Threaded Steinmann Pin Research Articles

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.

Novel and reproducible technique coping with intraoperative anchor pullout during arthroscopic rotator cuff repair.

To evaluate the incidence of intraoperative anchor pullout during arthroscopic rotator cuff repair, to compare the outcomes of different methods of managing anchor pullout, and to introduce a new technique for anchor pullout. 1076 patients who underwent arthroscopic rotator cuff repair using a single-row repair technique were included. In 483 patients, rotator cuff repair was performed using a screw-in type anchor, and in 593 patients, soft anchors were used. When intraoperative anchor pullout occurred, it was managed by buddy screwing, anchor insertion in a different location, cement augmentation, or by bar anchoring using a threaded Steinmann pin. Plain radiography and sonography were used to check anchor locations and healing. Fifty-two patients experienced anchor pullout intra- or postoperatively (48 and four patients, respectively). Anchor pullouts were more frequently observed for larger tears, women, older patients, and in patients with preoperative stiffness (limitations of both active and passive movements of the affected shoulder joint). For screw-in type anchors, pullout during surgery occurred in 16 patients (3.3%, 16/483), and all were managed using the buddy screwing technique. For soft anchor cases, pullout occurred in 32 patients (5.4%, 32/593) and was managed by anchor insertion in a different location (17 patients), cement augmentation (two patients), or bar anchoring using a threaded Steinmann pin (13 patients). Three patients managed by buddy screwing and two patients managed by anchor insertion in a different location had anchor failure after repair. Tendon healing at 6months was observed in 12/16 patients treated by buddy screwing, 11/17 treated by anchor insertion in a different location, 2/2 treated by cement augmentation, and 12/13 treated by bar anchoring with a threaded Steinmann pin. Intraoperative anchor pullout during arthroscopic rotator cuff repair is an uncommon but cumbersome complication. There are some techniques already introduced to deal with this complication. In comparison, not one technique is overwhelmingly superior to others; however, our new technique which is bar anchoring with a threaded Steinmann pin could be another solution, since it could utilize primary anchor sites and results appear to be acceptable. Level of evidence III.

Clinical and Radiological Outcomes after Various Treatments of Midshaft Clavicle Fractures in Adolescents.

BackgroudControversy exists about the optimal treatment of midshaft clavicle fractures in the presence of significant displacement, comminution, or shortening of the fracture in adolescents. The purpose of this study was to compare the clinical and radiological outcomes of 4 different treatments for midshaft clavicle fractures in adolescents: conservative treatment with a figure-of-8 (FO8) brace, open reduction and internal fixation with a plate (OPL), minimally invasive plate osteosynthesis (MIPO), and intramedullary nail fixation with a threaded Steinmann pin (TSP).MethodsA total of 94 teenagers with midshaft clavicle fractures were divided into the FO8, OPL, MIPO, and TSP groups (n = 24, 33, 16, and 21, respectively). We analyzed clinical and radiological outcomes and complications in each group and compared the results among the groups.ResultsAll groups showed satisfactory clinical and radiological outcomes, but each group showed different results for the assessment items. The Constant-Murley scores were higher in the operated groups than in the FO8 group. Recovery of joint motion was faster in the operated groups. The TSP group had the highest cosmetic satisfaction with respect to the satisfaction score and measured scar length. Fracture union was achieved in all patients. At the final follow-up, the bone length was closer to normal in the OPL and TSP groups than in the FO8 and MIPO groups, and angulation was less in the OPL and TSP groups than in the MIPO and FO8 groups. The TSP and MIPO groups obtained faster bone healing than the OPL and FO8 groups. In the operated groups, 9 patients had metal-induced irritating symptoms; 1, supraclavicular nerve injury symptoms; and 4, refractures after plate removal.ConclusionsThe nonoperatively treated group had no iatrogenic complications. The operated groups complained of various disadvantages induced by surgery; however, these groups achieved faster functional recovery and slightly better radiological and functional results than the nonoperative group.

Treatment of Severe Hallux Valgus Deformity in Rheumatoid Arthritis With 1st MTP Joint Fusion Combined With Proximal Chevron Metatarsal Osteotomy

