curettage, showed no mechanical failure or loosening. This suggests that the construct can be durable where there is no recurrence of disease and can also be a valuable asset in selected nontumor cases in adjunct to contemporary techniques.

Treatment of Zygomatic Complex Fractures with Steinmann Pins

Head and Neck Surgery Ronald Reagan UCLA Medical Center JSalinas@mednet.ucla.edu This case series presents an update on our experience treating zygomatiomaxillary complex (ZMC) fractures through closed reduction, using a Steinmann pin. In order to gather data, charts for twenty-three consecutive patients with ZMC fractures presenting to the Otolaryngology-HNS Department at Harbor-UCLA Medical Center from 2005 to 2009 were reviewed. Of the twenty-three patients, twelve patients had sufficient data for analysis. Average operative time was significantly lower for patients treated via the closed technique as compared to the open technique: 65.3 minutes and 162.5 minutes (p = 0.02). Additionally, only a single one-centimeter incision was required with the closed-repair system versus several incisions using traditional methods. Treatment of Zygomatic Complex Fractures with Steinmann Pins Jonathan B. Salinas, M.D.; Darshni Vira, M.D.; David Hu, M.D.; Maie St. John M.D., Ph.D. Division of Head and Neck Surgery Ronald Reagan UCLA Medical Center

The Modified Static Spacers Using Antibiotic-Impregnated Cement Rod in Two-Stage Revision for Infected Total Knee Arthroplasty

The two-stage exchange arthroplasty (one- or two-stage) is believed to be the gold standard for the management of infections following total knee arthroplasty. We herein report a novel two-stage exchange arthroplasty technique using an antibiotic-impregnated cement intramedullary nail, which can be easily prepared during surgery using a straight thoracic tube and a Steinmann pin, and may provide additional stability to the knee to maintain normal mechanical axis. In addition, there is less pain between the period of prosthesis removal and subsequent reimplantation. Less soft tissue contracture, less scar adhesion, easy removal of the cement intramedullary nail, and successful infection control are the advantages of this technique.

Technique and Early Results of Percutaneous Reduction of Sagittally Unstable Intertrochateric Fractures

BackgroundThis paper introduces a percutaneous reduction technique using one or two Steinman pin(s) to reduce sagittally unstable intertrochanteric fractures.MethodsA fracture was defined as a sagittally unstable intertrochanteric fracture when posterior sagging of a distal fragment and flexion of the proximal fragment worsens after usual maneuvers for a closed reduction. Of 119 intertrochanteric fractures treated from June 2007 to December 2008, twenty-one hips showed sagittal instability. The sagittal displacement was reduced using a Steinmann pin as a joystick, and stabilized with a nail device. Nineteen hips were followed up for more than one year. The clinical and radiological results were reviewed in 19 hips and compared with those of the remaining cases.ResultsThe demographics were similar in both groups. The mean anesthetic time did not differ. Although the pre-injury and final activity levels were significantly lower in the study group, the degree of recovery was the same. No clinical complications related to this technique were encountered. Radiologically, the reduction was good in all hips in both groups. Union was obtained in all cases without any time differences.ConclusionsThis less invasive reduction technique is simple and safe to use for this type of difficult fracture.

Quantification of equine sacral and iliac motion during gait: A comparison between motion capture with skin‐mounted and bone‐fixated sensors

Information regarding movement at the ilium and sacrum in nonlame horses during normal gait may assist in understanding the biomechanics of the equine sacroiliac joint. To determine the amount and direction of motion at the ilium and sacrum using 3D orientation sensors during walk and trot in sound Thoroughbreds. To compare results from sensors fixed to the skin with results from sensors fixed to bone-implanted pins. Three 3D wireless orientation sensors were mounted to the skin over the tuber sacrale (TS) and sacrum of 6 horses and motion at the ilium and sacrum was recorded for lateral bending (LB) flexion-extension (F-E) and axial rotation (AR) during walk and trot. This process was repeated with the orientation sensors mounted to the same pelvic landmarks via Steinmann pins. Mean walk values were greater than trot values using pin-mounted sensors for all planes of movement (P < 0.05). Walk had 1.64 ± 0.22° (mean ± s.e.) more LB than trot (pin-mounted) yet 0.68 ± 0.22° less than trot when skin-mounted; 3.45 ± 0.15° more F-E (pin- and skin-mounted), and 4.99 ± 0.4° more AR (pin-mounted), but trot had 3.4 ± 0.40° more AR than walk with skin mounting. Using pinned sensors for trot resulted in less LB (2.47 ± 0.22°), F-E (1.12 ± 0.15°) and AR (10.62 ± 0.40°); and for walk less F-E (1.12 ± 0.15°) and AR (2.15 ± 0.40°) compared to skin-mounted. Poor correlation existed between mean values for skin- and pin-mounted data for walk and trot, for all planes of motion. Movements were smaller at trot with bone-fixated sensors compared to walk, suggesting increased muscular control of movement at the trot. The apparent increase in skin motion at the trot and no clear correlation between skin- and bone-mounted sensors indicates inaccuracies when measuring sacral and iliac movement with skin mounting.