Transarticular Screw Research Articles

Only spinal fixation as treatment of prolapsed cervical intervertebral disc in patients presenting with myelopathy.

Aim:An alternative form of surgical treatment of prolapsed cervical intervertebral disc in patients presenting with symptoms related to myelopathy is discussed. The treatment involved fixation of the affected spinal segments and aimed at arthrodesis. No direct manipulation or handling of the disc was done.Materials and Methods:During the period August 2010 to June 2017, 16 patients presenting with symptoms attributed to myelopathy and diagnosed to have prolapsed cervical intervertebral disc were surgically treated by spinal stabilization. There were 11 males and 5 females and their ages ranged from 20 to 66 years (average: 40.6 years). Apart from clinical and radiological indicators, the number of spinal segments that were stabilized depended on direct observation of facetal morphology, alignment, and stability. Surgery involved distraction-fixation of facets using Goel facet spacer (8 patients), transarticular facetal fixation (5 patients) using screws or a combination of both facetal spacer, and transarticular screws (3 patients).Results:All patients had “remarkable” clinical improvement in the immediate postoperative period as assessed by visual analog scale, Goel's clinical grading, and Japanese Orthopedic Association scores. Follow-up ranged from 3 to 84 months (average: 50 months). The herniated disc regressed or disappeared at follow-up radiological assessment that ranged from 24 h to 3 months after surgery.Conclusions:Spinal segmental fixation aiming at arthrodesis with or without distraction of facets and without any direct surgical manipulation in the disc space or removal of the prolapsed portion of the disc can be considered in the armamentarium of the surgeon.

Posterior atlantoaxial fusion using a C2 transverse foramen-penetrating screw: A technical note.

Background:Although recent development of screw instrumentation techniques for rigid fixation of the atlantoaxial joint has increased surgical options, patients in whom screws of any type cannot be safely placed are sometimes encountered. We present a unique surgical technique for C1-2 transarticular screw placement utilizing a novel trajectory.Methods:A 35-year-old male with a history of Down's syndrome and cognitive dysfunction with hyperkinesis spontaneously developed rapid onset of tetraparesis and gait disturbance. Radiographs of the cervical spine revealed atlantoaxial subluxation (AAS) that could not be reduced. Computed tomography (CT) of the head showed multiple subacute cerebral infarctions in the territory of the right vertebral artery (VA). Three-dimensional CT angiography of the craniovertebral junction additionally confirmed right VA occlusion at the C2/3 level, a left C2 origin of the posterior inferior cerebellar artery, and hypoplasia of the bilateral C2 pedicles/C2 lamina. Because traditional screw-placement was not feasible, we performed a unique atlantoaxial fusion utilizing a C2 transverse foramen-penetrating screw with iliac bone grafting performed under neuronavigation.Results:The postoperative course was uneventful, and the patient regained the ability to ambulate, returning to his previous level of function. The CT of the cervical spine 12 months postoperatively showed rigid bony C1-C2 fusion, without recurrence of stroke.Conclusion:We introduced a novel C1-C2 transarticular screw-placement technique in which the trajectory went through the ipsilateral VA foramen due to already extent VA occlusion.

Comparison of Transarticular Screw Fixation and C1 Lateral Mass-C2 Pedicle Screw Fixation in Patients with Rheumatoid Arthritis with Atlantoaxial Instability

Many surgical procedures have been introduced to manage atlantoaxial instability caused by rheumatoid arthritis (RA) to prevent complications and improve fusion rate. We report the surgical outcome between transarticular screw fixation (TAF) and C1 lateral mass-C2 pedicle screw fixation (C1LM-C2P) in patients with atlantoaxial instability from RA. Between 2002 and 2012, 58 patients were enrolled in the study. According to surgical procedures, patients were divided into 2 groups: group I who received TAF (n= 33) and group II who received C1LM-C2P (n= 25). Bony fusion was assessed by radiologic comparison immediately after the operation and 1 year postoperatively. In addition, complications and clinical and functional outcomes were evaluated. Overall, bone fusion was achieved in 32 patients in group I (97%). In group II, the fusion rate was evaluated in 100% of patients. Complications (regardless of neurologic deterioration) were cable loosening and screw malposition in group I and violation into the vertebral canal and spinal canal in group II. There was no statistical significance in fusion rate, clinical outcomes, or complications. The 12-month atlantodental interval after operation for the C1LM-C2P group was significantly lower than that for the TAF group after adjusting for all variables. Two surgical techniques showed a good fusion rate by rigid fixation in the immediate postoperative period and fewer surgery-related complications in patients with RA. Because surgical complications are more likely during the learning curve (as with other surgical techniques), surgeons should carefully evaluate patients before surgery by radiologic and neurologic examinations.

