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Lormans P, Loos PJ, Vanbrabant S, Quetin P, Huybrechts X, Ghekiere O. Hip Fracture in the Sportive Adult: Case Report of Complete Functional Recovery After Removal of Hardware. J Sport Rehabil 2024:1-4. [PMID: 39293791 DOI: 10.1123/jsr.2023-0338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 05/17/2024] [Accepted: 07/04/2024] [Indexed: 09/20/2024]
Abstract
CONTEXT Pertrochanteric hip fractures in sportive young adults are mainly caused by a high-energy trauma and treated in the same way as in the older population, using an osteosynthesis immediately followed by a rehabilitation program for several months. The current standard is not to remove osteosynthesis material, similar to the case of older patients. CASE PRESENTATION A 45-year-old male cyclist experienced a right pertrochanteric femoral fracture, treated with cephalomedullary nails. After 9 months of adequate rehabilitation, weakness of the quadriceps musculature and functional complaints persisted, objectified through an isokinetic strength test and a significantly reduced score on the Hip Disability and Osteoarthritis Outcome Score questionnaire. The patient was unable to return to his previous level of cycling performance. MANAGEMENT AND OUTCOME After exclusion of structural bone complications, nerve injury, and central sensitization, the functional complaints and strength deficiency were hypothesized to be related to the osteosynthesis material. Therefore, the hardware was removed 9 months after the first surgery, and the rehabilitation was continued for another 20 weeks. Very soon after the removal of the hardware, the functional complaints disappeared with a remarkable improvement of the Hip Disability and Osteoarthritis Outcome Score. The isokinetic strength test showed complete recovery of muscle strength 20 weeks after osteosynthesis removal, and preinjury cycling performance values were obtained 9 months posthardware removal. CONCLUSION Despite an adequate rehabilitation following a hip fracture, sporty young adults may fail to reach their previous level of functioning. Osteosynthesis removal may be indicated in this sportive population to reach complete muscle strength and functional recovery. The management of hip fractures in the sportive young adult and the identification of patients who may benefit from removal of the hardware require more research.
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Affiliation(s)
- Pieter Lormans
- Department of Physical Medicine and Rehabilitation, Jessa Ziekenhuis, Hasselt, Belgium
| | - Pieter-Jan Loos
- Department of Physical Medicine and Rehabilitation, Jessa Ziekenhuis, Hasselt, Belgium
| | - Stefanie Vanbrabant
- Department of Physiotherapy, Jessa Ziekenhuis, Hasselt, Belgium
- Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Philippe Quetin
- Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Xavier Huybrechts
- Department of Physical Medicine and Rehabilitation, Jessa Ziekenhuis, Hasselt, Belgium
| | - Olivier Ghekiere
- Department of Radiology, Jessa Ziekenhuis, Hasselt, Belgium
- Faculty of Medicine and Life Sciences, Cardiology and Organ Systems, Hasselt University, Diepenbeek, Belgium
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Jiménez de Cisneros Gutiérrez A, Suárez Quintero A, Arrieta Martinez CJ. Use of ultrasound for hardware removal. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:482-489. [PMID: 38280626 DOI: 10.1016/j.recot.2024.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 01/08/2024] [Accepted: 01/15/2024] [Indexed: 01/29/2024] Open
Abstract
INTRODUCTION Osteosynthesis hardware removal is one of the most frequent practices in Orthopedic electives surgeries and is usually carried out guided under fluoroscopy. There are other tools such as ultrasound that allow us to visualize the hardware with the advantage of being free of ionizing radiation and with better availability. The objective of our study is to analyze the results obtained in patients undergoing hardware removal in the operating room under ultrasound assistance and local anesthesia. MATERIAL AND METHODS A descriptive study was carried out collecting variables such as demographic data, reason for the removal, pain during the procedure and in subsequent days, as well as the duration and rate of success of the procedure and the degree of satisfaction. RESULTS We obtained a 100% success in ultrasound-guided extraction without the need for conventional radiology, with a mean VAS of 1.91 and need for subsequent analgesia in 36.4% of the cases, with syndesmotic dynamization being the most frequent reason for intervention. CONCLUSION Ultrasound is a useful tool in osteosynthesis hardware removal, and that may be sufficient by itself; also saving health personnel and patients from ionizing radiation resulting from the use of conventional fluoroscopy.
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Affiliation(s)
- A Jiménez de Cisneros Gutiérrez
- Servicio de Cirugía Ortopédica y Traumatología, Complejo Hospitalario de Torrecárdenas, Almería, España; Sociedad Española de Cirugía Ortopédica y Traumatología (SECOT), Madrid, España; Sociedad Andaluza de Traumatología y Ortopedia (SATO), Sevilla, España.
| | - A Suárez Quintero
- Servicio de Cirugía Ortopédica y Traumatología, Complejo Hospitalario de Torrecárdenas, Almería, España; Asociación Española de Artroscopia (AEA), Madrid, España; Sociedad Española de Cirugía de Hombro y Codo (SECHC), España
| | - C J Arrieta Martinez
- Servicio de Cirugía Ortopédica y Traumatología, Complejo Hospitalario de Torrecárdenas, Almería, España; Sociedad Española de Cirugía Ortopédica y Traumatología (SECOT), Madrid, España; Sociedad Andaluza de Traumatología y Ortopedia (SATO), Sevilla, España; Asociación Española de Artroscopia (AEA), Madrid, España; Sociedad Española de Cirugía de Hombro y Codo (SECHC), España
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3
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Jiménez de Cisneros Gutiérrez A, Suárez Quintero A, Arrieta Martinez CJ. [Translated article] Use of ultrasound for hardware removal. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:T482-T489. [PMID: 38971562 DOI: 10.1016/j.recot.2024.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 01/08/2024] [Accepted: 01/15/2024] [Indexed: 07/08/2024] Open
Abstract
INTRODUCTION Osteosynthesis hardware removal is one of the most frequent practices in Orthopaedic electives surgeries and is usually carried out guided under fluoroscopy. There are other tools such as ultrasound that allow us to visualise the hardware with the advantage of being free of ionising radiation and with better availability. The objective of our study is to analyse the results obtained in patients undergoing hardware removal in the operating room under ultrasound assistance and local anaesthesia. MATERIAL AND METHODS A descriptive study was carried out collecting variables such as demographic data, reason for the removal, pain during the procedure and in subsequent days, as well as the duration and rate of success of the procedure and the degree of satisfaction. RESULTS We obtained a 100% success in ultrasound-guided extraction without the need for conventional radiology, with a mean VAS of 1.91 and need for subsequent analgesia in 36.4% of the cases, with syndesmotic dynamisation being the most frequent reason for intervention. CONCLUSION Ultrasound is a useful tool in osteosynthesis hardware removal, and that may be sufficient by itself; also saving health personnel and patients from ionising radiation resulting from the use of conventional fluoroscopy.
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Affiliation(s)
- A Jiménez de Cisneros Gutiérrez
- Servicio de Cirugía Ortopédica y Traumatología, Complejo Hospitalario de Torrecárdenas, Almería, Spain; Sociedad Española de Cirugía Ortopédica y Traumatología (SECOT), Madrid, Spain; Sociedad Andaluza de Traumatología y Ortopedia (SATO), Sevilla, Spain.
| | - A Suárez Quintero
- Servicio de Cirugía Ortopédica y Traumatología, Complejo Hospitalario de Torrecárdenas, Almería, Spain; Asociación Española de Artroscopia (AEA), Madrid, Spain; Sociedad Española de Cirugía de Hombro y Codo (SECHC), Spain
| | - C J Arrieta Martinez
- Servicio de Cirugía Ortopédica y Traumatología, Complejo Hospitalario de Torrecárdenas, Almería, Spain; Sociedad Española de Cirugía Ortopédica y Traumatología (SECOT), Madrid, Spain; Sociedad Andaluza de Traumatología y Ortopedia (SATO), Sevilla, Spain; Asociación Española de Artroscopia (AEA), Madrid, Spain; Sociedad Española de Cirugía de Hombro y Codo (SECHC), Spain
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Mennen AHM, Posthuma JJ, Kooijman EM, Trietsch MD, De Vries EN, Bloemers FW, Goslings JC, Van Embden D. The mode of delivery after operative fixation of pelvic ring fractures-a retrospective observational study. Eur J Trauma Emerg Surg 2024:10.1007/s00068-024-02618-4. [PMID: 39126519 DOI: 10.1007/s00068-024-02618-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Accepted: 07/19/2024] [Indexed: 08/12/2024]
Abstract
PURPOSE The purpose of this study is to investigate whether retained hardware after surgical treatment for a pelvic fracture prior to pregnancy affects the choice of delivery method. The study aims to provide insights into the rates of vaginal delivery and caesarean sections, understanding whether the mode of delivery was influenced by patient preference or the recommendations of obstetricians or surgeons, and examining the rate of complications during delivery and postpartum. METHODS All women of childbearing age who underwent surgical fixation for a pelvic ring fracture between 1994 and 2021 were identified. A questionnaire was sent about their possible pregnancies and deliveries. Of the included patients, surgical data were collected and the fracture patterns were retrospectively classified. Follow-up was a minimum of 36 months. RESULTS A total of 168 women with a pelvic fracture were identified, of whom 13 had a pregnancy after surgical stabilization. Eleven women had combined anterior and posterior fracture patterns and two had isolated sacral fractures. Four women underwent combined anterior and posterior fixation, the others either anterior or posterior fixation. Seven women had a total of 11 vaginal deliveries, and 6 women had 6 caesarean sections. The decision for vaginal delivery was often the wish of the mother (n = 4, 57%) while the decision to opt for caesarean section was made by the surgeon or obstetrician (n = 5, 83%). One woman in the vaginal delivery group suffered a postpartum complication possibly related to her retained pelvic hardware. CONCLUSION Women with retained hardware after pelvic ring fixation can have successful vaginal deliveries. Complications during labor or postpartum are rare. The rate of primary caesarean sections is high (46%) and is probably influenced by physician bias. Future research should focus on tools that can predict labor outcomes in this specific population, and larger multicenter studies are needed. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Anna H M Mennen
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, Netherlands.
| | - Jelle J Posthuma
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, Netherlands
- Department of Surgery, Flevoziekenhuis, Almere, Netherlands
| | - Eline M Kooijman
- Department of Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Marjolijn D Trietsch
- Department of Obstetrics and Gynaecology, Ikazia Hospital, Rotterdam, Netherlands
- Department of Obstetrics and Gynaecology, Leiden University Medical Center, Leiden, Netherlands
| | - Eefje N De Vries
- Department of Surgery, Tjongerschans Hospital, Heerenveen, Netherlands
| | - Frank W Bloemers
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, Netherlands
| | | | - Daphne Van Embden
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, Netherlands
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Previ L, Iorio R, Solmone M, Mazza D, Marzilli F, Di Niccolo R, Corsetti F, Viglietta E, Carrozzo A, Maffulli N. Worrying Presence of Asymptomatic Bacterial Colonisation on Implanted Orthopedic Devices. Cureus 2024; 16:e68126. [PMID: 39347164 PMCID: PMC11438488 DOI: 10.7759/cureus.68126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2024] [Indexed: 10/01/2024] Open
Abstract
Background Bacterial infection after hardware implantation in orthopedic and trauma surgery is devastating, resulting in increased hospital costs and stays, multiple revision surgeries, and prolonged use of antibiotics. The present study aims to determine whether a symbiotic relationship between the human organism and bacteria in hardware implantation may be present, without clinically evident infection. Materials and methods We studied explanted devices for microbiological analysis, using the sonication technique, from patients who underwent surgical removal of musculoskeletal hardware for mechanical reasons. None of the patients included in the study had clinical or biochemical signs of infection. Results Forty-nine patients were enrolled. Cultures tested positive for bacteria in 42.8% of the 49 patients (21 of 49). In 13 patients, Gram-positive bacteria were isolated, while Gram-negative bacteria were isolated from nine patients. The most frequent bacterial species found was Pseudomonas aeruginosa, with six positive cultures (28.5%). Coagulase-negative staphylococci were isolated from ten implants (47%). Conclusion A pacific coexistence between humans and bacteria is possible following the implantation of metallic devices for trauma or orthopedic ailments. It is still unclear how strong or unstable this equilibrium is.
