Transarticular Fixation Research Articles

上位頚椎部における椎骨動脈の走行の検討

We analyzed the relations hip between the upper cervical spine and vertebral artery by angiography. The subjects of this study were 50 patients, whose ages ranged from 19 to 77 years. We measured; 1) the distance between the vertebral artery and midline at the level of C1 and C2; 2) the distance between the vertebral artery and midline at the level of the atlantoaxial joint; 3) the distance between the vertebral artery and C2 pedicle. The point of screw placement for C1-2 transarticular fixation was found to be 40% from the medial side of the atlantoaxial joint from the A-P view and 5% from the C2 pedicle from the lateral view.

Posterior C1-C2 transarticular screw fixation in the treatment of displaced type II odontoid fractures in the geriatric population—review of seven cases

BACKGROUND Seven geriatric patients presented with displaced Type II odontoid fractures. All patients underwent a posterior C1-C2 transarticular fixation between November 1994 and December 1996. Ages ranged between 63 and 88 years. METHODS Fractures were treated with placement of bilateral transarticular screws, allowing immediate fixation, except in one patient, for whom only a unilateral screw was used. An autograft interspinous strut was also placed, allowing three-point fixation. Mean follow-up was 10.6 months. RESULTS Six patients received rigid fixation and developed a stable union. One patient died before any follow-up could be obtained. Two other patients died within 1 year of unrelated causes. The remaining four patients remain active and independent. One intraoperative vertebral artery injury was identified. No clinical sequalae were noted. CONCLUSION Posterior transarticular screw fixation is a reasonable option in treating these controversial fractures. Seven geriatric patients tolerated this surgery well, and were mobilized early, avoiding complications related to external immobilization.

Our modification of the splint for the treatment of injuries of the finger extensor tendon at the level of the distal interphalangeal joint

A large number of methods have been proposed to treat injuries of the hand extensor tendon at the level of the distal interphalangeal joint, the so-called "hammertoe". These include the use of various plaster casts, metal and plastic splints, tendon suture, transarticular fixation with Kirschner spokes, etc. Meanwhile, getting a good result in the treatment of this minor injury is not easy. After many years of trying different ways to treat the hammer toe, we chose the method of fixation of the distal interphalangeal joint with a palmless, unlabelled concave aluminum splint.

Posterior atlantoaxial fixation: the Magerl screw technique.

Atlantoaxial transarticular fixation is a proven stabilization technique used to augment conventional sublaminar fusion. Along with its superior biomechanical profile comes the inherent risk of neurovascular injury and potential compromised fixation during its application. This article presents a detailed systematic guide to this procedure including preoperative evaluation, positioning, and the more subtle aspects of the surgical technique. A new instrumentation design that has enhanced the ease and accuracy of screw placement with less operative frustration and potential morbidity of previous systems also is presented.

A Comparison of the Mechanical Properties of Two External Fixator Designs for Transarticular Stabilization of the Canine Hock

SummaryBiomechanical testing was performed on 20 canine tibiotarsal joints. The conventional transarticular external skeletal fixator (ESF) was applied to one rear limb while the alternative design using acrylic was applied to the contralateral rear limb. The mode of failure for all models was fracture of the phalanges at the point of fixation in the distal grip device.The mean stiffness for the acrylic design was 58.5 N/mm and for the conventional ESF 44.8 N/mm. The mean maximum load to failure for the acrylic design was 490.7 N, compared to 405.1 N for the conventional ESF. The angle of deformation at maximum for the acrylic apparatus was 0.45 degrees compared to 2.36 degrees for the standard ESF. The mean energy absorbed to maximum load was 1.92 N-m for the acrylic design and for the conventional ESF 2.69 N-m. This study indicated that the acrylic design was superior in maintaining immobilization across the tibiotarsal joint, indicated by the angle of deformation (p = 0.002) and was structurally comparable in stiffness (p = 0.295), maximum strength (p = 0.438), and total energy absorbed to failure (p = 0.276).The properties of an acrylic and a stainless steel external transarticular skeletal fixator were biomechanically evaluated. Biomechanical parameters evaluated included: maximum load to failure, stiffness, angle of deformation across the tibiotarsal joint, and energy absorbed to failure. The angle of deformation was less (p = 0.002) for the acrylic device. Based on this study, we conclude that the new acrylic design is structurally comparable to the conventional transarticular ESF and warrants clinical trials.