Comparison of outcomes after atlantoaxial fusion with C1 lateral mass-C2 pedicle screws and C1-C2 transarticular screws.

To compare the clinical and radiological outcomes of posterior atlantoaxial fixation and fusion using C1 lateral mass-C2 pedicle screws (screw-rod constructs, SRC) with C1-C2 transarticular screws (TAS). A retrospective review was conducted of 105 patients with atlantoaxial instability who underwent posterior C1-C2 fixation and fusion by SRC group (60 pt) and TAS group (45 pt). The follow-up period was minimum 2years. Clinical outcomes measurements included the Numeric Rating Scale (NRS) for pain assessment, the Neck Disability Index (NDI), the Japanese Orthopedic Association (JOA) score and the American Spinal Injury Association (ASIA) impairment scale for the functional and neurological outcomes that were assessed. Radiological outcomes were assessed by evaluating the fusion rate and proper screws position. Both outcomes were evaluated in the early postoperative period, 3, 6, 12 and 24months after surgery. Operative time, estimated blood loss, complications and length of stay were also reviewed. The majority of cases were caused by trauma and presented with axial neck pain. The improvement of NRS, NDI, JOA score and ASIA impairment scale were not different between the two groups. Proper screw position and fusion rate were also observed similarly between the two groups. Estimated blood loss was lesser and operative time was shorter in TAS group than SRC group (p=0.047, p=0.001, respectively). Operative complications and the length of hospital stay were also not different between the two groups. Both SRC and TAS produced excellent outcomes for atlantoaxial stabilization. But the volume of bleeding and operation time tended to be better in TAS group compared to SRC group.

Robot-Assisted Posterior C1-2 Transarticular Screw Fixation for Atlantoaxial Instability: A Case Report.

Case report. The aim of this study was to assess the feasibility, safety, and accuracy of a new robotic system for performing posterior C1-2 transarticular screw fixation for atlantoaxial instability. C1-2 transarticular fixation is a reliable procedure. However, the procedure is high-risk because of the important structures and frequent anatomical variation around the atlantoaxial region. Navigation improves the accuracy, but it might require repeated adjustments of the trajectories, which is inconvenient. Robot-assisted surgery can make this process easier and has the potential to improve the safety and accuracy. A 43-year-old man with atlantoaxial deformity and instability underwent posterior C1-2 transarticular screw fixation under the guidance of the new robotic system (TiRobot, co-designed by Beijing Jishuitan hospital and TINAVI Medical Technologies Co., Ltd.). We performed a surgery of posterior decompression and C0-2 fusion. Based on the intraoperative 3D images, we planned the trajectory on the robot system. Then, the robotic arm spontaneously moved to guide the screw insertion. A unilateral C1-2 transarticular screw was safely placed with good accuracy. The calculated deviation of the planned position and actual position was 0.8798 mm. There were no intraoperative complications. Postoperative computed tomography showed there were no perforations and loosening of the screw. We report the first case of atlantoaxial transarticular screw fixation using the TiRobot system. Robotic guidance for complex upper cervical deformity based on intraoperative 3D images could be feasible, safe, and accurate, and has a significant clinical potential in spine surgery. 4.

Lag screw and tension band wire arthrodesis of the scapulohumeral joint in a miniature bull calf

An eight-month-old miniature zebu bull calf, 50 kg, was presented for evaluation of a moderate (grade 4 out of 5) right forelimb lameness of eight weeks’ duration. Clinical and radiographic...

Epidemiology, pathophysiology, and treatment of traumatic cervical vascular injury

Operative techniques to treat traumatic cervical instability have evolved with the development of techniques such as occipital segmental plating, C1 lateral mass screws, a variety of C2 fixation techniques, and C1/C2 transarticular screw fixation, in addition to lateral mass and pedicle screws in the subaxial cervical spine. These advances have led to benefits, such as improved construct strength and enhanced biomechanical stability. In the current era, it is essential to have a good familiarity with the types of instrumentation available and a comprehensive understanding of the regional anatomy to avoid complications and optimize clinical outcomes.