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Affiliation(s)
- Leonardo Previ
- Orthopedics and Traumatology, Ospedale Sant'Andrea, Rome, ITA
| | - Raffaele Iorio
- Orthopedics and Traumatology, Ospedale Sant'Andrea, Rome, ITA
| | | | - Daniele Mazza
- Orthopedics and Traumatology, Ospedale Sant'Andrea, Rome, ITA
| | - Fabio Marzilli
- Orthopedics and Trauma, Ospedale Santo Spirito, Pescara, ITA
| | | | | | | | | | - Nicola Maffulli
- Trauma and Orthopaedic Surgery, University of Rome, Rome, ITA
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Desai VM, Mahon SJ, Pang A, Hauth L, Shah AS, Anari JB. Complications of Hardware Removal in Pediatric Orthopaedic Surgery. J Pediatr Orthop 2024:01241398-990000000-00623. [PMID: 39087515 DOI: 10.1097/bpo.0000000000002780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Abstract
BACKGROUND Hardware removal (HR) is one of the most common surgical procedures in pediatric orthopaedics. Surgeons advocate for HR for a variety of reasons, including to limit peri-implant fracture risk, restore native anatomy for adult reconstruction surgery, permit bone growth and development, and mitigate implant-related pain/irritation. To our knowledge, no recent study has investigated the characteristics and complications of HR in pediatric orthopaedics. The goal of this study is to report the prevalence and complications of hardware removals across all of pediatric orthopaedic surgery. METHODS A retrospective case series was conducted of all hardware removals from 2012 to 2023 performed at a single urban tertiary-care children's hospital. Cases were identified using CPT codes/billing records. Spinal hardware and cases for which hardware was either implanted or explanted at an outside hospital were excluded. Patient demographic and clinical data were recorded. For patients with multiple hardware removals, each case was recorded independently. RESULTS A total of 2585 HR cases for 2176 children met study criteria (57.7% male; mean age 12.3±4.4 y). The median postoperative follow-up time was 1.7 months (interquartile range: 0.6 to 6.9). The most common sites of hardware removal were the femur/knee (32.7%), tibia/fibula/ankle (19.3%), and pelvis/hip (18.5%). The most common complications included sustained, new-onset postoperative pain (2.6%), incomplete hardware removal (1.6%), and perioperative fracture (1.4%). The overall complication rate of hardware removal was 9.5%. Eighty-eight percent of patients who underwent hardware removal for pain experienced pain relief postoperatively. HR >18 months after insertion had a 1.2x higher odds of overall complication (P=0.002) and 3x higher odds of incomplete removal/breakage (P<0.001) than hardware removed 9 to 18 months after insertion. CONCLUSIONS The overall complication rate of hardware removal across a large series in the pediatric population was 9.5%. Despite hardware removal being one of the most common and often routine procedures in pediatric orthopaedics, the complication rate is not benign. Surgeons should inform patients and families about the likelihood of success and the risks of incomplete removal during the informed consent process. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Vineet M Desai
- Department of Orthopaedics, The Children's Hospital of Philadelphia, Philadelphia, PA
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Page BJ, Sheridan GA, Greenstein MD, Reif TJ, Fragomen AT, Rozbruch SR. Percutaneous removal of hardware after orthopedic surgery: Is it safe? and What are patients saying? EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:3135-3143. [PMID: 38981919 DOI: 10.1007/s00590-024-04038-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Accepted: 06/24/2024] [Indexed: 07/11/2024]
Abstract
OBJECTIVES To analyze our patient's complication profile and rate after removal of hardware (ROH) surgery, and survey our patients to ask their overall status and improvement in symptomatology post-operatively. DESIGN Retrospective chart review and survey. SETTING Academic, tertiary referral center. PATIENTS/PARTICIPANTS 173 patients with 314 pieces of hardware. Seventy-six patients (43.9%) responded to our survey. INTERVENTION ROH surgery. MAIN OUTCOME MEASUREMENTS Patient demographics and complications were recorded. All patients were sent a brief 3-question survey which asked: (1) Why did you get your hardware removed? (2) How did your overall status change after ROH? (3) How did the ROH affect your stiffness, pain, swelling, and mobility? RESULTS There were 10 complications (5.5%): 5 infections, 2 with unresolved pain, 1 hematoma, 1 chronic regional pain syndrome exacerbation, and 1 recurrent deformity. All infections were treated with oral antibiotics and improved. All other complications resolved with treatment except for the patient who developed recurrent deformity. Patients underwent ROH surgery because their doctor suggested it (76.3%) and to improve mobility (39.5%). 86.9% reported their overall status improved after ROH. They improved regarding stiffness (73.7%), pain (73.6%), swelling (61.8%), and mobility (76.3%). Similar results were seen among different implants removed. CONCLUSIONS The majority of patients who underwent percutaneous ROH were satisfied. They reported improvement in stiffness, pain, swelling and mobility (greatest improvement). The complication rate was low (5.5%). ROH can be a meaningful operation to patients allowing them to improve their quality of life with a low complication rate. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Brian Joseph Page
- Orthopaedic Trauma Service, Hospital for Special Surgery and New York Presbyterian - Weill Cornell Medical Center, New York, NY, USA.
| | - Gerard A Sheridan
- Department of Orthopaedic Surgery, University Hospital Galway, Galway, Ireland
| | | | - Taylor J Reif
- Limb Lengthening and Complex Reconstruction Service, Hospital for Special Surgery, New York, NY, USA
| | - Austin T Fragomen
- Limb Lengthening and Complex Reconstruction Service, Hospital for Special Surgery, New York, NY, USA
| | - S Robert Rozbruch
- Limb Lengthening and Complex Reconstruction Service, Hospital for Special Surgery, New York, NY, USA
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Matsuura Y, Suzuki T, Akasaka T, Kanazuka A, Ozawa Y, Shiko Y, Ohtori S. Recovery of Forearm Bone Strength After Plate Removal: A Finite Element Analysis Study. J Hand Surg Am 2024; 49:608.e1-608.e8. [PMID: 36123221 DOI: 10.1016/j.jhsa.2022.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 06/16/2022] [Accepted: 07/29/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to estimate the bone strength after plate removal over time and to investigate the progression of bone strength recovery. METHODS A consecutive series of 31 patients was investigated to evaluate bone strength before and after forearm plate removal. Patients who were included underwent plate fixation for forearm diaphyseal fractures and were scheduled for plate removal. Computed tomography (CT) scans of the entire length of the bilateral forearms were taken before plate removal and at 1, 3, and 6 months after surgery. Patient-specific CT-based finite element analysis was used to predict the forearm bone fracture strength against an axial load (N), defined as the bone strength. Bone strength was estimated by patient-specific CT-based finite element analysis at each time point. RESULTS The mean age of the patients was 40.4 years. The mean time between plate fixation and removal was 27.5 months. Bone strength before the removal was estimated as reduced to 47% of that of the uninjured side. This was constant regardless of age group, involvement of the radius or ulna, Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification, open fracture, or type of plate. Bone strength at 1, 3, and 6 months after removal was estimated to be 66%, 85%, and 97%, respectively. The bone strength of the distal ulna was weaker than that at the other sites in the forearm and showed delayed recovery. CONCLUSIONS Bone strength after plate removal showed recovery within 3-6 months and was fully recovered by 6 months. The degree of recovery of bone atrophy varies from site to site, and patients should be careful about refracture after removal. CLINICAL RELEVANCE Clinicians should be aware that bone strength may not be sufficiently restored even 6 months after plate removal of forearm fractures.
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Affiliation(s)
- Yusuke Matsuura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chou-Ku, Chiba city, Chiba, Japan.
| | - Takane Suzuki
- Department of Bioenvironmental Medicine, Graduate School of Medicine, Chiba University, Chou-Ku, Chiba city, Chiba, Japan
| | - Tomoyo Akasaka
- Department of Rehabilitation Medicine, Graduate School of Medicine, Chiba University, Chou-Ku, Chiba city, Chiba, Japan
| | - Aya Kanazuka
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chou-Ku, Chiba city, Chiba, Japan
| | | | - Yuki Shiko
- Clinical Research Center, University of Chiba, Chiba, Japan
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chou-Ku, Chiba city, Chiba, Japan
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Hambrecht J, Canal C, Klingebiel FKL, Köhli P, Neuhaus V, Pape HC, Kalbas Y, Hierholzer C. Patient satisfaction after elective implant removal of the lower extremity - a retrospective cohort study. Eur J Trauma Emerg Surg 2024; 50:1165-1172. [PMID: 38319352 PMCID: PMC11249532 DOI: 10.1007/s00068-024-02462-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 01/22/2024] [Indexed: 02/07/2024]
Abstract
PURPOSE The topic of elective implant removal (IR) in healed fractures of the lower extremity remains controversial, particularly when unspecific symptoms of discomfort, which cannot be quantified, are the primary indication. This study aims to assess indications and outcomes of elective IR of the lower extremity, focusing on unspecific symptoms of discomfort and patient satisfaction postoperatively. MATERIALS AND METHODS The retrospective cohort study was conducted at a single level I academic trauma center. We included patients who underwent elective IR for healed fractures of the ankle, foot, patella, and proximal tibia from 2016 to 2021. All patients were followed-up for a minimum of 6 weeks after IR. Our outcomes of interest were patient satisfaction, complications, and alleviation of complaints. RESULTS A total of 167 patients were included in the study. Unspecific symptoms of discomfort were the most common reason for IR in all investigated anatomical regions of the lower extremity (47.9%), followed by pain (43.1%) and limited range of motion (4.2%). 4.8% of patients experienced a combination of pain and range of motion limitation. Among all patients, 47.9% reported subjective improvement after IR. IRs based on unspecific symptoms of discomfort were significantly less likely to show alleviation of complaints after IR (27.5%, OR 0.19, p ≤ 0.01). Patients who reported limited range of motion (OR 1.7, p = 0.41) or pain (OR 6.0, p = 0) were significantly more likely to be satisfied after IR. Patients who reported sensitivity to cold weather also showed a decrease of complaints after IR (OR 3.6, p = 0.03). Major complications occurred in 2.1% of cases. The minor complication rate was 8.4% (predominantly impaired wound healing). Smoking patients showed a significantly higher risk of complications after IR (OR 5.2, p = 0.006). Persistent pain postoperatively was detected in 14.7%. CONCLUSION When elective IR for consolidated fractures of the lower extremity is primarily motivated by patients' subjective symptoms of discomfort, the risk for postoperative dissatisfaction significantly increases. Objective symptoms on the other hand are associated with higher satisfaction after IR. While the procedure is generally safe, minor complications such as wound healing disorders can occur, especially in smokers. Patient education and well-documented informed consent are critical.
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Affiliation(s)
- Jan Hambrecht
- University Hospital Zurich: UniversitatsSpital Zurich, Zurich, Switzerland
| | - Claudio Canal
- University Hospital Zurich: UniversitatsSpital Zurich, Zurich, Switzerland
| | | | - Paul Köhli
- Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Valentin Neuhaus
- University Hospital Zurich: UniversitatsSpital Zurich, Zurich, Switzerland
| | | | - Yannik Kalbas
- University Hospital Zurich: UniversitatsSpital Zurich, Zurich, Switzerland.
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Garner MT, Ibanez K, Erkilinc M, Espina-Rey A, Ilgenfritz RM, Lovejoy JF, Malone JB. No Value Found With Routine Early Postoperative Radiographs after Implant Removal in Pediatric Patients. J Am Acad Orthop Surg 2024; 32:396-400. [PMID: 38261769 DOI: 10.5435/jaaos-d-22-00883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 12/06/2023] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Implants are routinely removed in pediatric patients. Fracture through the prior implant site is a common worry after implant removal. Early post-implant removal radiographs are routinely used to evaluate the prior implant removal sites and to assess when a patient may return to normal activities. To our knowledge, the value of early, routine postoperative radiographs after elective implant removal in pediatric patients has not been studied. METHODS A retrospective patient cohort of pediatric patients who had implant removal from an extremity from 2017 to 2019 was used in this study. Data were collected for patient demographics, implant site, reason for primary surgery, complications, number of postoperative radiographs, radiation exposure, cost of imaging, and whether the postoperative plan was changed by imaging. RESULTS Two hundred ninety patients were included in the study. Postoperative plans were changed only in 0.69% of patients (n = 2) because of abnormal 2-week radiographs and 1.72% (n = 5) because of abnormal 6-week radiographs. However, the event's proportion difference (change of management) was not statically significant ( P = 0.182) between those who had a radiograph obtained and those who did not. The mean follow-up time was 16 months. The mean number of postoperative radiographs obtained was 3.74, the mean cost per radiograph was $103, and the mean postoperative radiation exposure was 1.34 mSv. No fractures were observed after implant removal. DISCUSSION A retrospective review of the value of early, postoperative radiographs after routine orthopaedic implant removal found that postoperative radiographs at 2 and 6 weeks did not change the postoperative plan for most of the patients. Postoperative radiographs have an average cost of $103, and radiation exposure equal to approximately 6 months of natural background radiation. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- M Tyrel Garner
- From the University of Central Florida College of Medicine, Orlando, FL (Garner and Ibanez), Department of Orthopedics, Nemours Children's Hospital Florida, Orlando, FL (Erkilinc, Espina-Rey, Ilgenfritz, Lovejoy, and Malone)
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Fleischhacker E, Sprecher CM, Milz S, Saller MM, Wirz R, Zboray R, Parrilli A, Gleich J, Siebenbürger G, Böcker W, Ockert B, Helfen T. Inflammatory tissue response in human soft tissue is caused by a higher particle load near carbon fiber-reinforced PEEK compared to titanium plates. Acta Biomater 2024; 180:128-139. [PMID: 38636789 DOI: 10.1016/j.actbio.2024.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 03/19/2024] [Accepted: 04/11/2024] [Indexed: 04/20/2024]
Abstract
Titanium as the leading implant material in locked plating is challenged by polymers such as carbon fiber-reinforced polyetheretherketone (CFR-PEEK), which became the focus of interest of researchers and manufacturers in recent years. However, data on human tissue response to these new implant materials are rare. Osteosynthesis plates and peri‑implant soft tissue samples of 16 healed proximal humerus fractures were examined (n = 8 CFR-PEEK, n = 8 titanium). Soft tissue was analyzed by immunohistochemistry and µCT. The entrapped foreign bodies were further examined for their material composition by FTIR. To gain insight into their origin and formation mechanism, explanted and new plates were evaluated by SEM, EDX, profilometry and HR-CT. In the peri‑implant soft tissue of the CFR-PEEK plates, an inflammatory tissue reaction was detected. Tissues contained foreign bodies, which could be identified as tantalum wires, carbon fiber fragments and PEEK particles. Titanium particles were also found in the peri‑implant soft tissue of the titanium plates but showed a less intense surrounding tissue inflammation in immunohistochemistry. The surface of explanted CFR-PEEK plates was rougher and showed exposed and broken carbon fibers as well as protruding and deformed tantalum wires, especially in used screw holes, whereas scratches were identified on the titanium plate surfaces. Particles were present in the peri‑implant soft tissue neighboring both implant materials and could be clearly assigned to the plate material. Particles from both plate materials caused detectable tissue inflammation, with more inflammatory cells found in soft tissue over CFR-PEEK plates than over titanium plates. STATEMENT OF SIGNIFICANCE: Osteosynthesis plates are ubiquitously used in various medical specialties for the reconstruction of bone fractures and defects and are therefore indispensable for trauma surgeons, ENT specialists and many others. The leading implant material are metals such as titanium, but recently implants made of polymers such as carbon fiber-reinforced polyetheretherketone (CFR-PEEK) have become increasingly popular. However, little is known about human tissue reaction and particle generation related to these new implant types. To clarify this question, 16 osteosynthesis plates (n = 8 titanium and n = 8 CFR-PEEK) and the overlying soft tissue were analyzed regarding particle occurrence and tissue inflammation. Tissue inflammation is clinically relevant for the development of scar tissue, which is discussed to cause movement restrictions and thus contributes significantly to patient outcome.
