Use Of Bone Anchors Research Articles

Use of bone anchors for the treatment of partial and complete traumatic elbow luxations: A retrospective case series of three dogs

AbstractThree dogs presented with traumatic lateral elbow luxation following road traffic accidents. Concurrent injuries included skin abrasions and coxofemoral luxation. All luxations were reduced and stabilised with bone anchors through a lateral approach to the elbow joint and had an augmented or prosthetic lateral collateral ligament placed. One elbow joint was stabilised with FASTak anchor (Arthrex, Karsfeld, Germany) and two with suture anchors by IMEX bone anchor (Veterinary, Longview, TX). Reluxation occurred in one case 24 hours after discharge requiring revision surgery. Median follow‐up time for the three cases was 180 days (range: 49–2920) and the functional outcome was considered excellent in all cases as determined by veterinary assessment, clinical record reviews, owner communication and Liverpool Osteoarthritis in Dogs (LOAD) questionnaire. In conclusion, placement of bone anchors with augmentation of the lateral collateral ligament for management of traumatic elbow luxation in dogs is a good alternative to previously reported surgical techniques.

Tendon transfer via self-made nonproprietary external button: Technique paper and case series

Tendon transfers are a versatile surgical procedure for correcting deformities in and about the foot and ankle. The purpose of these procedures can include improving a lost function, strengthening a weakened or damaged tendon, and ultimately help produce a biomechanically stable foot and ankle. There have been various fixation types proposed for these tendon transfers including most commonly the use of bone anchors and interference screws. In this study, we present a novel technique for an inexpensive, technically simple, and convenient use of a non-proprietary external button for primary or secondary fixation of tendon transfers. We also report on a case series of patients who have undergone this technique.

Chronic post-traumatic volar plate avulsions of the finger proximal interphalangeal joint: A literature review of different surgical techniques.

Avulsions of the volar plate of the finger proximal interphalangeal joint (PIPJ) following sprains are often undiagnosed in the acute setting. Therefore, the chronic outcomes of this injury are most frequently the object of study and treatment. Different techniques for volar plate chronic avulsion repair are described in the literature. The most used among these are mainly two: the direct suturing with or without the use of bone anchors and the tenodesis techniques with flexor digitalis superficialis (FDS). The aim of this systematic review is to determine outcomes and complications associated with these surgical treatments of post-traumatic volar plate avulsions without phalangeal fractures. An electronic literature research was carried out and pertinent articles were selected. Surgical techniques details, outcomes and complications for direct sutures and tenodesis technique are discussed. Outcomes (Range of motion and pain) seem to be comparable, whereas authors that use the direct suture technique describe more frequently PIPJ flexion contracture complication. From this review of the literature, authors believe that both techniques are available for the repair of chronic injuries of the volar plate of the PIPJ, although direct suturing can be considered as less reproducible.

The Accommodation of Bone Anchors Within the Distal Phalanx for Repair of Flexor Digitorum Profundus Avulsions

Avulsion injury of the flexor digitorum profundus (FDP) tendon has been traditionally repaired with a pull-out suture over the nail plate. Complication rates with this method and improvements in anchor design have led to the increased use of bone anchors to give a rigid all-inside repair. However, the dimensions of the distal phalanx may limit their use. The primary hypothesis was that 2 micro bone anchors could fit in either perpendicular or 45° proximally angled positions within each distal phalanx. A further hypothesis was that 1 mini bone anchor could fit in similar positions in the distal phalanx. Thirty-two fresh frozen fingers were dissected, and the FDP tendon was removed from the distal phalanx footprint. Two bone anchor types were used, mini and micro sizes, and inserted at 2 angles, perpendicular and 45° proximally angled. Observations of dorsal cortex and joint space penetration were recorded. Distal phalanx dimensions were measured for each finger. The micro anchors penetrated the dorsal cortex in perpendicular tests in little fingers only. The micro anchor did not penetrate the joint in any angled tests. The mini bone anchor penetrated the dorsal cortex in 100% of perpendicular tests and the joint in 63% of angled tests, although none of these included the middle finger. Two micro bone anchors fit within the distal phalanx in all fingers tested, except the little finger, when placed in the perpendicular position. At a 45° angle, the distal phalanx of the little finger can also accommodate micro bone anchors without any evidence of complication when placed 4 mm from the joint. The mini anchors were too large to fit in a perpendicular position within the distal phalanx. In the 45° angled position, the joint was not penetrated by the mini anchor in only middle fingers. The study provides anatomical evidence of the accommodation of micro bone anchors within the distal phalanx in perpendicular or 45° angled positions for the repair of FDP tendon avulsion injury.