Operative techniques for the management of traumatic instability in the cervical spine

Operative techniques to treat traumatic cervical instability have evolved with the development of techniques, such as occipital segmental plating, C1 lateral mass screws, a variety of C2 fixation techniques, C1/C2 transarticular screw fixation, in addition to lateral mass and pedicle screws in the subaxial cervical spine. These advances have led to benefits, such as improved construct strength and enhanced biomechanical stability. In the current era, it is essential to have a good familiarity with the types of instrumentation available and a comprehensive understanding of the regional anatomy to avoid complications and optimize clinical outcomes.

Minimally Invasive Surgery of Perilunate Dislocations and Fracture Dislocations

Background: The gold standard for the treatment of perilunate dislocations (PLD) and fracture dislocations is currently an open reduction and internal fixation. However, as many authors have suggested, minimally invasive surgery (MIS) is being positioned as an alternative management of the condition. Purpose: The purpose of this retrospective, nonrandomized study was to evaluate the clinical and radiographic outcomes of a series of acute PLD and trans-scaphoid perilunate dislocation (TSPD) treated operatively by a minimally invasive technique. Patients and Methods: In all, 11 patients (2 PLD and 9 TSPD) had surgery performed between 2005 and 2010. All patients were males with an average age of 34.6 years (range, 17-55) at their final evaluation. The procedure involves (1) closed reduction of the carpus; (2) closed reduction and percutaneous screw fixation of the scaphoid fracture; (3) closed reduction, k wires, and screws for stabilization of the carpal dissociation. Clinical outcomes were evaluated on the basis of range of motion, pain, functional status, and Mayo scores. We performed a radiographic assessment of the radiolunate angle, scapholunate angle, and gap between these 2 bones. The right wrist was involved in 7 patients, and the left in 4 patients; the dominant hand was affected in 6 occasions. Seven patients sustained a fall from a height with the wrist in hyperextension, 2 cases occurred during sport practice (1 rugby, 1 skiing), and the other 2 were involved in traffic accidents (1 motor vehicle, 1 motorcycle). The average time from injury to operation was 6 days (range, 4-22). Five patients had associated fractures: 3 in upper limb (1 elbow dislocation, 1 clavicle fracture, 1 radial head fracture), 2 in lower limb (1 patellar fracture, 1 calcaneal fracture). Results: The average follow-up period was 28 months (range, 14-52) and no patient was lost to follow-up. All patients achieved satisfactory reduction of the midcarpal joint and intercarpal bone alignment by closed reduction. Clinically, patients had functional mobility with an average loss of about 23% compared with the contralateral wrist. The mean Disabilities of the Arm, Shoulder and Hand (DASH) outcome score was 23, demonstrating a moderate average disability in activities of daily living (ADL). The average Mayo wrist score was 84 with 4 excellent, 6 good and 1 fair result. On the basis of radiographic parameters, reduction obtained during the operation was maintained within normal ranges in all patients. Scaphoid fracture union occurred at an average time of 16 weeks (12-27 weeks) and there was no case of nonunion. Radiographic results showed an average scapholunate angle of 52°, a radiolunate angle of 10°, and a scapholunate distance of 1.6 mm. No case of lunotriquetral instability was noted. In pure injuries, there was almost no loss of scapholunate reduction after removal of trans-articular screw at 7 month. At the last follow-up, arthritis had not developed in any patient. Conclusions: This study suggests that a percutaneous procedure (MIS), with reduction of carpal dislocations and fixation of scaphoid fracture, seems an acceptable method for the treatment of acute and reducible PLD and TSPD in selected cases.

A Method to Prevent Occipitocervical Joint Violation Using Plain Radiography During Percutaneous Anterior Transarticular Screw Fixation.