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Affiliation(s)
- E Fleischhacker
- Department of Orthopedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University Hospital, LMU Munich, Germany.
| | - C M Sprecher
- AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland
| | - S Milz
- Anatomische Anstalt der Ludwig-Maximilians-Universität, Pettenkoferstrasse 11, 80336 München, Germany
| | - M M Saller
- Department of Orthopedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University Hospital, LMU Munich, Germany
| | - R Wirz
- RMS Foundation, Bischmattstrasse 12, 2544, Bettlach, Switzerland
| | - R Zboray
- EMPA, Überlandstrasse 129, Dübendorf, Switzerland
| | - A Parrilli
- EMPA, Überlandstrasse 129, Dübendorf, Switzerland
| | - J Gleich
- Department of Orthopedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University Hospital, LMU Munich, Germany
| | - G Siebenbürger
- Department of Orthopedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University Hospital, LMU Munich, Germany
| | - W Böcker
- Department of Orthopedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University Hospital, LMU Munich, Germany
| | - B Ockert
- Department of Orthopedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University Hospital, LMU Munich, Germany
| | - T Helfen
- Department of Orthopedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University Hospital, LMU Munich, Germany
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Khan ST, Pasqualini I, Mesko N, McLaughlin J, Brooks PJ, Piuzzi NS. Conversion Birmingham Hip Resurfacing in Managing Post-traumatic Arthritis With Retained Femoral Hardware: A Case Report. JBJS Case Connect 2024; 14:01709767-202406000-00053. [PMID: 38870321 DOI: 10.2106/jbjs.cc.23.00559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2024]
Abstract
CASE A 70-year-old man with a year-long history of arthritic pain in his left hip presented to our clinic. He had a left intertrochanteric hip fracture 6 years ago, fixed with an open reduction internal fixation with a cephalomedullary nail. He underwent a conversion Birmingham Hip Resurfacing (BHR) with removal of the proximal helicoidal blade and retention of the intramedullary nail. At 7-year follow-up, the patient reported satisfactory clinical outcomes and excellent radiographic fixation. CONCLUSION This case highlights using conversion BHR in patients with post-traumatic arthritis with retained femoral hardware as an alternative to conventional total hip arthroplasty.
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Affiliation(s)
- Shujaa T Khan
- Cleveland Clinic Adult Reconstruction Research (CCARR), Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
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13
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AlOmran AK, Alosaimi N, Alshaikhi AA, Bakhurji OM, Alzahrani KJ, Salloot BZ, Alabduladhem TO, AlMulhim AI, Alumran A. Burden of routine orthopedic implant removal a single center retrospective study. World J Orthop 2024; 15:139-146. [PMID: 38464354 PMCID: PMC10921180 DOI: 10.5312/wjo.v15.i2.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 12/18/2023] [Accepted: 01/09/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Open reduction and internal fixation represent prevalent orthopedic procedures, sparking ongoing discourse over whether to retain or remove asymptomatic implants. Achieving consensus on this matter is paramount for orthopedic surgeons. This study aims to quantify the impact of routine implant removal on patients and healthcare facilities. A retrospective analysis of implant removal cases from 2016 to 2022 at King Fahad Hospital of the University (KFHU) was conducted and subjected to statistical scrutiny. Among these cases, 44% necessitated hospitalization exceeding one day, while 56% required only a single day. Adults exhibited a 55% need for extended hospital stays, contrasting with 22.8% among the pediatric cohort. The complication rate was 6%, with all patients experiencing at least one complication. Notably, 34.1% required sick leave and 4.8% exceeded 14 d. General anesthesia was predominant (88%). Routine implant removal introduces unwarranted complications, particularly in adults, potentially prolonging hospitalization. This procedure strains hospital resources, tying up the operating room that could otherwise accommodate critical surgeries. Clearly defined institutional guidelines are imperative to regulate this practice. AIM To measure the burden of routine implant removal on the patients and hospital. METHODS This is a retrospective analysis study of 167 routine implant removal cases treated at KFHU, a tertiary hospital in Saudi Arabia. Data were collected in the orthopedic department at KFHU from February 2016 to August 2022, which includes routine asymptomatic implant removal cases across all age categories. Nonroutine indications such as infection, pain, implant failure, malunion, nonunion, restricted range of motion, and prominent hardware were excluded. Patients who had external fixators removed or joints replaced were also excluded. RESULTS Between February 2016 and August 2022, 360 implants were retrieved; however, only 167 of those who met the inclusion criteria were included in this study. The remaining implants were rejected due to exclusion criteria. Among the cases, 44% required more than one day in the hospital, whereas 56% required only one day. 55% of adults required more than one day of hospitalization, while 22.8% of pediatric patients required more than one day of inpatient care. The complication rate was 6%, with each patient experiencing at least one complication. Sick leave was required in 34.1% of cases, with 4.8% requiring more than 14 d. The most common type of anesthesia used in the surgeries was general anesthesia (88%), and the mean (SD) surgery duration was 77.1 (54.7) min. CONCLUSION Routine implant removal causes unnecessary complications, prolongs hospital stays, depletes resources and monopolizing operating rooms that could serve more critical procedures.
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Affiliation(s)
- Ammar K AlOmran
- Department of Orthopedic, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
| | - Nader Alosaimi
- Department of Orthopedic, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
| | - Ahmed A Alshaikhi
- Department of Orthopedic, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
| | - Omar M Bakhurji
- Department of Orthopedic, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
| | - Khalid J Alzahrani
- Department of Orthopedic, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
| | - Basil Ziyad Salloot
- Department of Orthopedic, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
| | - Tamim Omar Alabduladhem
- Department of Orthopedic, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
| | - Ahmed I AlMulhim
- Department of Orthopedic, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
| | - Arwa Alumran
- Health Information Management and Technology Department, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
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14
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Hambrecht J, Canal C, Klingebiel F, Pfammatter C, Teuben M, Neuhaus V, Pape HC, Kalbas Y, Hierholzer C. Elective implant removal in the upper extremity: only symptomatic patients benefit. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1153-1161. [PMID: 37982914 PMCID: PMC10858111 DOI: 10.1007/s00590-023-03777-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 11/01/2023] [Indexed: 11/21/2023]
Abstract
PURPOSE Elective implant removal (IR) in the upper extremity remains controversial. Implants in the olecranon and clavicle are commonly removed for prominence, unlike in the distal radius. Patient-reported symptomatic cannot be verified, and nonspecific discomfort remains unquantified. In this study, indications and outcomes of IR at the clavicle, olecranon and distal radius were evaluated, with a focus on postoperative patient satisfaction. MATERIALS AND METHODS In this retrospective, single-center cohort study, patients, who received elective IR of the clavicle, olecranon and distal radius were included. Patients were followed up at least six weeks after IR. Outcomes included patient satisfaction, symptom resolution, and complications. RESULTS One hundred and eighty-nine patients were included. Unspecific symptoms of discomfort were the most prevalent indication for IR (48.7%), followed by pain (29.6%) and objective limited range of motion (ROM) (7%). Pain and limited ROM combined was observed in 13.8%. Subjective benefit following IR was described in 54%. Patients with limited ROM (OR 4.7, p < 0.001) or pain (OR 4.1, p < 0.001) were more likely to experience alleviation of complaints. Patients with unspecific symptoms of discomfort, often did not report improvement. Major complications occurred in 2%. Refractures were detected at the clavicle (3.7%) and at the olecranon (2.5%). Minor complication rate was 5%. CONCLUSION IR is a safe procedure in the upper extremity. Indications based on unspecific symptoms of discomfort have a significant lower rate of patient satisfaction postoperatively. Elective IR should be considered cautiously, if it is driven primarily by unspecific symptoms of discomfort. Patient education is relevant to prevent dissatisfying outcome.
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Affiliation(s)
- Jan Hambrecht
- Department of Trauma Surgery, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.
- Department of Surgical Research, Harald Tscherne Laboratory for Orthopaedic and Trauma Research, Zurich University Hospital, Zurich, Switzerland.
| | - Claudio Canal
- Department of Trauma Surgery, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
- Department of Surgical Research, Harald Tscherne Laboratory for Orthopaedic and Trauma Research, Zurich University Hospital, Zurich, Switzerland
| | - Felix Klingebiel
- Department of Trauma Surgery, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
- Department of Surgical Research, Harald Tscherne Laboratory for Orthopaedic and Trauma Research, Zurich University Hospital, Zurich, Switzerland
| | - Cyrill Pfammatter
- Department of Trauma Surgery, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
- Department of Surgical Research, Harald Tscherne Laboratory for Orthopaedic and Trauma Research, Zurich University Hospital, Zurich, Switzerland
| | - Michel Teuben
- Department of Trauma Surgery, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
- Department of Surgical Research, Harald Tscherne Laboratory for Orthopaedic and Trauma Research, Zurich University Hospital, Zurich, Switzerland
| | - Valentin Neuhaus
- Department of Trauma Surgery, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
- Department of Surgical Research, Harald Tscherne Laboratory for Orthopaedic and Trauma Research, Zurich University Hospital, Zurich, Switzerland
| | - Hans-Christoph Pape
- Department of Trauma Surgery, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
- Department of Surgical Research, Harald Tscherne Laboratory for Orthopaedic and Trauma Research, Zurich University Hospital, Zurich, Switzerland
| | - Yannik Kalbas
- Department of Trauma Surgery, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
- Department of Surgical Research, Harald Tscherne Laboratory for Orthopaedic and Trauma Research, Zurich University Hospital, Zurich, Switzerland
| | - Christian Hierholzer
- Department of Trauma Surgery, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
- Department of Surgical Research, Harald Tscherne Laboratory for Orthopaedic and Trauma Research, Zurich University Hospital, Zurich, Switzerland
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15
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Lewis AJ, Barker EP, Griswold BG, Blair JA, Davis JM. Pelvic Ring Fracture Management and Subsequent Pregnancy: A Summary of Current Literature. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202402000-00005. [PMID: 38323930 PMCID: PMC10849384 DOI: 10.5435/jaaosglobal-d-23-00203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 12/12/2023] [Accepted: 12/18/2023] [Indexed: 02/08/2024]
Abstract
INTRODUCTION The incidence of pelvic ring injuries is 34.3% per 100,000 capita. No studies have determined the ability of a female patient to have a vaginal delivery after undergoing pelvic fracture fixation. However, many obstetricians are generally unwilling to have their patients attempt a vaginal delivery in the setting of symphyseal or sacroiliac fixation. METHODS An exhaustive search of the National Library of Medicine database was performed, and it is hypothesized that cesarean section rates would be higher for women who have a child after one of these pelvic ring injuries. RESULTS There is a 15% increase in cesarean rates using data from the National Center for Health Statistics. In addition, there is an observable increase in new cesarean rates. DISCUSSION Currently, there is no clear evidence to support an elective cesarean section as the sole indication after a prior pelvic fracture. To date, no studies have determined the ability of a female patient to have a vaginal delivery after undergoing pelvic fracture fixation. CONCLUSION Thus, until the increased cesarean section rate has been explained, it could be problematic to counsel the patient to avoid a vaginal delivery after sustaining a pelvic ring fracture. Hence, conducting additional studies on this topic would deem to be necessary.
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Affiliation(s)
- Allison J Lewis
- From the Medical College of Georgia at Augusta University, Augusta, GA (Ms. Lewis); the University of South Carolina School of Medicine, Columbia, SC (Ms. Barker); the Western Orthopaedics, Denver, CO (Dr. Griswold); the Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA (Dr. Blair); and the Department of Orthopaedics and Rehabilitation, Penn State College of Medicine, Hershey, PA (Dr. Davis)
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16
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Kasai Y, Okabayashi R, Aoki K. Femoral Shaft Fracture Developed Late-Onset Infection in 27 Years after Intramedullary Nailing: A Case Report. J Long Term Eff Med Implants 2024; 34:13-17. [PMID: 38505888 DOI: 10.1615/jlongtermeffmedimplants.2023048585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
Postoperative late-onset infections more than 1 year after intramedullary nail surgery for femoral shaft fractures are very rare. We show an extremely rare case of developed late-onset infection 27 years after surgery, report on risk factors for late-onset infection, and infer why the infection occurred.
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Affiliation(s)
| | - Ryo Okabayashi
- Department of Orthopaedic Surgery, Aoyama General Hospital, Toyokawa City, Aichi Prefecture, Japan
| | - Kentaro Aoki
- Department of Orthopaedic Surgery, Aoyama General Hospital, Toyokawa City, Aichi Prefecture, Japan
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17
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Wang W, Mei Q, Guo Y, He B, Mei H, Li Y, Canavese F, Chen S. The Duration of Hardware Retention After Radiologic Union of Surgically Treated Femoral Neck Fractures in Children May Predict the Aggravation or Occurrence of Avascular Necrosis of the Femoral Head or Neck After Hardware Removal. J Pediatr Orthop 2024; 44:e7-e14. [PMID: 37737685 DOI: 10.1097/bpo.0000000000002523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
BACKGROUND The incidence of aggravation or occurrence of avascular necrosis (AVN) following hardware removal in surgically treated pediatric femoral neck fractures who achieved radiologic consolidation is unknown. This study aimed to investigate the risk factors for this complication. METHODS Seventy-one pediatric (mean age: 9.8±3.9 y) were retrospectively analyzed. Risk factors (age, sex, laterality, severity of initial displacement, type of fracture, time from trauma to reduction, reduction and fixation method, quality of reduction, time required to achieve radiologic union, duration of hardware retention, presence of AVN before hardware removal and follow-up time) were recorded. The severity of AVN was assessed based on radiographs with Ratliff's classification. RESULTS Following hardware removal, the aggravation/occurrence of AVN was detected in 11 hips (15.5%). Among the 5 hips (7%) with aggravation of AVN, 1 (1.4%) with type II AVN and 3 (4.2%) with type III AVN exhibited aggravation of type I AVN, while the remaining hip (1.4%; type I) showed enlargement of the involved AVN area. Six hips (8.5%) developed AVN following hardware removal: 2 (2.8%) were classified as type I and 4 (5.6%) as type III. Receiver operating characteristic curve analysis indicated that hardware retention >7 months after union is associated with a decreased rate of aggravation or occurrence of AVN of the femoral neck or head following hardware removal. CONCLUSIONS The incidence of aggravation or occurrence of AVN following hardware removal in surgically treated pediatric femoral neck fractures is 15.5%; hardware retention >7 months after radiologic union may reduce the risk of aggravation or occurrence of AVN of the femoral neck or head postimplant removal. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- WenTao Wang
- Scientific Research Center, The Seventh Affiliated Hospital, Sun Yat-sen University
| | - QianQian Mei
- Department of Pediatric Orthopedics, Shenzhen Children's Hospital, Shenzhen
| | - YueMing Guo
- Department of Pediatric Orthopaedics, Foshan Hospital of Traditional Chinese Medicine, Foshan
| | - Bo He
- Department of Pediatric Orthopaedics, Children's Hospital of Chongqing Medical University, Chongqing
| | - HaiBo Mei
- Department of Pediatric Orthopaedics, Hunan Children's Hospital, Hunan
| | - YiQiang Li
- Department of Pediatric Orthopaedics, Guangzhou Women and Children's Medical Center, GuangZhou Medical University, Guangzhou
| | - Federico Canavese
- Department of Pediatric Orthopaedics, Lille University Center, Jeanne de Flandre Hospital, Lille cedex, France
| | - ShunYou Chen
- Department of Pediatric Orthopaedics, FuZhou Second Hospital, FuZhou, China
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18
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Okwesili IC, Enweani UN, Muoghalu ON, Okwara BO, Ogbu DC, Anagor AA, Ekwedigwe HC. Nail-extraction device mismatch: an issue in developing countries intramedullary nail removal practice. INTERNATIONAL ORTHOPAEDICS 2024; 48:261-265. [PMID: 37938321 DOI: 10.1007/s00264-023-06025-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 10/23/2023] [Indexed: 11/09/2023]
Abstract
PURPOSE Intramedullary nail is the gold standard in the management of long bone diaphyseal fractures of tibia and femur. The jig of these nails has corresponding extraction device whose pitch for nail coupling come in various sizes. This unlike plate and screws may be difficult to predict preoperatively and may pose a problem during removal. Difficulties in removal may arise due to the proliferation of nail brands especially in developing countries. The study aims to identify the incidence of extraction device mismatch among orthopaedic surgeons in Nigeria as well as the indications and complications associated with intramedullary nail removal. METHODS A two-page questionnaire was administered to 87 orthopaedic surgeons attending the Annual General Meeting of the Nigerian Medical Association. The attitudes of the participants towards intramedullary nail were assessed. RESULTS All participants agree to asymptomatic removal. Patients wish was the leading indication for asymptomatic removal among the participants. Sixty-one percent of the surgeons have had the need to remove a nail different from the brand in the hospital their practice. The commonest indication for symptomatic removal was infections. Forty-seven percent of the participant encountered nail extraction-device mismatch. CONCLUSIONS The incidence of extraction device mismatch may portend a public health issue. There may be need for patient who had intra medullary nail insertion to be told their brand. We advocate for standardization of extraction device pitch for intramedullary nail.