Category: Bunion Introduction/Purpose: A severe hallux valgus deformity in rheumatoid patient is usually treated with the 1st MTP fusion, since the high success rate with low percentage of recurrence leads to higher patient satisfaction. However the large 1st inter- metatarsal angle, sometimes, is not decreased after the fusion, and the patient may suffer the persistent bunion pain. We tried to solve this problem by performing the 1st MTP fusion and the 1st proximal metatarsal osteotomy in one stage. We report our surgical technique with the outcome analysis of the patients. Methods: Six patients with the severe rheumatoid hallux valgus deformity were followed for more than 12 months after the combined 1st MTP fusion and 1st proximal metatarsal osteotomy. All were women. The mean age of patients was 51.3 years, and the mean follow up period was 2 years and 1 month. Inclusion criterion was a rheumatoid hallux valgus deformity of more than 18 degrees of the 1st intermetatarsal angle. The MTP fusion was fixed with threaded Steinmann pins and the proximal metatarsal osteotomy was fixed with Kirschner wires through the single curvilinear skin incision. Clinically American Orthopaedic Foot and Ankle Society (AOFAS) hallux MP-IP scale, and patient’s satisfaction after the surgery were analyzed. Radiographically the union of the fusion and the osteotomy was investigated. Results: Clinically the AOFAS scale improved from the preoperative 51.2 points to the postoperative 84.3 points. All patients were satisfied with the results. There were no wound problem or nonunion of fusion/osteotomy. Conclusion: The combined 1st MTP fusion and 1st proximal metatarsal osteotomy was an effective and safe procedure for the severe rheumatoid hallux valgus deformity with the large 1st inter-metatarsal angle.

A Nondestructive, Reproducible Method of Measuring Joint Reaction Force at the Distal Radioulnar Joint

To develop a nondestructive method of measuring distal radioulnar joint (DRUJ) joint reaction force (JRF) that preserves all periarticular soft tissues and more accurately reflects in vivo conditions. Eight fresh-frozen human cadaveric limbs were obtained. A threaded Steinmann pin was placed in the middle of the lateral side of the distal radius transverse to the DRUJ. A second pin was placed into the middle of the medial side of the distal ulna colinear to the distal radial pin. Specimens were mounted onto a tensile testing machine using a custom fixture. A uniaxial distracting force was applied across the DRUJ while force and displacement were simultaneously measured. Force-displacement curves were generated and a best-fit polynomial was solved to determine JRF. All force-displacement curves demonstrated an initial high slope where relatively large forces were required to distract the joint. This ended with an inflection point followed by a linear area with a low slope, where small increases in force generated larger amounts of distraction. Each sample was measured 3 times and there was high reproducibility between repeated measurements. The average baseline DRUJ JRF was 7.5 N (n = 8). This study describes a reproducible method of measuring DRUJ reaction forces that preserves all periarticular stabilizing structures. This technique of JRF measurement may also be suited for applications in the small joints of the wrist and hand. Changes in JRF can alter native joint mechanics and lead to pathology. Reliable methods of measuring these forces are important for determining how pathology and surgical interventions affect joint biomechanics.

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.

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.

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.

The Operative Treatment of Mid-Shaft Clavicular Nonunions: Intramedullary Fixation with Threaded Steinmann Pin and Bone Grafting

목 적: 나사산 Steinmann 핀을 이용한 쇄골 중간부 불유합의 치료의 임상적 및 방사선적 결과를 평가하고자 하였다. 대상 및 방법: 보존적 치료 후 발생한 쇄골 중간부 골절부의 불유합에 대해 나사산 Steinmann 핀의 골수강내 고정술을 시행했던 16명의 환자 들 중 1년 이상 추시 관찰이 가능했던 10명을 대상으로 하였다. 환자의 평균 나이는 56세 (18세~70세)였으며, 비후성 불유합을 보인 경우가 2례, 위축성 불유합이 8례였다. 전 례에서 자가 장골 이식술을 함께 시행하였으며, 임상적 평가는 술 후 5개월에 Kona 등의 평가 방법을 이 용하였다. 결 과: 전 례에서 평균 9주 (7~12.5주)에 감염 또는 핀의 이동 및 파손 등이 발생하지 않고 골유합을 얻었으며, Kona 등의 평가 방법에 따 라 4례에서 최우수, 5례에서 우수, 1례에서 보통의 임상적 결과를 얻었다. 합병증으로 1례에서 핀의 외측 말단에 의한 피부 자극 증상이 나타났으나, 골유합을 얻은 후 핀을 제거함으로써 증상이 소실되었다. 결 론: 성인 쇄골 중간부 골절의 보존적 치료 후 발생한 불유합의 치료로 나사산 Steinmann 핀을 이용한 골수강내 고정 및 골 이식술을 이 용하여 만족할 만한 결과를 얻었으며 연부 조직 손상을 최소화하면서, 비교적 견고한 내 고정을 얻을 수 있으며, 조기에 견관절 운동이 가능하 며, 국소 마취하에서도 핀의 제거가 용이한 점 등의 장점이 있어 효과적인 치료 술식이라고 생각한다.