Laparoscopic repair of traumatic flank hernias.

Traumatic flank hernias (TFH) are caused by a blunt abdominal trauma with resultant detachment of the oblique musculofascial complex at the iliac crest and/or costal margin. Given such proximity to the bony structures and essential absence of healthy fascia to anchor the mesh, TFH represent a challenging surgical problem. Although laparoscopic repair of ventral hernias has become very common, no series of laparoscopic repairs of TFH has been reported to date. We present a series of patients undergoing laparoscopic repair of TFH. After retrospective review of prospective hernia database at two Hernia centers, patients undergoing laparoscopic TFH repair were identified and analyzed. Main outcome measures included patient demographics, surgical technique, intraoperative data, and post-operative outcomes. From December 2007 to December 2013, 14 patients underwent laparoscopic repair of a TFH. Eleven patients had chronically incarcerated viscera within the defect. Operative steps included complete reduction of the hernia sac, pre/retroperitoneal dissection to expose the entire lateral edge of a psoas muscle, defect closure with transabdominal sutures, wide mesh overlap, and transabdominal suture fixation with selective use of bone anchors. The mean operative time was 174min (range 125-230). Mean estimated blood loss was 65cc. Mean mesh size was 295cm2. There were no peri-operative complications. Mean hospital stay was 3.1days and all patients returned to full activities by 6weeks. At a mean follow-up of 35months, there have been no recurrences. Laparoscopic approach to TFH is feasible and safe. It is associated with minimal hospital stay and fast functional recovery. The key components of our approach include wide pre/retroperitoneal with defect closure and subsequent wide mesh underlay coverage with fixation to bony structures using anchors/screws. We believe that the laparoscopic approach should safely considered for the majority of patients with TFH.

Fingertip Winding Suture: Pull-out Suture Technique for Flexor Tendon Repair in Zone I.

Injuries to flexor tendons in zone I has always been challenging during repair. Over the time several techniques were developed and modified to achieve the highest repair strength and thus the best functional outcome. These techniques vary from pull-out sutures with internal and external fixation to the use of bone anchors. All techniques were accompanied with advantages and disadvantages as well as postoperative morbidities related to certain techniques. In the present technique we introduce a subperiosteal pull-out suturing technique. It is a simple, strong, and cost-effective method for repair of flexor tendon injuries in zone I or in the context of tendon grafting.

Osteomyelitis of the Pubic Symphysis as a Complication of Bladder Neck Suspension Procedure with Use of Bone Anchors: A Case Report

Bladder neck suspension procedure using bone anchors in the pubic bone is employed as the standard treatment for stress urinary incontinence. A 76-year-old woman who had an osteomyelitis of the pubic symphysis following this procedure is presented. She complained of lower abdomen, suprapubic, and left groin pain after she had received an operation for urinary incontinence. The pain persisted and gradually led to gait disturbance. Hematology showed mild inflammation, plain radiograph and computed tomography of the pelvis revealed osteomyelitis of the pubic symphysis and retropubic abscess. Bone anchors and the attached suture material were removed, necrotic bone was curetted. After the surgery, her pain decreased and urinary incontinence remained improved. Osteomyelitis of the pubic bone is uncommon entity that must be recognized in elderly women who received an operation for stress urinary incontinence.

TMJ disc displacement as a cause of changes in facial skeletal morphology

To evaluate an efficiency of TMJ open disc repositioning surgery with use of bone anchors. TMJ open disc repositioning surgery was indicated for patients with TMJ anterior disc displacement without reduction and skeletal class II or asymmetric forms of dysgnathia related to condyle resorption. Surgery was performed on 9 patients divided into two groups: the first one (5 patients) consisted of patients that were seeking help for bite problems, the second one (4 patients) consisted of patients with signs of TMJD, such as decreased mouth opening and pain in TMJ area. The first group patients underwent open disc repositioning and orthognathic surgery with counterclockwise rotation of occlusal plane. All the patients showed stability in skeletal and occlusal elements at 6 months follow-up period. The second group patients underwent disc-repositioning surgery only. In all the cases pain was completely eliminated but there was no sufficient improvement in MIO at 6 months follow-up period. Open TMJ disc repositioning surgery can be used for prevention of relapse after orthognathic surgery in patients with TMJ internal derangements such as anterior disc displacement without reduction.