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Affiliation(s)
- Ikechukwu C Okwesili
- Department of Surgery, College of Medicine University of Nigeria, Ituku Ozalla, Enugu, Nigeria.
- Department of Orthopaedics, University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu, Nigeria.
| | | | - Obiora N Muoghalu
- Department of Orthopaedics and Traumatology, National Orthopaedic Hospital, Enugu, Nigeria
| | - Blasius O Okwara
- Department of Orthopaedics, University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu, Nigeria
| | - Damian C Ogbu
- Department of Orthopaedics and Traumatology, National Orthopaedic Hospital, Enugu, Nigeria
| | - Anthony A Anagor
- Department of Orthopaedics, Alex Ekwueme Federal Teaching Hospital, Abakiliki, Ebonyi, Nigeria
| | - Henry C Ekwedigwe
- Department of Orthopaedics and Traumatology, National Orthopaedic Hospital, Enugu, Nigeria
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19
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Kim SH, Lee SH, Lee YK. The Clinical Outcomes of Syndesmotic Flexible Fixation for Syndesmotic Injury With Ankle Fracture. Foot Ankle Int 2023; 44:1112-1119. [PMID: 37679997 DOI: 10.1177/10711007231194045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
BACKGROUND We evaluated whether the quality of syndesmotic reduction affects the short-term clinical outcomes of flexible fixation in patients with a rotational ankle fracture. METHODS This study included 59 patients (32 men and 27 women) who underwent syndesmotic flexible fixation. The degree of syndesmotic reduction was evaluated on computed tomography (CT) images acquired within 3 days after surgery. We measured the divergence between anterior and posterior incisura at 1 cm above the distal tibial articular joint, then evaluated the degree of fibular rotation relative to the tibia. At 1 year after surgery, an objective clinical evaluation was performed using the American Orthopaedic Foot & Ankle Society (AOFAS) score, the visual analog scale (VAS), and the Foot and Ankle Outcome Score (FAOS). Additionally, repeat arthroscopy was performed during routine implant removal at nearly 1 year postoperatively. RESULTS Among 59 patients who underwent syndesmotic flexible fixation, 56 patients had syndesmotic stability on repeat arthroscopy. At 1 year postoperation, AOFAS, VAS, and FAOS scores were, respectively, 90, 2.0, and 94 in the accurate reduction group (n = 24) and 90, 1.0, and 94.5 in the malreduction group (n = 35). CONCLUSION Reduction quality after syndesmotic injury with flexible fixation, as determined by early postoperative CT imaging, did not affect patient prognosis. In this cohort, syndesmotic reduction and flexible fixation may produce good clinical outcomes in patients with syndesmotic injury and ankle fracture. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
- Sung Hwan Kim
- Department of Orthopaedic Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| | - Sang Heon Lee
- Department of Orthopaedic Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| | - Young Koo Lee
- Department of Orthopaedic Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
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20
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ALJuhani W, Almusallam MH, Almosa MS, Bin Dukhi MM, Bin Akrish AM, Alaraidh SA, Alanazi A. Etiologies of Orthopedic Implant Removal Among Patients Who Underwent Orthopedic Fixation Surgeries in King Abdulaziz Medical City. Cureus 2023; 15:e43809. [PMID: 37731419 PMCID: PMC10508870 DOI: 10.7759/cureus.43809] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND Hardware removal surgeries are considerably common. However, the justifications for these surgeries are debatable. The indications may vary from pain, surgical site infection, or failure of osteosynthesis. Additionally, the surgery can be performed without medical indication. Following these surgeries, many complications can occur. Therefore, surgeons and patients should be aware of the appropriate indications and have realistic expectations of the risks and benefits of implant removal. METHODS This was a retrospective chart review study. We included all patients aged 17-86 years who underwent hardware removal surgery in the orthopedic surgery department of King Abdulaziz Medical City, Riyadh, Saudi Arabia, from 2010 to 2019. All relevant data, such as demographic characteristics, location and type of hardware, indication for hardware removal, duration between insertion and removal, and complications after removal were recorded and analyzed. RESULTS A total of 244 medical records were reviewed with a mean patient age of 34 years. Out of the total, 190 patients (77.9%) were male. The femur was the most common location of hardware removal, in 50 cases (20.58%). Plates and screws were the most common type of implants (40.2%). Most patients underwent hardware implantation because of fractures (89.3%). In total, 119 patients (48.8%) had the hardware removed electively. Only 29 patients (12%) reported postoperative complications; 190 patients (77.9%) were advised by their surgeon against hardware removal. CONCLUSION Hardware removal procedures are commonly performed worldwide for various reasons, including infection, pain, and loosening. In this study, we have outlined the reasons for implant removal, the locations, complications, and the rationale behind this surgery. We have provided a new decision-making assessment, aimed at the general population and surgeons alike, that will help patients better comprehend the complications and risks associated with this elective surgery.
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Affiliation(s)
- Wazzan ALJuhani
- Department of Surgery, Ministry of the National Guard - Health Affairs, Riyadh, SAU
- Department of Surgery, King Abdullah International Medical Research Center, Riyadh, SAU
- Department of Surgery, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Mohammed H Almusallam
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Mohammad S Almosa
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Musaad M Bin Dukhi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Abdulaziz M Bin Akrish
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Soliman A Alaraidh
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Abdullah Alanazi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
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Ben Amara H, Martinez DC, Shah FA, Loo AJ, Emanuelsson L, Norlindh B, Willumeit-Römer R, Plocinski T, Swieszkowski W, Palmquist A, Omar O, Thomsen P. Magnesium implant degradation provides immunomodulatory and proangiogenic effects and attenuates peri-implant fibrosis in soft tissues. Bioact Mater 2023; 26:353-369. [PMID: 36942009 PMCID: PMC10024189 DOI: 10.1016/j.bioactmat.2023.02.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 02/01/2023] [Accepted: 02/14/2023] [Indexed: 03/17/2023] Open
Abstract
Implants made of magnesium (Mg) are increasingly employed in patients to achieve osteosynthesis while degrading in situ. Since Mg implants and Mg2+ have been suggested to possess anti-inflammatory properties, the clinically observed soft tissue inflammation around Mg implants is enigmatic. Here, using a rat soft tissue model and a 1-28 d observation period, we determined the temporo-spatial cell distribution and behavior in relation to sequential changes of pure Mg implant surface properties and Mg2+ release. Compared to nondegradable titanium (Ti) implants, Mg degradation exacerbated initial inflammation. Release of Mg degradation products at the tissue-implant interface, culminating at 3 d, actively initiated chemotaxis and upregulated mRNA and protein immunomodulatory markers, particularly inducible nitric oxide synthase and toll-like receptor-4 up to 6 d, yet without a cytotoxic effect. Increased vascularization was demonstrated morphologically, preceded by high expression of vascular endothelial growth factor. The transition to appropriate tissue repair coincided with implant surface enrichment of Ca and P and reduced peri-implant Mg2+ concentration. Mg implants revealed a thinner fibrous encapsulation compared with Ti. The detailed understanding of the relationship between Mg material properties and the spatial and time-resolved cellular processes provides a basis for the interpretation of clinical observations and future tailoring of Mg implants.
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Affiliation(s)
- Heithem Ben Amara
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Diana C. Martinez
- Biomaterials Group, Materials Design Division, Faculty of Materials Science and Engineering, Warsaw University of Technology, Warsaw, Poland
| | - Furqan A. Shah
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anna Johansson Loo
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lena Emanuelsson
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Birgitta Norlindh
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Tomasz Plocinski
- Biomaterials Group, Materials Design Division, Faculty of Materials Science and Engineering, Warsaw University of Technology, Warsaw, Poland
| | - Wojciech Swieszkowski
- Biomaterials Group, Materials Design Division, Faculty of Materials Science and Engineering, Warsaw University of Technology, Warsaw, Poland
| | - Anders Palmquist
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Omar Omar
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Peter Thomsen
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Corresponding author. Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg Box 412, SE-405 30, Gothenburg, Sweden.
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22
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Böker KO, Gätjen L, Dölle C, Vasic K, Taheri S, Lehmann W, Schilling AF. Reduced Cell Adhesion on LightPLAS-Coated Implant Surfaces in a Three-Dimensional Bioreactor System. Int J Mol Sci 2023; 24:11608. [PMID: 37511369 PMCID: PMC10380481 DOI: 10.3390/ijms241411608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 07/03/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023] Open
Abstract
Most implants used in trauma surgery are made of steel and remain inside the body only temporarily. The strong tissue interaction of such implants sometimes creates problems with their explantation. Modified implant surfaces, which decrease tissue attachment, might allow an easier removal and therefore a better outcome. Such a modification must retain the implant function, and needs to be biocompatible and cost-effective. Here, we used a novel VUV-light (Vacuum-Ultraviolett)-based coating technology (LightPLAS) to generate coated stainless-steel plates. The tested LightPLAS coating only had an average thickness of around 335 nm, making it unlikely to interfere with implant function. The coated plates showed good biocompatibility according to ISO 10993-5 and ISO 10993-12, and reduced cell adhesion after four different time points in a 2D cell culture system with osteoblast-like MG-63 cells. Furthermore, we could show decreased cell adhesion in our 3D cell culture system, which mimics the fluid flow above the implant materials as commonly present in the in vivo environment. This new method of surface coating could offer extended options to design implant surfaces for trauma surgery to reduce cell adhesion and implant ingrowth. This may allow for a faster removal time, resulting in shorter overall operation times, thereby reducing costs and complication rates and increasing patient wellbeing.
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Affiliation(s)
- Kai Oliver Böker
- Department of Trauma Surgery, Orthopaedics and Plastic Surgery, University Medical Center Goettingen, Georg-August-University, 37075 Goettingen, Germany
| | - Linda Gätjen
- Fraunhofer Institute for Manufacturing Technology and Advanced Materials IFAM, 28359 Bremen, Germany
| | - Christopher Dölle
- Fraunhofer Institute for Manufacturing Technology and Advanced Materials IFAM, 28359 Bremen, Germany
| | - Katarina Vasic
- Department of Trauma Surgery, Orthopaedics and Plastic Surgery, University Medical Center Goettingen, Georg-August-University, 37075 Goettingen, Germany
| | - Shahed Taheri
- Department of Trauma Surgery, Orthopaedics and Plastic Surgery, University Medical Center Goettingen, Georg-August-University, 37075 Goettingen, Germany
| | - Wolfgang Lehmann
- Department of Trauma Surgery, Orthopaedics and Plastic Surgery, University Medical Center Goettingen, Georg-August-University, 37075 Goettingen, Germany
| | - Arndt Friedrich Schilling
- Department of Trauma Surgery, Orthopaedics and Plastic Surgery, University Medical Center Goettingen, Georg-August-University, 37075 Goettingen, Germany
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23
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Li Y, Jiang K, Zhao T, Guo X, Liu K, Zhao Y. If we should remove internal fixation devices for rib fractures? J Cardiothorac Surg 2023; 18:214. [PMID: 37403105 DOI: 10.1186/s13019-023-02330-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 06/29/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Internal fixation for rib fractures has been widely carried out worldwide, and its surgical efficacy has been recognized. However, there is still controversy about whether implant materials need to be removed. At present, the research on this topic is still lacking at home and abroad. Therefore, in this study, the patients undergoing removal of internal fixation for rib fractures in our department within one year were followed up, to statistically analyze implant-related complications, postoperative complications and postoperative remission rate. METHODS A retrospective analysis was conducted on 143 patients undergoing removal of internal fixation for rib fractures from 2020 to 2021 in our center. The implant-related complications, postoperative complications and postoperative remission rate of patients with internal fixation were analyzed. RESULTS In this study, a total of 143 patients underwent removal of internal fixation, among which 73 suffered from preoperative implant-related complications (foreign-body sensation, pain, wound numbness, sense of tightness, screw slippage, chest tightness, implant rejection), and 70 had no post operative discomfort but asked for removal of internal fixation. The average interval between rib fixation and removal was 17 ± 9.00 (months), and the average number of removed materials was 5.29 ± 2.42. Postoperative complications included wound infection (n = 1) and pulmonary embolism (n = 1). of the 73 patients with preoperative implant-related complications, the mean postoperative remission rate was 82%. Among the 70 patients without preoperative discomfort, the proportion of discomforts after removal was 10%. No perioperative death occurred. CONCLUSION For patients with internal fixation for rib fractures, removal of internal fixation can be considered in the case of implant-related complications after surgery. The corresponding symptoms can be relieved after removal. The removal presents low complication rate, and high safety and reliability. For patients without obvious symptoms, it is safe to retain the internal fixation in the body. For the asymptomatic patients who ask for removal of internal fixation, the possible risk of complications should be fully informed before removal.