Comparison and outcome of grade II and III acromioclavicular joint injuries

Eighty-five patients with grade 2 or grade 3 sprains of the acromioclavicular (AC) joint were evaluated clinically and radiographically 32 months after injury. Group I included 34 patients with grade 2 sprains (Tossy II) and group II included 51 patients with grade 3 injuries (Tossy III). In group I, 15 patients were treated surgically (group Ia) and 19 patients were treated conservatively (group Ib), while in group II, 41 patients were treated surgically (group IIa) and 10 patients were treated conservatively (group IIb). At surgery open reduction and transarticular fixation of the AC joint with Kirschner wires was performed. Conservative treatment included the initial use of a sling or a knapsack bandage and early performance of range-of-motion exercises. Shoulder function was assessed according to the score devised by Constant and Murley. In both groups, 97 of 100 possible points (minimum 72, maximum 100) were obtained after conservative and after surgical treatment. Nine of 10 patients (90%) with grade 3 sprains (group IIb) had more pronounced displacement and increased mobility of the lateral end of the clavicle after conservative treatment. After surgery, dislocation and increased horizontal, mobility of the lateral end of the clavicle occurred in 18 (44%) of 41 patients with grade 3 sprains (group IIa P < 0.0001). However, these findings did not correlate with the functional outcome. At follow-up there was a significant increase in degenerative changes seen on radiographs (P < 0.035) in all patients. Again these findings did not correlate with the functional outcome. More degenerative radiological changes were observed in patients who had undergone surgery (P < 0.003). Patients with grade 2 sprains were more frequently restricted in sporting activity after surgery (P < 0.05). Patients with grade 3 sprains who were treated surgically complained of pain more frequently (P < 0.01), and they returned to work later than patients who were treated conservatively after grade 3 sprains. An additional rehabilitation program guided by a physiotherapist seemed to have no impact on the functional outcome. A total of 56 patients were treated by surgery. Among these patients 11 complications occurred, requiring five additional surgical procedures. Among 29 conservatively treated patients, only in 1 patient did subacromially located arthritic changes of the AC joint have to be removed.

Management of a Caudolateral Radial Head Luxation in a five-month-old Shih Tzu

SummaryA caudolateral radial head luxation and concurrent distal humeroulnar subluxation were diagnosed in the left forelimb of a five-month-old Shih Tzu. The problems were treated successfully by proximal ulna osteotomy, reduction of the radial head luxation and placement of a transarticular external skeletal fixator (TESF). Three weeks postoperatively the reduction of the radial head luxation had been successfully maintained, the humero-ulnar luxation had corrected and the fixator was removed. There was a full range of motion in the left elbow joint and the radial head could not be reluxated.A caudolateral left radial head luxation in a five-month-old Shih Tzu was treated by ulna osteotomy, reduction of the luxation and placement of a transarticular external skeletal fixator. A concurrent humero-ulnar subluxation suggested that the problem was developmental, associated with premature closure of the distal ulnar growth plate in a chondrodys-trophic breed.

Operative stabilization of fracture dislocations of the sacroiliac joint.

Posterior fracture dislocations of the sacroiliac joint (crescent fracture) represent a subset of lateral compression pelvic fractures. The crescent fracture consists of a posterior iliac wing fracture with extension into the sacroiliac joint and a dislocation of the inferior 1/2 of the sacroiliac joint. The posterior superior iliac spine remains firmly attached to the sacrum by the strong posterior ligaments. As a result of this combination of bony and soft tissue injury, the hemipelvis is rotationally unstable, but because the sacrospinous and sacrotuberous ligaments remain intact the involved hemipelvis is stable to vertically applied forces. Operative stabilization is necessary to restore articular congruity of the sacroiliac joint, pelvic stability, and to allow early mobilization of the patient. Stabilization of the pelvis may be achieved through either an anterior or a posterior approach with or without transarticular fixation. A posterolateral approach to the crescent fracture and a method of stabilization using extraarticular fixation, intertable lag screws and outer table antiglide plates are described. The results of using this technique in 22 patients are reviewed.

環軸関節水平亜脱臼に対するＭａｇｅｒｌ法の検討 従来の環軸椎後方固定術との比較

Preoperative radiological findings and surgical results of 13 bidirectional anterior and posterior atlantoaxial subluxation (AAS) cases and 11 unidirectional anterior AAS cases were compared. Bidirectional AAS showed more angular instability of the atlantoaxial joint than anterior AAS (p<0.005).Four bidirectional AAS cases and 4 anterior AAS cases, who were treated using the modified McGraw method combined with Magerl's transarticular fixation of C1/2, achieved solid union except for three cases with hypoplastic C1 posterior arches. This combined method was useful for a RA patient, whose spinal cord was compressed statically by synovitis of the odontoid process even when the neck was in a neutral position.

Fracture of the humeral capitellum fixed with absorbable polyglycolide pins. 1-year follow-up of 8 adults.