The outcomes of zone 1 flexor tendon injuries treated using micro bone suture anchors

This article evaluates the outcome of 42 consecutive zone 1 flexor tendon injuries treated by using micro bone anchors during the period 2003-2008. Patients were rehabilitated using the modified Belfast Regime. The range of motion at the distal interphalangeal joint was assessed using Moiemen's classification. A total of 56% of patients achieved excellent or good results for range of motion at the distal interphalangeal joint and 23% had a poor outcome. The mean distal interphalangeal joint and proximal interphalangeal joint range of motion were 48° and 96°, respectively. A total of 94% of patients returned back to work by 12 weeks. One patient sustained a tendon rupture and one developed osteomyelitis. The mean QuickDASH score was 13.5 and 81% of patients were satisfied with their outcomes. This is the largest clinical study on the use of bone anchors for zone 1 tendon injuries. Our study demonstrated a low rate of complications and outcomes that compare favourably with other published techniques.

Repair of the central slip of extensor tendon and the open mallet using Mitek mini bone anchors

There has been a recent upsurge in the use of bone anchors in repairing hand tendon injuries, which substantiates our use of Mitek anchors in the late 1990s with good results. The objective of this study was to describe our technique of using Mitek bone anchors to repair open mallet and open central slip avulsion injuries, hence evaluating their post-operative outcomes. Four patients with open mallet injury and ten patients with open central slip avulsions were treated using the Mitek mini bone anchors. In each case, the extensor tendon was shaved off its point of insertion on the middle or distal phalanx. All patients were operated in within 2 days of the open injury without any conservative measures pre-operatively. Post-operatively, the joint was maintained in an extension with a single trans-articular Kirschner wire or splint for 2 weeks, followed by gradual mobilization and active and passive exercises. Each patient underwent an objective evaluation to assess joint stability, the joint’s range of motion and grip strength compared to the uninjured side. Patients also underwent a subjective evaluation at the end of the follow-up period. The operative procedure was successful in all but one patient. One patient needed a relook procedure. Two patients were lost to follow-up, while the rest were followed up for a mean duration of 11 months (range = 5–24 months). Subjectively, two patients had excellent results, seven had good results, two had fair, and one achieved poor results. The Mitek bone anchor is a useful tool to treat open extensor tendon injuries, especially ones where the tendon has been shaved off at its insertion on the bone.

Use of bone anchors for flap fixation in burned patients

Mitek ® or Arim ® anchors were developed for use in orthopaedic surgery to facilitate soft tissue fixation to bone. We believe this tool can be useful in difficult cases when securing various flaps to bone, we present a retrospective study of deep thickness burns patients. Materials and methods We conducted a retrospective study, including severely burned patients who underwent flap reconstruction with Mitek ® or Arim ® anchor fixation between 1999 and 2007 in our unit. Characteristics analysed included indications for surgery, and postoperative complications. Results Nine patients (nine flaps) were included, seven men and two women with age ranging from 22 to 59 years old. Flaps were as follows: one gracilis, two latissimus dorsi, four medial gastrocnemius and two lateral gastrocnemius flaps. Indications for reconstruction were: open fractures or joint exposure in severely burned patient. Only one complication was noted: partial flap necrosis with infection of the bone anchor necessitating ablation and a new mobilisation of the flap. Conclusion Mitek anchors are a useful tool in plastic surgery. Suture anchors are used when coverage poses a risk of shearing away from the bone or adequate periosteum and soft tissue is not available for standard suture techniques. The anchor system provides a simple, fast, and efficient technique for flap fixation.