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Affiliation(s)
- Yang Li
- Department of Thoracic surgery, Shanghai Sixth People's Hospital, Shanghai, China
| | - Kaile Jiang
- Department of Thoracic surgery, Shanghai Sixth People's Hospital, Shanghai, China
| | - Tiancheng Zhao
- Department of Thoracic surgery, Shanghai Sixth People's Hospital, Shanghai, China.
| | - Xiang Guo
- Department of Thoracic surgery, Shanghai Sixth People's Hospital, Shanghai, China
| | - Kaibin Liu
- Department of Thoracic surgery, Shanghai Sixth People's Hospital, Shanghai, China
| | - Yonghong Zhao
- Department of Thoracic surgery, Shanghai Sixth People's Hospital, Shanghai, China
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24
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Mavrommatis S, LaRoque MC, Yang G, Brahme IS, Cole PA. Does the Option to Keep Explanted Orthopaedic Trauma Implants Influence Patient Satisfaction and Perception of Care? Results of a Survey Study. J Orthop Trauma 2023; 37:e288-e293. [PMID: 36728021 DOI: 10.1097/bot.0000000000002573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/11/2023] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Orthopaedic trauma implants may be electively explanted after fracture healing; reasons include symptomatic implants, cosmetic/functional concerns, or personal expectations. Certain institutions provide the option to keep implants after removal, although this has been retracted in others. This study examines patients' desire for return of implants, reasons for desiring return, and influence of return on perceptions of care. METHODS A cohort of adult patients who underwent elective orthopaedic implant removal by a single surgeon at a Level I trauma center between 2008 and 2019, with the option to keep their removed implants, was identified. Surveys were sent to patients with contact information. Demographics, reasons for removal, satisfaction, and perceptions of care were studied. RESULTS The overall response rate was 47.4% (117 of 247). Respondents' mean age was 46.9 years, and 50% were female. Ninety-one percent kept their implants. Eighty-nine percent of patients felt that removal achieved their desired outcome, with decreasing pain cited as primary motivation for explantation (62%). Forty-five percent reported a strong desire to keep their implants, most commonly to show to family (49%). Seventy-four percent were happy to have this option. Thirty-seven percent of patients reported respecting their provider more for having this option, and 27% reported that this positively impacted their satisfaction. CONCLUSIONS Patients perceive elective implant removal as highly effective. A majority were pleased to have the option to keep their implants, and many reported increased respect and satisfaction. Thus, providing patients with this option should be strongly considered to honor patient choice and optimize outcomes when feasible.
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Affiliation(s)
- Sophia Mavrommatis
- Department of Orthopaedic Surgery, Regions Hospital, St. Paul, MN
- Department of Orthopaedic Surgery, University of Minnesota Medical School, Minneapolis, MN; and
| | - Michael C LaRoque
- Department of Orthopaedic Surgery, Regions Hospital, St. Paul, MN
- Department of Orthopaedic Surgery, University of Minnesota Medical School, Minneapolis, MN; and
| | - Gaonhia Yang
- Department of Orthopaedic Surgery, Regions Hospital, St. Paul, MN
- Department of Orthopaedic Surgery, University of Minnesota Medical School, Minneapolis, MN; and
| | - Indraneel S Brahme
- Department of Orthopaedic Surgery, Regions Hospital, St. Paul, MN
- Department of Orthopaedic Surgery, University of Minnesota Medical School, Minneapolis, MN; and
| | - Peter A Cole
- Department of Orthopaedic Surgery, Regions Hospital, St. Paul, MN
- Department of Orthopaedic Surgery, University of Minnesota Medical School, Minneapolis, MN; and
- HealthPartners Orthopaedics & Sports Medicine, Bloomington, MN
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25
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The Necessity of Implant Removal after Fixation of Thoracolumbar Burst Fractures—A Systematic Review. J Clin Med 2023; 12:jcm12062213. [PMID: 36983216 PMCID: PMC10057639 DOI: 10.3390/jcm12062213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 02/24/2023] [Accepted: 02/27/2023] [Indexed: 03/14/2023] Open
Abstract
Background: Thoracolumbar burst fractures are a common traumatic vertebral fracture in the spine, and pedicle screw fixation has been widely performed as a safe and effective procedure. However, after the stabilization of the thoracolumbar burst fractures, whether or not to remove the pedicle screw implant remains controversial. This review aimed to assess the benefits and risks of pedicle screw instrument removal after fixation of thoracolumbar burst fractures. Methods: Data sources, including PubMed, EMBASE, Cochrane Library, Web of Science, Google Scholar, and Clinical trials.gov, were comprehensively searched. All types of human studies that reported the benefits and risks of implant removal after thoracolumbar burst fractures, were selected for inclusion. Clinical outcomes after implant removal were collected for further evaluation. Results: A total of 4051 papers were retrieved, of which 35 studies were eligible for inclusion in the review, including four case reports, four case series, and 27 observational studies. The possible risks of pedicle screw removal after fixation of thoracolumbar burst fractures include the progression of the kyphotic deformity and surgical complications (e.g., surgical site infection, neurovascular injury, worsening pain, revision surgery), while the potential benefits of pedicle screw removal mainly include improved segmental range of motion and alleviated pain and disability. Therefore, the potential benefits and possible risks should be weighed to support patient-specific clinical decision-making about the removal of pedicle screws after the successful fusion of thoracolumbar burst fractures. Conclusions: There was conflicting evidence regarding the benefits and harms of implant removal after successful fixation of thoracolumbar burst fractures, and the current literature does not support the general recommendation for removal of the pedicle screw instruments, which may expose the patients to unnecessary complications and costs. Both surgeons and patients should be aware of the indications and have appropriate expectations of the benefits and risks of implant removal. The decision to remove the implant or not should be made individually and cautiously by the surgeon in consultation with the patient. Further studies are warranted to clarify this issue. Level of evidence: level 1.
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26
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Kim JK, Shin YH, Kim M. Ultrasonographic evaluation of contact configuration between flexor pollicis longus tendon and the volar prominence of volar plate in patients with distal radius fracture. Arch Orthop Trauma Surg 2023; 143:1103-1108. [PMID: 35674821 DOI: 10.1007/s00402-022-04499-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 05/22/2022] [Indexed: 11/02/2022]
Abstract
INTRODUCTION We classified the contact configuration between the volar prominence of volar locking plate (VLP) and flexor pollicis longus (FPL) tendon using ultrasound (US) into indentation contact and smooth contact, and investigated whether the contact configuration is associated with the flexor tendon attrition. MATERIALS AND METHODS Ninety-four patients who underwent VLP removal were included in this study. We assessed pain using visual analogue scale, grip strength, and Disabilities of the Arm, Shoulder and Hand score for clinical evaluations, radial inclination, palmar tilt, ulnar variance, and Soong classification for radiological evaluations, and contact configuration using US at 1 year after VLP fixation. After these evaluations, we removed the VLP with observation for the presence of fibrillation or wear of FPL tendon substance. Subsequently, we classified the patients into either of FPL attrition and FPL intact group. RESULTS Twenty-eight patients had indentation contact configuration and 66 patients had smooth contact configuration. The kappa value for inter-observer reliability for the contact configuration was 0.78. Twelve patients were included in the FPL attrition group and 82 in the FPL intact group. There was no significant difference in clinical outcomes and Soong classification between the groups. However, palmar tilt of the flexor tendon attrition group was significantly lower than that of the flexor tendon intact group and the FPL attrition group showed significantly higher indentation contact configuration rate than the FPL intact group. FPL tendon attrition was diagnosed using the contact configuration on US with a sensitivity of 100% and specificity of 80%. CONCLUSION This study demonstrated that FPL tendon attrition was significantly associated with indentation contact on US with high sensitivity. Therefore, we recommend selective implant removal in patients with indentation contact configuration.
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Affiliation(s)
- Jae Kwang Kim
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic road 43-gil, Songpa-gu, Seoul, 05505, South Korea.
| | - Young Ho Shin
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic road 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Minsoo Kim
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic road 43-gil, Songpa-gu, Seoul, 05505, South Korea
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27
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Effectiveness of orthopedic implant removal surgery in patients with no implant-related symptoms after fracture union of isolated lower extremity shaft fractures: patient-centered evaluation. Arch Orthop Trauma Surg 2023; 143:107-114. [PMID: 34180004 DOI: 10.1007/s00402-021-03993-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 06/10/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Routine orthopedic implant removal surgery (OIRS) in patients with no implant-related symptoms after union is controversial. Various factors, such as various fracture sites, fracture types, and accompanying fractures at other sites, act as error variables in the evaluation of routine OIRS. The purpose of this study is to evaluate the benefits of orthopedic implant removal surgery (OIRS) in patients with no implant-related symptoms such as infection and soft tissue irritation after union of isolated lower extremity shaft fractures from a patient-centered evaluation MATERIALS AND METHODS: Eighty-four patients who achieved fracture union after internal fixation of femoral shaft or tibial shaft fractures (March 2004 to December 2018) and who showed no implant-related symptoms were evaluated retrospectively. Minimum post-OIRS follow-up period was 1 year. Thirty-eight patients were treated with intramedullary nail and 13 were treated with plate and screws for femoral shaft fracture. Twenty patients were treated with intramedullary nail and 13 were treated with plate and screws for tibial shaft fracture. All patients subsequently underwent OIRS. Quality of life (QoL) and lower extremity pain using visual analogue scale (VAS) were evaluated 1 day before OIRS. Patient satisfaction with the OIRS, VAS, and QoL were assessed at least 1 year after OIRS using the SF-36 questionnaire. RESULTS The physical component score, mental component score, and scores of all eight domains showed significant improvement after OIRS (p < 0.01). Patients with femoral shaft fractures tended to have lower pre- and post-OIRS SF-36 scores than those with tibial shaft fracture. Among patients with femoral shaft fracture, SF-36 scores were comparable in the nail and plate groups. Among patients with tibial shaft fracture, nail group showed relatively better QoL than the plate group, before and after OIRS in spite of several complications such as formation of scar tissue, nerve damage, and refracture. CONCLUSIONS Patients with no implant-related symptoms showed significant improvement in QoL and satisfaction after OIRS. This suggests that OIRS is beneficial from the patients' evaluation. LEVEL OF EVIDENCE Therapeutic Level II.
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28
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Titanium Internal Fixator Removal in Maxillofacial Surgery: Is It Necessary? A Systematic Review and Meta-Analysis. J Craniofac Surg 2023; 34:145-152. [PMID: 36217228 DOI: 10.1097/scs.0000000000009006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 07/29/2022] [Indexed: 01/11/2023] Open
Abstract
Titanium plates and screws are essential devices in maxillofacial surgery since late 1980s, but despite their wide use there is no consensus in titanium internal fixators removal after bone healing. A systematic literature review and meta-analysis were conducted on seventeen retrospective studies. Effect size and 95% confidence intervals were calculated for plate removal (per plate and per patient) and for removal causes (infection, pain, screws complications, exposition, palpability). Odds ratio, 95% confidence intervals, and χ 2 test were measured for sex, smoking, and implant site. Heterogeneity was evaluated with Cochran and Inconstancy test. Obtained data were used to design Forest and Funnel plots. The aim of the study is to identify and clarify reasons and risk factors for plates and screws removal. Infection is the most frequent reason; the habit of tobacco usage and implant site (mandibula) are the main risk factors. The administration of antibiotic prophylaxis is essential, and patients must quit smoking before and after surgery. In conclusion there is no scientific evidence supporting the removal of internal devices as mandatory step of the postoperative procedure.
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29
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Ahluwalia R, Yip G, Richter M, Maffulli N. Surgical controversies and current concepts in Lisfranc injuries. Br Med Bull 2022; 144:57-75. [PMID: 36151742 DOI: 10.1093/bmb/ldac020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 08/06/2022] [Accepted: 08/09/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Lisfranc injuries, not as rare as previously reported, range from ligamentous to complex fracture-dislocations. Anatomical studies have identified a complex of discrete structures, and defined the anatomical characteristics of the Lisfranc joint. SOURCES OF DATA A narrative evidence-based review encompassed and analyzed published systematic reviews. Outcomes included clinical and surgical decision-making, including clinical-presentation, diagnosis, pathological-assessment, surgical-management techniques and indications, post-surgical care and comparative outcomes. AREAS OF AGREEMENT Better understanding of the Lisfranc complex anatomy aids surgical treatment and tactics. Prognosis is related to injury severity, estimated by the number of foot columns affected. Surgical outcome is determined by anatomical reduction for most fixation and fusion techniques. Appropriate treatment allows return to sport, improving outcome scores. AREAS OF CONTROVERSY Identification of Lisfranc injuries may be improved by imaging modalities such as weight-bearing computer tomography. Recent evidence supports dorsal plate fixation as a result of better quality of reduction. In complex injuries, the use of combined techniques such as trans-articular screw and plate fixation has been associated with poorer outcomes, and fusion may instead offer greater benefits. GROWING POINTS Open reduction is mandatory if closed reduction fails, highlighting the importance of understanding surgical anatomy. If anatomical reduction is achieved, acute arthrodesis is a safe alternative to open reduction internal fixation in selected patients, as demonstrated by comparable outcomes in subgroup analysis. AREAS FOR DEVELOPING RESEARCH The current controversies in surgical treatment remain around techniques and outcomes, as randomized controlled trials are infrequent.