The Lateral Closing Osteotomy using Threaded Steinmann Pin for the Cubitus Varus Deformity Followed by Supracondylar Fracture around the Elbow

The Lateral Closing Osteotomy using Threaded Steinmann Pin for the Cubitus Varus Deformity Followed by Supracondylar Fracture around the Elbow

Utilizing threaded steinmann pins to resect the talus and calcaneus for ankle joint disarticulation (Syme's procedure)

Syme, in 1843, was the first to describe ankle joint disarticulation preserving the heel pad. This amputation level has advantages over Lisfranc's amputation (tarsometatarsal disarticulation) and Chopart' s amputation (talonavicular/calcaneocubiod disarticulation). The major advantage of the Syrne's amputation includes decreased energy consumption and smoother gait during ambulation. Another advantage is that the other midfoot/hindfoot disarticulations are prone to soft-tissue breakdown on the plantar-lateral aspect of the stump. This is a result of the muscular imbalance that occurs due to the disruption of the tendinous insertions of the anterior musculature and subsequent overpowering of the posterior musculature. Despite these advantages, the Syme's procedure is often avoided because of the technical difficulties associated with its performance. There are two critical steps in the Syme's amputation that ultimately determine the success of the procedure. The first critical step is preservation of the posterior tibial artery at the distal aspect of the plantar flap. This artery will serve as the major blood supply to the plantar flap, and care must be taken to avoid injury of this vessel during dissection of the medial ankle joint ligaments. The second critical step is preservation of the heel pad during dissection of the talus and calcaneus. Dissection of the talus and

Use of the BendMeister rod bender for occipitocervical fusion: technical note.

The creation of various curves in bendable metallic rods remains difficult. We describe a simple instrument that uses two bending levers to provide the mechanical advantage required to easily shape up to 5.5 mm diameter bendable metallic rods with precision, control, and minimal nicking or scratching of the metal surface. We have successfully used this tool to contour primary and secondary curvatures in threaded Steinmann pins and grooved titanium rods for occipitocervical fusion.

Technique of occipitocervical fusion with a threaded steinmann pin

The threaded Steinmann pin technique of occipitocervical fusion represents an excellent method for treating occipitocervical instability, failed C1–C2 fusion, or atlantoaxial instability in situations in which the posterior arches of C1 or C2 are deficient, fractured, or absent. Immediate rigid internal fixation is achieved by securing a wide diameter, contoured, threaded Steinmann pin or grooved titanium rod to the occipitocervical region by means of suboccipital and sublaminar wires. Fusion is facilitated with autologous bone graft and a cervical orthosis.

Arthrodesis of the first metatarsophalangeal joint to salvage failed silicone implant arthroplasty.

Between 1987 and 1992, all patients presenting to the senior author with a symptomatic failed silicone implant arthroplasty refractory to conservative treatment were converted to a metatarsophalangeal joint arthrodesis. Internal fixation was achieved with either dual intrameduilary threaded Steinmann pins or an obliquely placed AO compression screw and a three- or four-hole one-third tubular dorsal neutralization plate. Bone grafting was used to maintain hallux length. Successful arthrodesis was achieved in all five feet in patients with rheumatoid arthritis. Subjectively, patients improved from an average of 0.69 before arthrodesis to 4.89 after arthrodesis. The average walking tolerance improved from 1.11 to 4.80, and the overall level of satisfaction improved from 0.0 to 4.79. The patient's ability to wear shoes improved from 0.87 to 3.1. Successful arthrodesis produces a foot that is more functional and durable than excisional arthroplasty. Subjectively, these patients stated that their level of pain, walking tolerance, and overall satisfaction improved significantly after the arthrodesis. Clinically, there was no evidence of transfer lesions, tenderness, or hallux subluxation. Hallux length was well maintained after surgery with bone grafting, but it was more difficult to obtain the alignment goals. The average postoperative metatarsophalangeal dorsiflexion angle was 15.6 degrees and the first metatarsophalangeal angle was 3.1 degrees. Despite this, patient satisfaction was high. Arthrodesis of the first metatarsophalangeal joint using a bone graft to salvage failed silicone implant arthroplasty produces acceptable subjective and radiographic results. Although technically demanding, it provides long-term stability to the hallux, restores weightbearing, and allows for maintenance of a propulsive gait. We recommend this procedure instead of an excisional arthroplasty to maintain high level of function and overall patient satisfaction.

Threaded steinmann pin fusion of the craniovertebral junction.