Long-term Results of the Acellular Human Dermal Allograft Sling With Transvaginal Bone Anchors

In Brief Objectives: We reviewed the long-term results of an acellular human dermal allograft (Repliform; Boston Scientific, Natick, MA) sling with transvaginal bone anchors for the treatment of stress urinary incontinence. Materials and Methods: A retrospective analysis was performed on 61 consecutive patients who underwent a transvaginal sling with an acellular human dermal allograft and transvaginal bone anchors for stress urinary incontinence. All procedures were performed by one surgeon (T.L.). Postoperatively, all patients received a questionnaire evaluating continence, pelvic pain, and satisfaction with the procedure. Patients who did not return the questionnaire were contacted by phone (if they could be located) and encouraged to participate. Results: Thirty-one of the 61 patients completed the questionnaire for a response rate of 51%. Follow up ranged from 14 to 63 months (mean, 33.5 months). Of the group that responded, 22.5% reported being completely dry and 70.9% reported incontinence with minimal to moderate activity. Forty-eight percent of patients report using one or more pads per day, whereas 19% never use a pad. Forty-five percent report being satisfied with the procedure. Fifty-one percent report that their urinary control is significantly better, whereas 9% report it is worse. No patient developed osteitis pubis but 4 (12.9%) developed dyspareunia. Conclusion: We conclude that the transvaginal sling with an acellular human dermal allograft and the use of bone anchors has poor long-term results as an antiincontinence procedure. The use of bone anchors did not seem to increase the risk of osseous complications. Long-term outcomes with a human dermal allograft sling with bone anchors are reviewed. At an average follow-up of 33.5 months 71% of patients experienced incontinence with minimal to moderate activity.

Pubic osteomyelitis following bladder neck surgery using bone anchors: a report of 9 cases.

We reviewed 9 cases of pubic osteomyelitis associated with placement of bone anchors for bladder neck suspension procedures for risk factors, bacterial speciation and sensitivities, and interventions performed. Nine women were treated for pubic osteomyelitis following the use of bone anchors for bladder neck suspension surgery. In 8 cases the bone anchors had been placed through a suprapubic incision and in 1 the bone anchors were placed by a vaginal route. Patient ages ranged from 36 to 74 years (mean 51.8). Symptomatic presentation ranged from 2 to 18 months following initial operation. Presenting symptoms included pain over the pubis and/or a draining wound. Staphylococcus species were cultured in all cases, most commonly Staphylococcus epidermidis. Resistance to methicillin was present in 7 cases (78%). Wound débridement and removal of the anchors provided definitive treatment in all but 1 patient, who eventually required partial pubectomy. Pain (3 of 9 cases) and mild incontinence (5 of 9) were present at last followup. Bone anchors used in surgery for urinary incontinence can be associated with pubic osteomyelitis. Infection characteristics are similar to those seen with other urological prosthetic implantation procedures. Aggressive treatment with surgical débridement and long-term antibiotics is usually effective. Staphylococcus species, especially methicillin resistant strains, are the most common bacteria identified in this setting. Careful attention to implantation technique, including appropriate perioperative antibiotic selection, should be considered when using this technique.

Soft Tissue Fixation in the Face With the Use of a Micro Mitek Anchor

An alternative method for fixation of soft tissue in the face, such as the medial and lateral canthus and free flaps, and for reconstruction of the nasolabial fold is presented, using the micro Mitek Anchor. The insertion of a bone anchor requires only a limited dissection, and the point of insertion can be determined accurately. These advantages are obvious when performing a canthoplasty. Using the bone anchor to fixate a free flap to the facial skeleton is an effective way to prevent sagging of the flap as a result of gravitational forces. In contrast, the use of bone anchors in facial neurofibromatosis has not been as rewarding.

Pubic Osteomyelitis Following Bladder Neck Surgery Using Bone Anchors: A Report of 9 Cases

We reviewed 9 cases of pubic osteomyelitis associated with placement of bone anchors for bladder neck suspension procedures for risk factors, bacterial speciation and sensitivities, and interventions performed. Nine women were treated for pubic osteomyelitis following the use of bone anchors for bladder neck suspension surgery. In 8 cases the bone anchors had been placed through a suprapubic incision and in 1 the bone anchors were placed by a vaginal route. Patient ages ranged from 36 to 74 years (mean 51.8). Symptomatic presentation ranged from 2 to 18 months following initial operation. Presenting symptoms included pain over the pubis and/or a draining wound. Staphylococcus species were cultured in all cases, most commonly Staphylococcus epidermidis. Resistance to methicillin was present in 7 cases (78%). Wound débridement and removal of the anchors provided definitive treatment in all but 1 patient, who eventually required partial pubectomy. Pain (3 of 9 cases) and mild incontinence (5 of 9) were present at last followup. Bone anchors used in surgery for urinary incontinence can be associated with pubic osteomyelitis. Infection characteristics are similar to those seen with other urological prosthetic implantation procedures. Aggressive treatment with surgical débridement and long-term antibiotics is usually effective. Staphylococcus species, especially methicillin resistant strains, are the most common bacteria identified in this setting. Careful attention to implantation technique, including appropriate perioperative antibiotic selection, should be considered when using this technique.