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Affiliation(s)
- Raju Ahluwalia
- Department of Orthopaedics, King's College Hospital, King's College Hospital NHS Foundation Trust, Bessemer Road, London, SE5 9RS, UK
| | - Grace Yip
- Department of Orthopaedics, King's College Hospital, King's College Hospital NHS Foundation Trust, Bessemer Road, London, SE5 9RS, UK
| | - Martinus Richter
- Department for Foot and Ankle Surgery Nuremberg and Rummelsberg, Hospital Rummelsberg, Rummelsberg 71, Schwarzenbruck 90592, Germany
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi, Salerno, Italy.,Centre for Sports and Exercise Medicine, Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, 275 Bancroft Road, London E1 4DG, UK.,School of Pharmacy and Bioengineering, Keele University School of Medicine, Thornburrow Drive, Stoke on Trent ST4 7QB, UK
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30
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Effect of screw tunnels on proximal femur strength after screw removal: A finite element analysis. Orthop Traumatol Surg Res 2022; 108:103408. [PMID: 36116705 DOI: 10.1016/j.otsr.2022.103408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 06/14/2022] [Accepted: 07/12/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND The presence of screw tunnels in the femoral neck is a problem for patients with proximal femoral fractures after removal of internal fixation. The question of how much does the existence of the screw tunnels affect the strength of the femur and whether the patient needs to be protected with an adjunctive device has been controversial. The objective of this finite element analysis was to determine (1) whether the screw tunnels affects normal weight bearing after removal of internal fixation of a proximal femur fracture, (2) which screw tunnels parameters affect the weight bearing capacity of the entire femur. HYPOTHESIS The presence of the screw tunnels reduces the load-bearing capacity of the femur, and the arrangement, diameter and wall thickness of the screw tunnels affect the load-bearing capacity of the femur. MATERIALS AND METHODS Twenty patients who underwent surgical treatment for proximal femur fracture at our hospital were included in the study. Computed tomography (CT) values of the screw tunnel wall in the femur after removal of internal fixations were analysed. Mimics v16.0 and Hypermesh v13.0 software programs were used to generate 3-dimensional (3D) tetrahedral finite element models of the proximal femur with different screw tunnel numbers, diameters, thicknesses, and arrangements. An acetabulum exerting a vertical pressure load of 600N on the femoral head was simulated and the force on various parts of the femur in each model was calculated. RESULTS There was no difference in the Hounsfield Units of the tunnel walls and cortical bone of the proximal femur (893.48±61.28 vs. 926.34±58.43; p=0.091). In each of the 3D models, the cancellous bone was the first structure to reach maximal stress. The compressive strength of the femur decreased with increasing thickness of the screw tunnel wall and decreased with increasing tunnel diameter. The femoral neck model with the inverted triangle screw tunnel arrangement had the highest compressive strength. DISCUSSION The femoral neck with screw tunnels can withstand day-to-day stress without special intervention. For femoral neck fractures fixed with cannulated screws, inverted triangle screws are recommended; For a single screw tunnel in the femoral neck, the larger the diameter of the femoral neck internal screw channel, the weaker the load-bearing capacity of the femur. LEVEL OF EVIDENCE III; well-designed computational non-experimental study.
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31
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Padgett AM, Howie CM, Sanchez TC, Cimino A, Williams KA, Gilbert SR, Conklin MJ. Pediatric fractures following implant removal: A systematic review. J Child Orthop 2022; 16:488-497. [PMID: 36483642 PMCID: PMC9723876 DOI: 10.1177/18632521221138376] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 10/26/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To evaluate the available literature for postoperative fracture rates following implant removal in the pediatric population. METHODS A systematic review of articles in the PubMed and Embase computerized literature databases from January 2000 to June 2022 was performed using PRISMA guidelines. Randomized controlled trials, case-control studies, cohort studies (retrospective and prospective), and case series involving pediatric patients that included data on fracture rate following removal of orthopedic implants were eligible for review. Two authors independently extracted data from selected studies for predefined data fields for implant type, anatomic location of the implant, indication for implantation, fracture or refracture rate following implant removal, mean time to implant removal, and mean follow-up time. RESULTS Fifteen studies were included for qualitative synthesis. Reported fracture rates following implant removal vary based on several factors, with an overall reported incidence of 0%-14.9%. The available literature did not offer sufficient data for conduction of a meta-analysis. CONCLUSION Our systematic review demonstrates that fracture following implant removal in pediatric patients is a relatively frequent complication. In children, the forearm and femur are the most commonly reported sites of fracture following removal of implants. Traumatic fractures treated definitively with external fixation have the highest reported aggregate rate of refracture. Knowledge of the incidence of this risk is important for orthopedic surgeons. There remains a need for well-designed studies and trials to further clarify the roles of the variables that contribute to this complication.
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Affiliation(s)
- Anthony M Padgett
- Department of Orthopaedic Surgery, The University of Alabama at Birmingham, Birmingham, AL, USA,Anthony M Padgett, Department of Orthopaedic Surgery, The University of Alabama at Birmingham, Lowder Building, Ste. 316, 1600 7th Ave. South, Birmingham, AL 35233, USA.
| | - Cole M Howie
- Department of Orthopaedic Surgery, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Thomas C Sanchez
- Department of Orthopaedic Surgery, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Addison Cimino
- Department of Orthopaedic Surgery, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kevin A Williams
- Department of Orthopaedic Surgery, The University of Alabama at Birmingham, Birmingham, AL, USA,Division of Orthopedic Surgery, Children’s of Alabama, Birmingham, AL, USA
| | - Shawn R Gilbert
- Department of Orthopaedic Surgery, The University of Alabama at Birmingham, Birmingham, AL, USA,Division of Orthopedic Surgery, Children’s of Alabama, Birmingham, AL, USA
| | - Michael J Conklin
- Department of Orthopaedic Surgery, The University of Alabama at Birmingham, Birmingham, AL, USA,Division of Orthopedic Surgery, Children’s of Alabama, Birmingham, AL, USA
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32
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Mathew SE, Malyavko A, Tabaie S. Simultaneous Bilateral Proximal Femur Implant Failure: A Case Report. Cureus 2022; 14:e32543. [PMID: 36531788 PMCID: PMC9752960 DOI: 10.7759/cureus.32543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2022] [Indexed: 12/23/2022] Open
Abstract
A seven-year-old boy with Moebius syndrome and bilateral hip dysplasia underwent left-sided adductor lengthening, bilateral proximal femur varus derotational osteotomies, and internal fixation with proximal femur blade plates, and left-sided Dega pelvic osteotomy. Postoperatively, he was immobilized in a Petrie cast. A month later, the child presented with bilateral proximal femur blade plate implant failure. Simultaneous bilateral proximal femur implant failure in a child, to our knowledge, has not yet been reported. Implant failure in the absence of significant trauma is rare. We describe various contributory factors that may lead to implant failure which must be carefully considered while managing a non-ambulatory child.
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Affiliation(s)
- Smitha E Mathew
- Orthopaedic Surgery and Sports Medicine, Children's National Hospital, Washington, DC, USA
| | - Alisa Malyavko
- Orthopaedic Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Sean Tabaie
- Orthopaedic Surgery and Sports Medicine, Children's National Hospital, Washington, DC, USA
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Abstract
Recovery from injury involves painful movement and activity, painful stretches and muscle strengthening, and adjustment to permanent impairment. Recovery is facilitated by embracing the concept that painful movement can be healthy, which is easier when one has more hope, less worry, and greater social supports and security. Evolution of one's identity to match the new physical status is a hallmark of a healthy outcome and is largely determined by mental and social health factors. When infection, loss of alignment or fixation, and nerve issues or compartment syndrome are unlikely, greater discomfort and incapability that usual for a given pathology or stage of recovery signal opportunities for improved mental and social health. Surgeons may be the clinicians most qualified to make this discernment. A surgeon who has gained a patient's trust can start to noticed despair, worry, and unhelpful thinking such as fear of painful movement. Reorienting people to greater hope and security and a healthier interpretation of the pains associated with the body's recovery can be initiated by the surgeon and facilitated by social workers, psychologist, and physical, occupational and hand therapists trained in treatments that combine mental and physical therapies.
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Wu L, Sun J, Fang N, Peng Q, Gao S, Liu L. Should cannulated screws be removed after a femoral neck fracture has healed, and how? A finite element analysis of the femur before and after cannulated screw removal. INTERNATIONAL ORTHOPAEDICS 2022; 46:2393-2403. [PMID: 35852654 DOI: 10.1007/s00264-022-05516-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 07/11/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE The removal of three inverted triangular parallel cannulated screws after the femoral neck fracture healing is sometimes accompanied by osteonecrosis of the femoral head (ONFH) or its refracture. The purpose of this study was to determine the biomechanical changes of the femur before and after the screw removal using a finite element analysis. METHODS The CT data of the femurs were obtained from a 69-year-old healthy female to establish the femur models. The established finite element models consisted of N, C, and R groups: N group, the normal femur; C group (to simulate the femoral neck fracture healing after the internal fixation), the normal femur with three inverted triangular parallel cannulated screws (C1) or with two upper parallel screws (C2). For the R1 or R2 groups, the screws in the model of the C1 or C2 individuals were gradually removed in seven or three types of different screw combinations, respectively. The stresses and displacements of the femur were determined. RESULTS (1) Compared with the N group, a uniform stress distribution was stopped by the addition of three screws in the C1 group; in contrast, all screw removals resulted in the stress concentration on the screw holes and the disappearance of stress shielding. Moreover, the average stress of the femoral head in C1 group increased by 37.85%, while that of the femoral neck decreased by 23.03%. (2) Compared with the C1 group, while only the lowest femoral calcar screw was removed, there was a similar stress distribution in the proximal femur, and the average stress of the femoral head increased only by 0.35% although that of the femoral neck increased by 63.62%; however, removal by any other means resulted in a significant stress concentration in the proximal femur and a significant increase in the average stresses of the femoral head and neck (5.96-40.95% and 12.82-75.46%, respectively). (3) Compared with the N or C1 group, there was a significant stress concentration on the screws and its surrounding proximal femur in the C2 group. (4) Compared with the C2 group, the simultaneous removal of two upper screws not only did not cause a significant stress concentration on the proximal femur but also significantly reduced the average stresses of the femoral head and neck by 87.49% and 65.51% respectively. On the contrary, the gradual removal of two screws caused a significant stress concentration on the screw and its surrounding proximal femur although the average stresses of the femoral head and neck decreased by 88.79-89.06% and 67.00-67.22%, respectively. (5) Compared with the N group, the average displacements of the femoral head and neck in the C1 group increased only by 3.12% and 3.37%, respectively. Additionally, compared with the C1 group, while three, two, or one screw was simultaneously removed, the average displacements of the femoral head and neck only fluctuated - 5.51-1.65% and 1.78-9.03%, respectively. CONCLUSIONS Residual internal fixation after femoral neck fracture healing may lead to stress concentration on screws and stress shielding around screws. The first removal of the lowest femoral calcar screw and then the second removal of two upper residual screws have a minimum effect on the stress concentration on the proximal femur and the average stress on the femoral head. The incorrect screw removal and resulting femoral load may well be closely related to occurrence in ONFH or its refracture.
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Affiliation(s)
- Le Wu
- Department of Trauma Orthopaedics, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Road, Shanghai, China
| | - Jun Sun
- Department of Trauma Orthopaedics, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Road, Shanghai, China
| | - Nan Fang
- Department of Trauma Orthopaedics, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Road, Shanghai, China
| | - Qing Peng
- Department of Trauma Orthopaedics, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Road, Shanghai, China
| | - Shuo Gao
- Department of Trauma Orthopaedics, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Road, Shanghai, China
| | - Lifeng Liu
- Department of Trauma Orthopaedics, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Road, Shanghai, China.
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Standardizing Screw Head Orthopaedic Trauma Implants. Is There an Interest? An OTA Member Survey. J Orthop Trauma 2022; 36:e393-e398. [PMID: 35580329 DOI: 10.1097/bot.0000000000002402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/13/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the level of interest in standardization of design for fracture fixation implants within the orthopaedic trauma community. METHODS A survey regarding implant removal concerns and implant design preferences was electronically distributed to members of Orthopaedic Trauma Association (OTA). RESULTS Three hundred thirty respondents participated in the survey (response rate of 19%) Only 2.4% of respondents indicated a consistent ability to identify the implant vendor and/or manufacturer of retained implants in the preoperative planning phase of care; >75% of respondents reported investing a minimum of an additional 30 minutes to their operative times to remove screw(s) to successfully extract a plate. More than 80% of respondents reported multiple occurrences requiring modification of their surgical plans because of implants that could not be removed, preventing the completion of the planned procedure. The majority of respondents expressed interest in the adoption of standardized locking head screws for mini, small, and large screw sizes sets (63.5%); 84.8% of respondents desire standardization of screw head and driver sizes across the industry. Also, 83.6% of respondents expressed interest in the adoption of a standardized locking screw head for each cannulated screw, regardless of manufacturer. CONCLUSIONS Members of the orthopaedic community, as represented in the membership of the OTA, are interested in the adoption of universal standards in implant design. Establishing standard screw heads and drivers will optimize the delivery of operative care.
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M L V SK, Nag HL, Gupta A. Removal of distal part of a broken intramedullary nail from the femoral shaft using stainless steel (SS) wire - An innovative surgical technique. JOURNAL OF ORTHOPAEDIC REPORTS 2022; 1:100036. [DOI: 10.1016/j.jorep.2022.100036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
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The Ethics of Explanted Orthopaedic Hardware Return to Requesting Patients. J Orthop Trauma 2022; 36:371-374. [PMID: 34999624 DOI: 10.1097/bot.0000000000002336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Golgelioglu F, Oguzkaya S, Uzun E, Uzun MF, Yoca G, Guney A. The impact of the level of anxiety and temperament in asymptomatic or mildly symptomatic patients requesting implant removal surgery after tibia intramedullary nailing. J Orthop Sci 2022; 27:887-891. [PMID: 34144881 DOI: 10.1016/j.jos.2021.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 04/19/2021] [Accepted: 05/12/2021] [Indexed: 10/21/2022]
Abstract
BACKROUND Implant removal (IR) surgery is one of the most frequent procedures in orthopedic practice. Many of the IR surgeries result from patient request rather than a medical necessity. The purpose of the study was to investigate the association between the level of anxiety, type of temperament and psychopathological status, and the willingness to receive IR surgery in asymptomatic or mildly symptomatic patients. We also aimed to compare pre- and postoperative pain scores and document the complication rates after IR surgery. METHODS The patients who received tibia intramedullary nailing after tibia diaphyseal fracture with a minimum of 18 months follow-up were included in the study. A total of 246 asymptomatic or mildly symptomatic patients were evaluated, and all patients received detailed oral and written information about the risks of IR surgery. The patients who wished to receive IR surgery were called Group 1 (N = 104), and the patients who did not wish to have surgery were called Group 2 (N = 146). All patients were referred to a psychologist to complete the Beck anxiety inventory (BAI), Symptom checklist-90-R (SCL-R-90), and the Temperament Evaluation of Memphis, Pisa, and San Diego Autoquestionnaire (TEMPS-A). RESULTS The mean age of the patients was 32.31 ± 9.56. One hundred thirteen (45.9%) of the patients were male, and 133 were female (54%). Mean BAI and SCL-90-R were higher in Group 1 than Group 2 (P = 0.001). Anxious and irritable temperament was higher in Group 1 (P = 0.045 and P = 0.035 respectively), and non-dominant and hyperthymic temperament was higher in Group 2 (P = 0.02 and P = 0.04 respectively). CONCLUSIONS The level of anxiety and type of temperament is associated with the willingness to receive implant removal surgery in asymptomatic or mildly symptomatic patients. Measures to reduce anxiety levels may reduce the rate of unnecessary implant removal surgeries, associated patient care costs, and potential complications.