A prospective study of anterior transarticular screw (ATS) fixation patients. To develop a method to determine screw tip position through plain radiography after percutaneous ATS fixation to prevent occipitocervical joint (OCJ) violation. No studies using plain radiography to prevent OCJ violation during percutaneous ATS fixation have been performed. In total, 34 subjects (with 68 screws) who had undergone percutaneous ATS fixation were enrolled. To evaluate the screw tip location in relation to the C1 lateral mass (LM), the screw tip positions were graded 1, 2, or 3 on anteroposterior (AP) radiographs, and I, II, or III on lateral radiographs. OCJ violation was analyzed by postoperative computed tomography (CT). Screws with tips located lower (tip I) in the LM did not result in OCJ violation. Only one tip in the tip 3 position showed OCJ perforation, and this screw was also located in tip III. Screw perforation rates of tip 1-tip II, tip 1-tip III, and tip 2-tip III were the highest (100%), followed by tip 2-tip II (10.5%) and tip3-tip III (10%). This study provides insights into OCJ violation during percutaneous ATS fixation. According to AP radiography, a percutaneous ATS with the screw tip located in the lateral part of the LM resulted in a lower rate of OCJ perforation, whereas screws located in the medial LM resulted in the highest rate of perforation. Percutaneous ATS with the screw tip located in the neutral part of the LM should ensure that the screw tip is below the upper part of the LM, preventing OCJ violation. These findings may help surgeons assess screw positioning both during and after the operation. 3.

Neurological outcomes following iatrogenic vascular injury during posterior atlanto-axial instrumentation

BackgroundIatrogenic vascular injury is a feared complication of posterior atlanto-axial instrumentation. A better understanding of clinical outcome and management options following this injury will allow surgeons to better care for these patients. The object of the study was to systematically review the neurologic outcomes after iatrogenic vascular injury during atlanto-axial posterior instrumentation. MethodsWe performed a systematic review of the Medline database following PRISMA guidelines. In our analysis, we included any retrospective cohort studies, prospective cohort studies, case reports, cases series, or systematic reviews with patients who had undergone posterior atlanto-axial fusion via screw rod constructs (SRC) or transarticular screws (TAS) that reported a patient with an injury to an arterial vessel directly attributable to the surgical procedure. ResultsSixty cases of vascular injury were reported in 2078 (2.9%) patients over 27 publications. The average age for this patient population was 55.7+/−17.9. Vascular injury following posterior C1/2 instrumentation resulted in ipsilateral stroke in 10.0% (n=6/60) and non-persistent neurologic deficit in 6.7% (n=4/60) of cases with the deficit being permanent (not including death) in 1.7% (n=1/60) of cases. Four patients (6.7%) died. Arteriovenous fistula or pseudoaneurysm occurred in 8.3% (n=5/60) and 3.3% (n=2/60) of cases, respectively. Eight patients (13.3%) underwent endovascular repair of the injury with no permanent deficit. ConclusionNeurological morbidity after iatrogenic vascular injury during posterior C1/2 fixation is higher than previously reported in literature. Some patients may benefit from endovascular treatment. Surgeons should be aware of normal and anomalous vertebral artery anatomy to avoid this potentially catastrophic complication.

Long-term outcome of first metatarsophalangeal joint fusion in the treatment of severe hallux rigidus.

This study was aimed to study the arthrodesis of the first metatarsophalangeal joint using an oblique interfragmentary lag screw and dorsal plate as an effective option for the treatment of hallux rigidus. Few researchers have studied the outcome of this surgical method over a long follow-up period. We performed a retrospective review of 60 patients status post arthrodesis of the first metatarsophalangeal joint. The mean age was 68.5years and average follow-up lasted for 47.3months. Patients' satisfaction and functional outcomes were evaluated with the American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal-Interphalangeal Scale, the foot and ankle questionnaire, the Functional Foot Index, and dynamic pedobarography. Fusion rate of 93.3% was recorded; 6.7% of the cases ended up with a painless pseudarthrosis and required no additional surgery. Pedobarographic measurements demonstrated first ray weight bearing function restoration. More physiological foot plantar pressure patterns were observed. Concerning the postoperative outcomes, 71.7% of the patients were very satisfied and 18.3% were satisfied. The American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal-Interphalangeal Scale increased post-operatively from 40.9 to 79.3. The arthrodesis of the metatarsophalangeal joint using transarticular screw and dorsal nonlocked plate is an effective method for the treatment of severe hallux rigidus with fair patient satisfaction rate and functional outcome.