Absorbable self-reinforced polyglycolide pins were used for transarticular fixation of displaced Type I capitellar fracture in 8 adult women. An anatomical reduction was obtained, the fixation was stable, and function became good in all the cases. A sterile synovitis in one case was drained and subsided within 3 weeks, without further intervention.

Transarticular Application of External Skeletal Fixation

External skeletal fixators provide a useful alternative to external coaptation techniques for immobilization of joints in selected patients. This is especially true when the orthopedic injury involves an open wound requiring daily treatment. Devices such as the K-E splint, the Rudy external fixator boot, and acrylic frame fixators are economical and effective for transarticular fixation in small animal patients. Clinical indications for these techniques have included fixation of tibial or radial fractures with a short distal fragment; arthrodesis of the elbow, carpus, stifle, or tarsus; protection of Achilles tendon repairs; protection of collateral ligament repairs of the tarsocrural joint; and protection when multiple ligaments of the stifle joint have been reconstructed. Use of contoured rods has facilitated transarticular application of type II Kirschner-Ehmer splints. Use of acrylic frames and the Rudy boot technique have extended safe use of transarticular external fixation to extremely small patients not accommodated by the Kirschner system alone. An understanding of the advantages and disadvantages inherent in each of these techniques is critical to proper selection of the best method for a given patient. Attention to the basic principles of pin selection, pin insertion, and frame design are needed for successful execution of the chosen technique.

A comparison of various types of fixation devices for protection of the posterior cruciate ligament against a posterior drawer force.

We compared four different fixation devices to determine which offers the greatest relative protection to the posterior cruciate ligament (PCL) against elongation with an applied posterior drawer force. We designed a system to monitor and record the change in distance between an approximate origin and insertion of the PCL as known forces were applied posteriorly to the tibia with the femur fixed. Six fresh cadaver knees were used in this investigative series. They were first tested with the PCL intact, then with the PCL transected, and then with the various fixation devices applied. After comparing the results with transarticular pins and quadrilateral and anterior half-frame external fixators, we found that transarticular fixation offers significantly greater protection to the PCL. This study may prove to be helpful to the orthopaedist when selecting ancillary fixation for posterior cruciate repair or reconstruction.

Dorsal dislocation of the fourth and fifth carpometacarpal joints and simultaneous dislocation of the metacarpophalangeal joint of the small finger: A case report

A patient with dorsal dislocation of the fourth and fifth carpometacarpal (CMC) joints and dislocation of the metacarpophalangeal (MP) joint of the small finger was managed successfully by open reduction and transarticular fixation of the CMC joint dislocation and closed reduction of the MP joint dislocation. This rare combination of injuries has not been reported previously.

Vertical Transarticular Pin Fixation for Unstable Ankle Fractures

The usage of vertical transarticular pin fixation combined with plaster immobilization for severe ankle injuries has been reviewed in 92 consecutive cases over a period of 16 years. Moderately simple in application and without a skin incision, the procedure has been found to provide efficient and reliable short-term stabilization of the ankle and subtalar joints with minimal complications. A new technique is described for accurate placement of the pin and the prevention of its migration. It is a reasonable alternative treatment for certain unstable distal tibial and ankle fractures when open reduction with conventional internal fixation cannot be done. In particular, the method is recommended in treating displaced fractures at the ankle and deltoid ligament ruptures in geriatric patients. It is often useful as a salvage or last-resort procedure in unusually severe ankle injuries with circulatory or neural deficits. In many instances additional trauma to the head, thorax or abdomen may have been sustained. Thus total patient care is essential and priorities must be recognized. The treatment of ankle trauma, furthermore, in a physiologically-aged diabetic patient is often not the same as that for similar injuries in a young healthy adult. The clinical judgement and experience of the operator is the basis for selection of the procedure. The simplest method is often the best. Pin fixation, however, is not for everyone. It should be done only by surgeons qualified to treat bone and joint trauma and even then only for those situations in which its usage is specifically indicated.

TRANSARTICULAR NAILING FOR FRACTURES OF THE FEMORAL NECK

1. A technique of transarticular nailing for subcapital and transcervical fractures of the neck of the femur is described. 2. Forty-four operations have been done, and twenty-one patients have been under observation for periods of from one to six years. In one of these pseudarthrosis has developed; in two others there has been delayed union. 3. The method gives sound fixation by a "squeezing effect" on the proximal fragment, which is enhanced by the locking of the adjacent articulation. 4. It is presented as an alternative to prosthetic replacement for treatment of femoral neck fracture in the aged. The nail damages the articular surface of the acetabulum but not the femoral head. 5. The importance of care after operation is stressed. 6. The advantages of the method, the role of circulatory changes in the femoral head and the mechanics of transarticular fixation are discussed.