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Affiliation(s)
- Fatih Golgelioglu
- Department of Orthopedics and Traumatology, Tunceli State Hospital, Tunceli, Turkey
| | - Sinan Oguzkaya
- Department of Orthopedics and Traumatology, Sarkisla State Hospital, Sivas, Turkey.
| | - Erdal Uzun
- Department of Orthopedics and Traumatology, Department of Orthopaedics and Traumatology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Mehmet Fatih Uzun
- Department of Orthopedics and Traumatology, Department of Orthopaedics and Traumatology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Gokhan Yoca
- Department of Psychiatry and Behavioral Sciences, Sarkisla State Hospital, Sivas, Turkey
| | - Ahmet Guney
- Department of Orthopedics and Traumatology, Department of Orthopaedics and Traumatology, Erciyes University School of Medicine, Kayseri, Turkey
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Amann P, Pastl K, Neunteufel E, Bock P. Clinical and Radiologic Results of a Human Bone Graft Screw in Tarsometatarsal II/+III Arthrodesis. Foot Ankle Int 2022; 43:913-922. [PMID: 35373594 DOI: 10.1177/10711007221081533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND For arthrodesis of the tarsometatarsal joints, there is the possibility of using a transplant screw made of allogenic human bone material (Shark Screw). This article investigates the clinical outcome and radiologic integration of the allogenic bone screw for arthrodesis of the tarsometatarsal joints II/+III. METHODS This is a prospective study involving 20 feet of 17 patients who received TMT II/+III arthrodesis with an allogenic bone screw. A visual analog scale (VAS pain and function), Foot Function Index (FFI), American Orthopaedic Foot & Ankle Society (AOFAS) midfoot score, and Foot and Ankle Outcome Score (FAOS) were used as measures to compare preoperative with postoperative results. Radiologic integration in the recipient bone was also evaluated. RESULTS A significant mean pre- to postoperative improvement of all evaluated scores has been observed (P < .05) after a mean follow-up of 15.87 months (minimum 12 months, maximum 33 months). VAS score (pain) decreased from 7.6 to 1.4 points as well as a decrease of the VAS (function) from 7.25 to 1.8 points. Further, a reduction of the FFI from 62.3% to 16.7% and an increase from 29.7 to 79.9 points of the AOFAS was detected. Analyzing the FAOS score, in all surveyed subscales, there was an increase in the score (Symptoms: 55.2 to 85.6 points; Pain: 30.5 to 86.9 points; Function: 33.1 to 88.3 points; Quality of life: 27.8 to 79.7 points). Moreover, in all cases, a complete radiologic integration into the receiving bone was appreciated, and after a minimum follow-up time from 12 months, the screw in 19 feet (95%) was no longer distinguishable from the original bone. CONCLUSION With these first results of the allogenic bone screw in TMT II/+III arthrodesis, a significant improvement from preoperative to postoperative was confirmed in the collected scores, and a full radiographic integration was demonstrated in all feet.
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Affiliation(s)
| | - Klaus Pastl
- Orthopedic Departement Klinik Diakonissen Linz, Linz, Austria
| | | | - Peter Bock
- Speising Orthopedic Hospital, Vienna, Austria
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Xu Y, Xu Y, Zhang W, Li M, Wendel HP, Geis-Gerstorfer J, Li P, Wan G, Xu S, Hu T. Biodegradable Zn-Cu-Fe Alloy as a Promising Material for Craniomaxillofacial Implants: An in vitro Investigation into Degradation Behavior, Cytotoxicity, and Hemocompatibility. Front Chem 2022; 10:860040. [PMID: 35734444 PMCID: PMC9208203 DOI: 10.3389/fchem.2022.860040] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 05/19/2022] [Indexed: 11/13/2022] Open
Abstract
Zinc-based nanoparticles, nanoscale metal frameworks and metals have been considered as biocompatible materials for bone tissue engineering. Among them, zinc-based metals are recognized as promising biodegradable materials thanks to their moderate degradation rate ranging between magnesium and iron. Nonetheless, materials’ biodegradability and the related biological response depend on the specific implant site. The present study evaluated the biodegradability, cytocompatibility, and hemocompatibility of a hot-extruded zinc-copper-iron (Zn-Cu-Fe) alloy as a potential biomaterial for craniomaxillofacial implants. Firstly, the effect of fetal bovine serum (FBS) on in vitro degradation behavior was evaluated. Furthermore, an extract test was used to evaluate the cytotoxicity of the alloy. Also, the hemocompatibility evaluation was carried out by a modified Chandler-Loop model. The results showed decreased degradation rates of the Zn-Cu-Fe alloy after incorporating FBS into the medium. Also, the alloy exhibited acceptable toxicity towards RAW264.7, HUVEC, and MC3T3-E1 cells. Regarding hemocompatibility, the alloy did not significantly alter erythrocyte, platelet, and leukocyte counts, while the coagulation and complement systems were activated. This study demonstrated the predictable in vitro degradation behavior, acceptable cytotoxicity, and appropriate hemocompatibility of Zn-Cu-Fe alloy; therefore, it might be a candidate biomaterial for craniomaxillofacial implants.
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Affiliation(s)
- Yan Xu
- Center of Oral Implantology, Stomatological Hospital, Southern Medical University, Guangzhou, China
| | - Yichen Xu
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, Department of Oral Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Section Medical Materials Science and Technology, University Hospital Tübingen, Tübingen, Germany
| | - Wentai Zhang
- Key Laboratory of Advanced Technologies of Materials, Ministry of Education, School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu, China
| | - Ming Li
- Key Laboratory of Advanced Technologies of Materials, Ministry of Education, School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu, China
- Department of Materials Engineering, Sichuan Engineering Technical College, Deyang, China
| | - Hans-Peter Wendel
- Department of Thoracic and Cardiovascular Surgery, Clinical Research Laboratory, University Hospital Tübingen, Tübingen, Germany
| | - Jürgen Geis-Gerstorfer
- Section Medical Materials Science and Technology, University Hospital Tübingen, Tübingen, Germany
| | - Ping Li
- Center of Oral Implantology, Stomatological Hospital, Southern Medical University, Guangzhou, China
- Section Medical Materials Science and Technology, University Hospital Tübingen, Tübingen, Germany
- *Correspondence: Ping Li, ; Guojiang Wan, ; Shulan Xu,
| | - Guojiang Wan
- Key Laboratory of Advanced Technologies of Materials, Ministry of Education, School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu, China
- *Correspondence: Ping Li, ; Guojiang Wan, ; Shulan Xu,
| | - Shulan Xu
- Center of Oral Implantology, Stomatological Hospital, Southern Medical University, Guangzhou, China
- *Correspondence: Ping Li, ; Guojiang Wan, ; Shulan Xu,
| | - Tao Hu
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, Department of Preventive Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China
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Deng Y, Staniforth TL, Zafar MS, Lau YJ. Posterior Antiglide Plating vs Lateral Neutralization Plating for Weber B Distal Fibular Fractures: A Systematic Review and Meta-analysis of Clinical and Biomechanical Studies. Foot Ankle Int 2022; 43:850-859. [PMID: 35373597 DOI: 10.1177/10711007221079617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Distal fibular fractures are extremely common, yet there remains controversy about which type of plating technique is the most appropriate. We aimed to compare clinical and biomechanical outcomes following posterior antiglide plating and lateral neutralization plating for Weber B distal fibular fractures. METHODS A systematic review and meta-analysis of the literature was conducted by two independent reviewers according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We included all comparative studies of distal fibular fracture fixation with either a posterior antiglide plate or a lateral neutralization plate. Our primary outcome of interest was reoperation for hardware removal. Secondary outcomes included hardware discomfort, peroneal tendon irritation, infection, wound complications, and mechanical torque to failure. RESULTS A total of 1122 patients with Weber B ankle fractures were included across nine eligible clinical studies, and 76 cadaveric ankles were subject to testing across three eligible biomechanical studies. Meta-analyses revealed a two-fold greater odds of requiring removal of hardware in the lateral plating group compared to the posterior plating group (odds ratio [OR] 2.48, 95% CI 1.58 to 3.91, P < .0001), and a three-fold greater odds of experiencing hardware discomfort in the lateral plating group compared to the posterior plating group (OR 2.96, 95% CI 1.83 to 4.80, P < .0001). There were no significant differences in rates of peroneal tendon irritation, infection, wound complications, operative time, and torque to failure when comparing the two plating methods. CONCLUSION The results of this review indicate that using posterior antiglide plating for distal fibular Weber B-type fractures is associated with significantly fewer reoperations due to hardware complications and less hardware discomfort compared to lateral neutralization plating. This technique does not appear to increase the risk of peroneal tendon irritation or increase operative time.
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Affiliation(s)
- Yi Deng
- Department of Orthopaedic Surgery, Canberra Hospital, Garran, ACT, Australia.,Trauma and Orthopaedic Research Unit, Australian National University Medical School, Garran, ACT, Australia
| | | | | | - Yeong Joe Lau
- Department of Orthopaedic Surgery, Canberra Hospital, Garran, ACT, Australia
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Pilot Study and Preliminary Results of Biodegradable Intramedullary Nailing of Forearm Fractures in Children. CHILDREN 2022; 9:children9050754. [PMID: 35626931 PMCID: PMC9140014 DOI: 10.3390/children9050754] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 05/12/2022] [Accepted: 05/17/2022] [Indexed: 11/21/2022]
Abstract
(1) Background: Diaphyseal forearm fractures are a common injury in children and adolescents. When operative treatment is needed, elastic stable intramedullary nailing (ESIN) is the most common surgical procedure. Although there is no clear evidence, hardware removal after fracture healing is performed in many patients. Often, the primary minimal invasive incision needs to be widened during implant removal. In order to decrease the burden of care of pediatric fractures, significant efforts were made to develop biodegradable implants, which make hardware removal unnecessary. Our study will conduct an observational trial on the clinical use of the Activa IM-Nail™ in forearm fractures in children between 3 and 13 years of age. The objective of this trial is to evaluate the risks and benefits of the Activa IM-Nail™. Among other objectives, the rate of refracture will be determined. (2) Methods: An international Europe-based, multicenter, prospective, single-arm, open-label study will be performed to ascertain the rate of refracture and to determine the subjective benefits of Activa IM-Nail™ for patients, parents and other caregivers. The study will include clinical follow-up including early post-operative complication, radiographs until bony healing and an additional follow-up after 1 year. At this stage, preliminary results and early complications on 76 patients are analyzed in this study and presented. (3) Results: As of April 2022, 76 patients were enrolled as per study protocol. There were 31 girls (40.8%) and 45 boys (59.2%). The mean age at the time of inclusion was 8.9 years (±2.4 years). The mean operation time was 58.9 ± 22.9 min (range, 15–119 min). The mean follow-up time was 8.9 ± 5.1 months (range, 0.2–18.6). Up to now, one refracture has occurred in one child falling from a height of about one meter 7 months after index surgery (1/76; 1.3%). (4) Conclusion: The research project assesses the safety and effectiveness of Activa IM-Nails™ as part of the surgical treatment of dislocated forearm fractures in children in the context of a PMCF study. The use of Activa IM-Nails™ with regard to various objectives, including postoperative complications and refracture rate, seems to be equal to the standard titan ESIN procedure compared to the literature. Preliminary results are encouraging and are made available.
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Black NR, Winslade WJ, Lindsey RW, Gugala Z. The Legal, Ethical, and Scientific Considerations for Returning Explanted Orthopaedic Hardware to the Patient. J Bone Joint Surg Am 2022; 104:e37. [PMID: 34793340 DOI: 10.2106/jbjs.21.00318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Orthopaedic hardware explantation is a multifaceted topic with complex legal, ethical, and scientific aspects that require thorough exploration. Issues of device ownership, explant-induced disease propagation, and potential device resale pose legal risks to providers and health-care institutions. Ethically, implant removal highlights the potential that performing procedures at the request of the patient will incentivize patient compliance and strengthen the patient-surgeon relationship. However, the return of explanted hardware to patients could hinder scientific study and innovation, ultimately limiting advancement in risk reduction and patient outcomes. Continued research into these topics remains paramount to ensure that clinicians and institutions deliver optimal patient care while abiding with legal and ethical imperatives. This article addresses the legal, ethical, and scientific issues that are pertinent to returning an explanted orthopaedic implant to the patient and the potential ramifications of such practice.
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Affiliation(s)
- Natalie R Black
- Department of Orthopedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, Texas
| | - William J Winslade
- Institute for Bioethics and Health Humanities, University of Texas Medical Branch, Galveston, Texas
| | - Ronald W Lindsey
- Department of Orthopedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, Texas
| | - Zbigniew Gugala
- Department of Orthopedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, Texas
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Lu X, Cai H, Li YR, Zheng X, Yun J, Li W, Geng X, Kwon JS, Jiang HB. A Systematic Review and Network Meta-Analysis of Biomedical Mg Alloy and Surface Coatings in Orthopedic Application. Bioinorg Chem Appl 2022; 2022:4529520. [PMID: 35399618 PMCID: PMC8991394 DOI: 10.1155/2022/4529520] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 02/19/2022] [Indexed: 12/15/2022] Open
Abstract
Magnesium alloys have great application prospects as ideal bone implant materials. However, their poor corrosion resistance limits their clinical orthopedic application. Surface modification promotes the corrosion resistance of magnesium. Conversion coatings, such as calcium phosphate (Ca-P) coating, microarc oxidation (MAO) treatment, and fluoride (FLU) treatment, have been extensively investigated in in vivo studies. This systematic review and network meta-analysis compared the influence of different conversion coatings on bone repair, material properties, and systemic host response in orthopedic applications. Using the PICOS model, the inclusion criteria for biodegradable magnesium and its alloys were determined for in vivo studies. Four databases were used. The standard and weight mean differences with 95% confidence intervals were used to analyze new bone formation and degradation rate. Network structure and forest plots were created, and ranking probabilities were estimated. The risk of bias and quality of evidence were assessed using SYRCLE, CERQual, and GRADE tools. In the qualitative analysis, 43 studies were selected, and the evaluation of each outcome indicator was not entirely consistent from article to article. In the quantitative analysis, 21 articles were subjected to network meta-analysis, with 16 articles on implant degradation and 8 articles for new bone formation. Additionally, SUCRA indicated that Ca-P coating exhibited the highest corrosion resistance, followed by FLU treatment. MAO demonstrated the best capability for new bone formation, followed by Ca-P coating. Ca-P coating exhibited the highest overall performance. To conclude, coated Mg can promote better new bone formation than bare Mg and has considerable biocompatibility. Ca-P-coated Mg and MAO-coated Mg have the greatest potential to significantly promote corrosion resistance and bone regeneration, respectively. The findings of this study will provide a theoretical basis for the investigation of composite coatings and guidance for the orthopedic application of Mg bone implants.