Revision Lapidus Arthrodesis by Bone Endoscopy

Revision arthrodesis is indicated in symptomatic nonunion of the first tarsometatarsal joint. Revision by first tarsometatarsal arthroscopy cannot deal with the dilated screw tract and associated bone cysts. Revision by bone endoscopy is indicated in symptomatic nonunion of the first tarsometatarsal joint, which is previously fixed by transarticular screw along with loosening of the screw and bone cyst formation. The screw tract makes up the portal tract, with the proximal and distal ends of the tract corresponding to the proximal and distal portals, respectively. In this technical note, we describe zonal debridement and bone grafting of the bone cysts, nonunion site, and the screw tract via the bone endoscopy. This can resolve all the co-pathologies of nonunion of the first tarsometatarsal fusion.

Biomechanical Study of 3 Atlantoaxial Proactive Vertebral Artery Injury Prevention Fixation Combinations

To evaluate the biomechanical stability of 3 atlantoaxial proactive vertebral artery injury prevention fixation combinations. We used 6 fresh human cadaveric C0-C4 specimens for the biomechanical test with moment control in 6 loading directions. First, range of motion (ROM) was measured in the intact specimens before they were destabilized; next, ROM of the 4 conditions fixed with 4 different fixation combinations were tested in alternating sequence: bilateral transarticular screw (TAS) and 3 test combinations: C1 laminar hook (C1LH) and C2 intralaminar screw (C2ILS) on 1 side combined with TAS (C1LH-C2ILS/TAS) or C1LH and TAS (C1LH-C2ILS/C1LH-TAS) or C1LH and C2ILS on the other side (C1LH-C2ILS/C1LH-C2ILS). ROM of all 4 instrumented sets significantly decreased compared with intact specimens in all the loading cases (flexion, left and right lateral bending, left and right axial rotation) except extension. Compared with the TAS group, all 3 test groups showed higher stiffness in flexion and equivalent stability in the other 5 directions. Side-by-side comparison among the 3 test fixation techniques showed no significant difference. The combination of C1LH and C2ILS supplemented with contralateral TAS or C1LH and TAS or C1LH and C2ILS was superior to bilateral TAS fixation with regard to biomechanics and vertebral artery safety.

Intraoperative reduction and internal fixation for atlanto-axial dislocation

Atlanto-axial complex is the most important functional unit of the cervical spine. Atlanto-axial instability or dislocation, one of the most serious pathologies in spinal surgery, is often managed by posterior atlantoaxial fixation and fusion. Several posterior fixation techniques have been used to stabilize the atlanto-axial complex, including wire/cable-bone fixation, Halifax clamps, transarticular screw fixation, screw-plate fixation and screw-rod fixation. For atlanto-axial dislocation that cannot be reduced with skull traction before operation, intraoperative reduction is often needed. Current intraoperative reduction techniques can be classified into tran-soropharyngeal surgical release followed by posterior reduction and fixation, transoropharyngeal reduction and fixation, and posterior reduction and fixation using screw-rod system according to approaches. Furthermore, posterior reduction can be performed using elevating-pull, leverages, and cantilever techniques. This study re-views the intraoperative reduction and fixation techniques mentioned above. Key words: Atlas; Axis; Dislocation; Reduction; Internal fixation

Functional Outcomes After Temporary Bridging With Locking Plates in Lisfranc Injuries

The standard operative treatment of Lisfranc fracture dislocations currently consists of open reduction and transarticular fixation. Recently, bridge plating has been used more often. Using joint spanning, the reduced fracture dislocation is temporary stabilized to minimize articular damage. The present study describes the outcomes of patients treated with bridge plating after tarsometatarsal fracture dislocations compared with transarticular screw fixation. A retrospective cohort study was performed. Patients with an isolated tarsometatarsal injury who had been treated operatively from June 2000 to October 2013 were included. The primary functional outcome was measured using the American Orthopaedic Foot and Ankle Society midfoot score and the Foot Function Index. The secondary outcome was patient satisfaction, which was measured using the EuroQol 5 dimensions questionnaire and a visual analog scale. A total of 34 patients were included. Bridge plating was used in 21 patients. In 13 patients, Kirschner wires or transarticular screws or a combination were used. The median follow-up period was 49 (interquartile range 18 to 89) months. The implants were removed in 10 of 13 patients in the transarticular group and 17 of 21 patients in the bridge plating group. The incidence of wound complications was comparable in both groups. The median American Orthopaedic Foot and Ankle Society score was lower in the transarticular group (77 versus 66). The Foot Function Index score was 18 in both groups. Patient satisfaction was 90% in the bridge plating group and 80% in the transarticular group. Bridge plating for Lisfranc injuries led to at least similar results compared with transarticular fixation in terms of functional outcomes and patient satisfaction. Longer follow-up is necessary to determine whether the prevention of secondary damage to the articular surface leads to less post-traumatic arthritis and better functional outcomes.