In a clinical retrospective study, the authors review long-term results of occipitocervical fusion using a wide diameter, contoured, threaded Steinmann pin. To evaluate the clinical and radiographic results of occipitocervical fusion using this technique in a variety of abnormalities including rheumatoid arthritis. SUMMARY OF BACKGROUND DATA. The various surgical techniques and hardware developed for occipitocervical fusion have been associated with mixed results, particularly in patients with rheumatoid arthritis or basilar invagination. Thirty-nine patients with occipitocervical instability were internally fixed with a wide diameter, contoured, threaded Steinmann pin wired to the occiput and cervical laminae or facets. Fusion was facilitated using autologous iliac crest bone graft and a cervical orthosis. Instability resulted from rheumatoid arthritis (n = 12), congenital anomalies (n = 12), trauma (n = 10), tumor (n = 4), or osteogenesis imperfecta (n = 1). Fifteen patients had radiographic evidence of basilar invagination. Long-term outcome (mean follow-up period, 38.9 months; range, 12-78 months) was based on clinical and radiographic review. Thirty-seven patients (97%) had a stable postoperative occipitocervical construct: there were 35 osseous unions, two fibrous unions, and one nonunion. There was on postoperative death from pulmonary complications. No patient developed evidence of new, recurrent, or progressive basilar invagination. The authors concluded that rigid segmental fixation of the craniovertebral junction using a wide diameter, contoured, threaded Steinmann pin and supplemental autograft creates excellent fusion with minimal complications. This technique is appropriate for a variety of abnormalities including rheumatoid arthritis.

Percutaneous in situ fixation of slipped capital femoral epiphysis using two threaded Steinmann pins.

Twenty-six patients with 34 slipped capital femoral epiphyses were treated by percutaneous in situ pinning with two 5/32-inch threaded Steinmann pins. Twenty-three patients with 31 hips were followed-up until the time of epiphyseal closure and pin removal. The average time to closure was 8.5 months (range, 3-25). The average operative time for pinning was 53 min (range, 18-115). The average operative time for pin removal was 42 min (range, 12-132). Complications included two progressive slips, two poorly placed pins, one pin breakage during removal, and one case of capital necrosis. This technique is a quick, efficient means of stabilizing the slipped capital femoral epiphysis, with case of hardware removal.

Percutaneous In Situ Fixation of Slipped Capital Femoral Epiphysis Using Two Threaded Steinmann Pins

Summary Twenty-six patients with 34 slipped capital femoral epiphyses were treated by percutaneous in situ pinning with two 5/32-inch threaded Steinmann pins. Twenty-three patients with 31 hips were followed-up until the time of epiphyseal closure and pin removal. The average time to closure was 8.5 months (range, 3-25). The average operative time for pinning was 53 min (range, 18-115). The average operative time for pin removal was 42 min (range, 12-132). Complications included two progressive slips, two poorly placed pins, one pin breakage during removal, and one case of capital necrosis. This technique is a quick, efficient means of stabilizing the slipped capital femoral epiphysis, with ease of hardware removal.

Epiphyseal growth after pinning of slipped capital femoral epiphysis.

Seventy-seven hips in 61 patients (mean age, 13 years) with slipped capital femoral epiphysis treated with in situ pinning were retrospectively evaluated to determine the frequency and magnitude of epiphyseal growth after pinning. Threaded Steinmann pins, Knowles pins, and cannulated screws were used. Evidence of the epiphysis "growing off" the pins was seen in 29 and 18% of the hips treated with Steinmann and Knowles pins, respectively. No hips with cannulated screws continued to grow after surgery. The use of one cannulated screw in the treatment of mild and moderate slipped capital femoral epiphysis is recommended.

Torsion???Treatment Indications

Rotational problems, when outside the normal range, are referred to as torsional deformity. These deformities are relatively common in infancy and childhood, generally resolve spontaneously with growth, and rarely persist into adult life. There are few situations in which treatment is necessary. (1) Rigid metatarsus adductus that does not resolve during the first six months should be corrected by casting. The long leg cast is most effective, as it controls the rotation of the tibia. With the tibia stabilized, the foot can be laterally rotated and abducted, which usually allows correction using one or two casts. (2) Persistent, severe tibial medial or lateral torsion after the age of eight years may be corrected by a supramalleolar tibial rotational osteotomy. This is indicated for medial torsion beyond 15 degrees and for lateral torsion beyond 30 degrees. Fixation is provided by crossed, smooth pins and a long leg cast. Compartment syndromes and peroneal nerve injury are avoided by the distal correction. (3) Persistent, severe femoral antetorsion of more than 50 degrees after the age of eight years may justify correction. For operative correction, medial rotation should exceed 85 degrees and lateral rotation should be less than 10 degrees. The osteotomy for correction is fixed by threaded Steinmann pins cut off below the skin and supplemented with a spica cast.

Treatment of the Fracture of the Middle Third of Clavicle by Intramedullary Threaded Steinmann Pin Fixation

Treatment of the Fracture of the Middle Third of Clavicle by Intramedullary Threaded Steinmann Pin Fixation