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Affiliation(s)
- XinYue Lu
- The Conversationalist Club, School of Stomatology, Shandong First Medical University and Shandong Academy of Medical Sciences, Tai'an 271016, Shandong, China
| | - HongXin Cai
- Department and Research Institute of Dental Biomaterials and Bioengineering, Yonsei University College of Dentistry, Seoul 03722, Republic of Korea
| | - Yu Ru Li
- The Conversationalist Club, School of Stomatology, Shandong First Medical University and Shandong Academy of Medical Sciences, Tai'an 271016, Shandong, China
| | - Xinru Zheng
- The Conversationalist Club, School of Stomatology, Shandong First Medical University and Shandong Academy of Medical Sciences, Tai'an 271016, Shandong, China
| | - Jiahao Yun
- The Conversationalist Club, School of Stomatology, Shandong First Medical University and Shandong Academy of Medical Sciences, Tai'an 271016, Shandong, China
| | - Wenhui Li
- The Conversationalist Club, School of Stomatology, Shandong First Medical University and Shandong Academy of Medical Sciences, Tai'an 271016, Shandong, China
| | - XiaoYu Geng
- The Conversationalist Club, School of Stomatology, Shandong First Medical University and Shandong Academy of Medical Sciences, Tai'an 271016, Shandong, China
| | - Jae-Sung Kwon
- Department and Research Institute of Dental Biomaterials and Bioengineering, Yonsei University College of Dentistry, Seoul 03722, Republic of Korea
| | - Heng Bo Jiang
- The Conversationalist Club, School of Stomatology, Shandong First Medical University and Shandong Academy of Medical Sciences, Tai'an 271016, Shandong, China
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Abstract
Hardware removal is among the most common orthopedic procedures performed in the United States. The goal of this study was to report the outcomes of deep hardware removal for children. This study received institutional review board approval. Patients younger than 18 years who underwent deep hardware removal between 2007 and 2017 were studied. We reviewed 227 procedures involving 132 boys and 95 girls. Mean follow-up was 25 months (range, 14-36 months). Mean age at the time of surgery was 12.8 years (range, 2-17 years). Mean time from initial surgery to hardware removal was 8.4 months (range, 1-72 months). Of the 227 cases, 75 used a tourniquet. Mean tourniquet time was 30.1 minutes (range, 1-118 minutes). Mean length of surgery was 44.0 minutes (range, 4-173 minutes). Mean resident level performing the surgery was postgraduate year 3 (range, postgraduate year 2 to fellow). There were 3 complications. Locations of the implanted hardware included: femur, 85; humerus, 49; tibia, 46; hip/pelvis, 17; ulna, 11; miscellaneous foot, 10; radius, 6; and fibula, 3. Indications for surgery included surgeon recommendations in 122 cases; symptomatic hardware in 68 cases, and parent wishes in 37 cases. Hardware removal for children was safe, and the outcomes were excellent. Complications of hardware removal at a teaching hospital can be minimized when a more senior resident is the primary surgeon. Despite the challenging and historically troublesome nature of deep hardware removal, the current study shows that hardware removal for children is safe and effective. [Orthopedics. 2022;45(2):e91-e95.].
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Jin JW, Kim HS, Jang MJ. Refracture After Removal of the PFNA in a Healed Intertrochanteric Femoral Fracture: Case Report. Geriatr Orthop Surg Rehabil 2022; 13:21514593221074179. [PMID: 35299833 PMCID: PMC8922191 DOI: 10.1177/21514593221074179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 12/28/2021] [Indexed: 11/17/2022] Open
Abstract
Hardware removal in a healed intertrochanteric fracture in elderly, which is not a routine procedure, should be needed in the case of irritable hardware. The reports of refracture after hardware removal can be seen as sparse in current literature, which are focused to secondary femoral neck fracture after removal of the lag screw or blade. We experienced a case of the intertrochanteric refracture and varus collapse after the PFNA removal in a healed fracture, treated with valgus trochanteric osteotomy and angled blade plate fixation. The PFNA is an innovative device for the treatment of the trochanteric fracture; however, the complications after removal never end. Therefore, the removal from healed fracture in elderly who have osteoporosis should not be recommended unless intractable pain had persisted.
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Affiliation(s)
- Jin-Woo Jin
- Department of Orthopedic Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Geyongsangnam-do, Republic of Korea
| | - Hyeon-Soo Kim
- Department of Orthopedic Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Geyongsangnam-do, Republic of Korea
| | - Min-Jae Jang
- Department of Orthopedic Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Geyongsangnam-do, Republic of Korea
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Niu S, Yang D, Ma Y, Lin S, Xu X. Is removal of the internal fixation after successful intervertebral fusion necessary? A case-control study based on patient-reported quality of life. J Orthop Surg Res 2022; 17:141. [PMID: 35246195 PMCID: PMC8895662 DOI: 10.1186/s13018-022-03031-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 02/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Intervertebral fusion and internal fixation are often applied to patients with lumbar spinal disease. Whether to remove the internal fixation after successful fusion remains uncertain, but such a question needs to be explored in light of concerns regarding patients' quality of life and health insurance. We sought to probe if the removal of internal fixation after successful lumbar intervertebral fusion affects patients' quality of life. METHODS This was a real-world retrospective case-control study. Data of 102 patients who had undergone posterior lumbar fusion with cage and internal fixation to treat lumbar degenerative diseases were extracted from a single center from 2012 to 2020. Fifty-one patients had undergone internal fixation removal surgery, and 51 controls who retained internal fixations were matched according to demographic and medical characteristics. The quality of life of patients based on the Medical Outcomes Study Short Form 36 (SF-36) scale and their self-assessment were surveyed. RESULTS There was no statistical difference in the overall score of the SF-36 questionnaire between the two groups, but the general health (GH) subscore was lower in the case group than in the control group (P = 0.0284). Among those patients who underwent internal fixation removal, the quality of life was improved after instrument removal as indicated by an increased overall score (P = 0.0040), physical functioning (PF) (P = 0.0045), and bodily pain (BP) (P = 0.0008). Among patients with pre-surgery discomfort, instrument removal generated better outcomes in 25% and poor outcomes in 4.2%. Among patients without pre-surgery discomfort, instrument removal generated better outcomes in 7.4% and poor outcomes in 11.1%. CONCLUSION Among patients who achieved successful posterior lumbar internal fixation, whether or not to remove the fixation instruments should be evaluated carefully. In patients experiencing discomfort, instrument removal could improve their quality of life, but the benefits and risks should be comprehensively explained to these patients. Instrument removal should not be routinely performed due to its limited or even negative effect in patients who do not report discomfort before surgery.
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Affiliation(s)
- Shangbo Niu
- Department of Orthopeadic Spine, Nanfang Hospital, Southern Medical University, 1838 Guangzhou North Ave, Guangzhou, 510515, China
| | - Dehong Yang
- Department of Orthopeadic Spine, Nanfang Hospital, Southern Medical University, 1838 Guangzhou North Ave, Guangzhou, 510515, China.
| | - Yangyang Ma
- Department of Orthopeadic Spine, Nanfang Hospital, Southern Medical University, 1838 Guangzhou North Ave, Guangzhou, 510515, China
| | - Shengliang Lin
- Department of Orthopeadic Spine, Nanfang Hospital, Southern Medical University, 1838 Guangzhou North Ave, Guangzhou, 510515, China
| | - Xuhao Xu
- Department of Orthopeadic Spine, Nanfang Hospital, Southern Medical University, 1838 Guangzhou North Ave, Guangzhou, 510515, China
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Kim BS, Kim DH, Choi JH, Choi BC, Cho CH. Is Device Removal Necessary after Fixed-Angle Locking Plate Osteosynthesis of Proximal Humerus Fractures? MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58030382. [PMID: 35334558 PMCID: PMC8949819 DOI: 10.3390/medicina58030382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/03/2022] [Accepted: 03/02/2022] [Indexed: 11/30/2022]
Abstract
Background and Objectives: The aim of this study was to evaluate whether device removal in symptomatic patients following locking plate osteosynthesis of a proximal humerus fracture improves the clinical outcomes. Materials and Methods: Seventy-one patients who underwent fixed-angle locking plate osteosynthesis of a proximal humerus fracture were included. Thirty-three patients underwent device removal at a mean time of 10.4 months after index surgery (removal group). Thirty-eight patients who retained the device after index surgery (retention group) were included in the control group. Visual analog scale (VAS) pain score, University of California at Los Angeles (UCLA) score, American Shoulder and Elbow Surgeons (ASES) score, and range of motion (ROM) were evaluated pre- and postoperatively. Results: At the final follow-up, mean UCLA score, ASES score, and all ROMs were significantly higher in the removal group compared to the retention group (p < 0.001). However, no significant difference in mean VAS pain score was observed between the two groups. Comparison of the clinical outcomes before and after device removal surgery showed significant improvement in all clinical scores and ROMs after device removal (p < 0.001). Conclusions: Device removal surgery in symptomatic patients following locking plate osteosynthesis of a proximal humerus fracture can result in significant improvement in functional outcomes.
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Affiliation(s)
- Beom-Soo Kim
- Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu 42601, Korea; (B.-S.K.); (D.-H.K.); (B.-C.C.)
| | - Du-Han Kim
- Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu 42601, Korea; (B.-S.K.); (D.-H.K.); (B.-C.C.)
| | - Jung-Hoon Choi
- Department of Orthopedic Surgery, Bogang Hospital, 102 Wolbae-ro, Dalseo-gu, Daegu 42801, Korea;
| | - Byung-Chan Choi
- Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu 42601, Korea; (B.-S.K.); (D.-H.K.); (B.-C.C.)
| | - Chul-Hyun Cho
- Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu 42601, Korea; (B.-S.K.); (D.-H.K.); (B.-C.C.)
- Correspondence: ; Tel.: +82-53-258-4771
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The Application of an Allogenic Bone Screw for Stabilization of a Modified Chevron Osteotomy: A Prospective Analysis. J Clin Med 2022; 11:jcm11051384. [PMID: 35268475 PMCID: PMC8911083 DOI: 10.3390/jcm11051384] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 03/01/2022] [Accepted: 03/02/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Distal first metatarsal osteotomies are commonly performed operative procedures for hallux valgus deformity, and usually involve fixation with a metal screw. However, various bioabsorbable osteosynthesis materials have been in use for a number of years. One recent innovation is the Shark Screw®, a human cortical bone allograft. This study aimed to evaluate the efficacy and safety of this allogeneic screw in the stabilization of Reversed L-Shaped osteotomy, a modified Chevron osteotomy. Methods: In a prospective study, 15 patients underwent a Reversed L-Shaped osteotomy stabilized with the allogenic bone screw Radiological data on osteointegration of the screw and correction of the intermetatarsal angle were recorded. Furthermore, each follow-up examination included the collection of clinical data, the American Orthopedic Foot and Ankle Society (AOFAS) score, evaluation of pain level, and patient’s overall satisfaction. Results: Full osseous fusion of the osteotomy was seen in all patients. The bone screws were radiographically integrated after approximately 6.5 (±2.6) months. Neither nonunion nor failure occurred in any of our cases. Furthermore, we did not find any potential graft reaction. The AOFAS score improved significantly from 51.6 (±15.2) points to 90.9 (±10.3) (p < 0.001). The preoperative hallux valgus angle and intermetatarsal angle decreased significantly from 24.8 (±4.9) degrees to 7.2 (±4.4) degrees (p < 0.001) and 12.6 (±3.2) degrees to 4.8 (±1.3) degrees (p < 0.001), respectively. Conclusions: With this study, we demonstrated the efficiency of the allogenic bone screw (Shark Screw®) in regard to clinical and radiological short-term outcomes.
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DeKeyser GJ, Campbell ML, Kellam PJ, Haller JM, Rothberg DL, Higgins TF, Marchand LS. True antiglide fixation of Danis-Weber B fibula fractures has lower rates of removal of hardware. Injury 2022; 53:1289-1293. [PMID: 34627627 DOI: 10.1016/j.injury.2021.09.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 09/18/2021] [Accepted: 09/26/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Plating of unstable OTA/AO 44-B2 equivalent lateral malleolus (Danis-Weber B) fractures has been associated with pain, peroneal irritation, and the need for subsequent hardware removal (ROH). The purpose of this study is to retrospectively compare the rates of ROH in unstable Weber B fractures fixed with a posterior, true antiglide plate with no screws in the distal segment versus those that were fixed with a similarly placed posterior, neutralization construct that included screws in the distal fragment. Thus, evaluating the role of the distal screws in rates of ROH. METHODS Skeletally mature patients that were treated for an unstable, isolated Weber B fracture at a single level-1 trauma center over a ten-year period were reviewed. Fractures treated with a single posterior plate with at least six months of follow-up were included and those fixed with a direct lateral plate were excluded. The primary outcome of this study was hardware removal defined as entire plate removal; isolated syndesmotic screw removal was not included. RESULTS Ninety-six patients were included in the study with average age of 46 years (range 17-83) and mean length of follow-up of 24.5 months (range 6.1-140.3). There were 33 patients in the antiglide group (mean follow-up 25.5 months) and 63 in the neutralization plate group (mean follow-up 24 months, p=0.81). Fractures fixed with or without distal screws had equivalent excellent results related to bony union and alignment. However, there was a statistically significant decrease in ROH rates in the antiglide group (antiglide ROH rate 15.2%; neutralization ROH rate 38.1%; p=0.02). Relative risk of ROH with antiglide plate was 0.4 (95% CI 0.17 - 0.95; p=0.04). CONCLUSIONS Antiglide plating shows a significant risk reduction in the rate of ROH when compared to posterior based neutralization plating. A true antiglide plating construct should be considered as a safe and effective way of managing Weber B fractures with a lower relative risk of a second operation for hardware removal. LEVEL OF EVIDENCE Therapeutic level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Graham J DeKeyser
- University of Utah, Department of Orthopaedic Surgery, Salt Lake City, UT, USA.
| | - Megan L Campbell
- University of Utah, Department of Orthopaedic Surgery, Salt Lake City, UT, USA
| | - Patrick J Kellam
- University of Utah, Department of Orthopaedic Surgery, Salt Lake City, UT, USA
| | - Justin M Haller
- University of Utah, Department of Orthopaedic Surgery, Salt Lake City, UT, USA
| | - David L Rothberg
- University of Utah, Department of Orthopaedic Surgery, Salt Lake City, UT, USA
| | - Thomas F Higgins
- University of Utah, Department of Orthopaedic Surgery, Salt Lake City, UT, USA
| | - Lucas S Marchand
- University of Utah, Department of Orthopaedic Surgery, Salt Lake City, UT, USA
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