Biomechanical Evaluation of a Novel Integrated C1 Laminar Hook Combined with C1–C2 Transarticular Screws for Atlantoaxial Fusion: An In Vitro Human Cadaveric Study

To evaluate the acute stability of a novel integrated C1 laminar hook (H) combined with a C1-C2 transarticular screw (TAS) with established techniques. A novel integrated C1 laminar hook was tested. Seven human cadaveric cervical spines (C0-C3) were used. The range of motion (ROM) of C1-C2 during flexion-extension, lateral bending, and axial rotation were recorded. The specimens were tested under the following conditions: intact, destabilized (using a type II odontoid fracture model), and destabilized but with internal fixation. The following screw systems were used: bilateral C1-C2 TAS combined with the Gallie (G) technique (TAS+G), C1-C2 TAS combined with a novel integrated C1 laminar hook (TAS+H), C1 lateral mass screw and C2 pedicle screws (C2PS+C1LMS), and novel integrated C1 laminar hook combined with C2 pedicle screws (C2PS+H). The TASs were always inserted after the C2PSs. The C2PS+C1LMS and C2PS+H tests were performed alternatively, as were the TAS+G and TAS+H tests. All fixation constructs greatly improved acute atlantoaxial stability, with no significant difference among TAS+H, TAS+G, and C2PS+C1LMS (all P > 0.05). C2PS+H showed the greatest C1-C2 ROM in axial rotation, significantly different from TAS+G, C2PS+C1LMS, and TAS+H fixation models (all P < 0.05). However, there were no significant differences between C2PS+H and the other 3 models in flexion-extension and lateral bending (all P > 0.05). The TAS+H technique can achieve acute stability comparable to that with the TAS+G technique for treating C1-C2 instability. The C2PS+H is a promising alternative, although it provides less stability in axial rotation than TAS+G, TAS+H, or C2PS+C1LMS.

Clinical Outcomes and Development of Symptomatic Osteoarthritis 2 to 24 Years After Surgical Treatment of Tarsometatarsal Joint Complex Injuries.

Injuries to the tarsometatarsal (TMT) joint complex, or Lisfranc injuries, have been reported to result in osteoarthritis (OA) following surgical treatment. Good outcomes with respect to short and medium-term results have been reported. However, long-term results, specifically regarding clinical outcomes and the development of symptomatic OA, are limited. The objectives of this study were to assess clinical outcomes, the occurrence of symptomatic OA, and risk factors for OA at 2 to 24 years after a Lisfranc injury treated surgically with open reduction and internal fixation (ORIF) or with primary arthrodesis. This was a retrospective study involving 61 patients treated surgically at our institution between 1988 and 2009 for an injury to the TMT joint complex. Patients underwent either ORIF with transarticular screws or primary arthrodesis when joint comminution at the TMT level was such that ORIF was not possible. Functional outcomes were assessed according to the American Orthopaedic Foot & Ankle Society (AOFAS) score, the Foot Function Index (FFI), and a visual analog scale (VAS) for pain. Global health was evaluated with the Short Form (SF)-12 Health Survey physical component summary (PCS). Sixty-one of the 128 patients were available for clinical evaluation, including the use of questionnaires, and radiographic assessment at a mean of 10.9 years postoperatively (range, 2.4 to 23.9 years). Mean scores were as follows: AOFAS score, 79.0; FFI, 16.9, and VAS for pain, 2.5. Radiographic evidence of OA was noted in 44 (72.1%) of the patients, and symptomatic OA, in 54.1%, the latter having worse outcomes. Risk factors for OA were nonanatomic reduction, fracture classification of Myerson type C, and a history of smoking. Two to 24 years following surgical treatment to restore and maintain joint anatomy for Lisfranc injuries, we found satisfactory clinical outcome scores and a large number of patients who had returned to their previous level of functioning and employment, with little need for secondary procedures. However, there was a substantial occurrence of posttraumatic OA, as evident on radiographs, albeit the occurrence of symptomatic OA was lower. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Magerl technique for children atlantoaxial rotatory subluxation