Bone anchor infections in female pelvic reconstructive procedures: a literature review of series and case reports.

We determined the reported prevalence of infectious osseous complications due to the use of bone anchors for suture fixation in female pelvic reconstructive procedures. In addition, the type and method of bone anchors as well as the reported pathogens associated with osseous infections were reviewed. Primary reported series of female pelvic reconstructive procedures involving bone anchor suture fixation referenced in Index Medicus from January 1990 to July 2000 were extracted using the MEDLINE bibliographic database on English language articles involving humans. All case reports of infectious osseous complications due to bone anchor use in female reconstructive procedures were also reviewed during this period. Since the inception of bone anchor suture fixation for female pelvic reconstructive procedures 10 years ago, the overall prevalence of related infectious complications has been 6 cases in 1,018 procedures (0.6%). This type of adverse event developed between followup weeks 1 and 24. The prevalence of suprapubic bone anchors has been 6 cases in 698 procedures (0.86%). For transvaginal bone anchor procedures no infectious cases have been reported in the combined series of 314 procedures and the same is true for 1 reported case of sacral bone anchor placement in 6 procedures. No statistical difference was noted in regard to the prevalence of infection in procedures involving suprapubic bone anchors and transvaginal bone anchor combined with sacral bone anchor placement (Fisher's exact test p = 0.19). The organisms reported in case reports suggest a coliform, skin or hematogenous source for contamination of the bone anchor site. An infectious bone anchor complication in female pelvic reconstructive procedures is an uncommon event with a reported prevalence of 0.6%. Currently there is no evidence of differences in the prevalence of osseous complications after transvaginal versus suprapubic bone anchor fixation. Preoperative broad-spectrum antibiotics are recommended to decrease the potential of infectious bone anchor complications.

BONE ANCHOR INFECTIONS IN FEMALE PELVIC RECONSTRUCTIVE PROCEDURES: A LITERATURE REVIEW OF SERIES AND CASE REPORTS

Purpose: We determined the reported prevalence of infectious osseous complications due to the use of bone anchors for suture fixation in female pelvic reconstructive procedures. In addition, the type and method of bone anchors as well as the reported pathogens associated with osseous infections were reviewed.Materials and Methods: Primary reported series of female pelvic reconstructive procedures involving bone anchor suture fixation referenced in Index Medicus from January 1990 to July 2000 were extracted using the MEDLINE bibliographic database on English language articles involving humans. All case reports of infectious osseous complications due to bone anchor use in female reconstructive procedures were also reviewed during this period.Results: Since the inception of bone anchor suture fixation for female pelvic reconstructive procedures 10 years ago, the overall prevalence of related infectious complications has been 6 cases in 1,018 procedures (0.6%). This type of adverse event developed between fol...

Use of bone anchors in female urology

Stress urinary incontinence remains one of the most prevalent conditions encountered by urologists. In many cases, surgical correction of this condition is carried out using a pubovaginal sling procedure. Bone anchors were initially used in transvaginal needle suspension procedures to improve stabilization of the bladder neck. This technology has been extended to sling procedures, allowing completion of these procedures by an entirely transvaginal approach. Early results of these procedures are encouraging, and overall morbidity appears much less when compared with conventional pubovaginal sling procedures. In this article, the application of bone anchors in female urology is reviewed. Techniques of pubovaginal sling and abdominal sacrocolpopexy using bone anchors and potential complications of bone anchor implantation are discussed. Surgeons performing procedures for the treatment of stress incontinence should be aware of the benefits and potential risks of bone anchor implantation.

Is osteitis pubis associated with the use of bone anchors in urinary continence operations?

We studied 130 patients who underwent either a vaginal needle suspension procedure or a pubofascial sling procedure with Mitek titanium bone anchors to determine the association of osteitis pubis with bone anchoring in these procedures. Fifteen patients complained of postoperative suprapubic pain; five cases were due to wound infections and another five were associated with tying the suspension sutures too tightly. We suggest the use of the term 'periostitis pubis' to describe the remaining five patients who suffered suprapubic pain. We found no radiological evidence of osteitis pubis in any patients.