Objective To discuss the feasibility and prognosis of magerl technique for children. Atlantoaxial Rotatory Subluxation. Methods 63 patients with Atlantoaxial Rotatory Subluxation were treated in our hospital, and 16 of whom were treated with bilateral C1, 2 posterior transarticular screw fixation and fusion. All cases aged from 8 to 14, with an average age of 11±2.3 years old. According to Fielding classification, 10 cases were in type II, and 6 in type III. 1 patient showed dizziness, 11 patients showed obvious appearance of deviation of head and neck; 14 patients showed varying degrees of occipito-cervical pain, and one patient showed incomplete paralysis. All patients had undergone Halo traction, then the Magerl surgery for atlantoaxial fixation fusion. Through follow-up and photograph of atlantoaxial mouth opening, lateral cervical X-ray and atlantoaxial 3D CT, the screw position and bone graft fusion were evaluated. The clinical and radiological outcomes were evaluated according to the Symon and Lavender clinical standard, the imaging index space available for the cord (SAC), and the atlas-dens interval (ADI). Results All cases were followed up for 3 to 98 months (mean 38±14.6 months). All patients had completed the bilateral UCSS screw fixation, and the symptoms were improved significantly, without neurological symptoms aggravated or complications such as neurovascular injury. All UCSS screw position through the atlantoaxial joint was accurate, without atlanto occipital joint activity limitation. All patients got bony fusion 3 to 6 months post-operation. The clinical recovery rate was 93.8%. The SAC of C1,2 segment increased by 6.06±1.29 mm postoperatively, which showed a significant difference compared with preoperative SAC. The SAC at the latest follow-up was 15.31±0.79 mm, showing no significant difference compared with that just postoperatively. The ADI at one month post-operatively decreased by 5.75±1.53 mm, showing a significant difference compared with preoperative SAC. The ADI at the latest follow-up was 1.94±0.57 mm, showing no significant difference compared with that just postoperatively. Conclusion Preoperative Halo-traction combined with Magerl surgery in treatment of children with atlantoaxial rotatory subluxation is a safe and effective method. Key words: Atlanto-axial joint; Dislocations; Child; Internal fixators; Spinal fusion

Plates, Screws, or Combination? Radiologic Outcomes After Lisfranc Fracture Dislocation

Traditionally, Lisfranc fracture dislocations have been treated with transarticular screw fixation. A more recent development has been the use of dorsal bridging plates. The aim of the present study was to compare the radiologic outcomes for these 2 methods. Currently, no data comparing the outcomes of these 2 treatment options have been reported. A total of 62 patients were treated for Lisfranc fracture dislocations during a 6-year period. The inclusion criteria included ≥6 months of follow-up data available. Each fracture was classified using the Hardcastle classification system. Each fracture was also allocated into 1 of 4 groups: transarticular screw fixation, dorsal plating, a combination of plate and screw fixation, and nonoperative management. The outcome measures included the Kellgren-Lawrence grading of osteoarthritis and the Wilppula classification of anatomic reduction. In terms of results, radiologic osteoarthritis is not associated with the type of injury according to the Hardcastle classification nor with having an open or closed fracture. The Hardcastle classification is not associated with the type of fixation used. Fractures fixed with a combination of plates and screws had a 3.01 (95% confidence interval 1.036 to 8.74) increased risk of having stage 3 or 4 radiologic osteoarthritis compared with being fixed solely with bridging plates (p = .009). Multivariate analysis revealed that this increased risk of osteoarthritis was dependent on the quality of reduction, with good reductions having a 18.2 (95% confidence interval 15.9 to 21.8) times decreased risk of severe osteoarthritis compared with fair or poor reductions, independent of the type of fixation used (p < .0001). No radiologic benefits were found when comparing plate or screw fixation for Lisfranc fracture dislocations (although screw fixation might be associated with a less planus foot and fewer complications). Instead, a good anatomic reduction was the only predictor of the radiologic outcome, and the Hardcastle classification of fractures did not predict the surgery type or radiologic outcome. Finally, treatment with combination plates and screws resulted in worse radiologic outcomes, possibly owing to more complex fracture patterns.