1
|
Trost M, Yarkin S, Knieps M, Frey S, Neiss WF, Eysel P, Gick S, Dargel J. Biomechanical comparison of different fixation methods in tibiotalocalcaneal arthrodesis: a cadaver study. J Orthop Surg Res 2023; 18:971. [PMID: 38105223 PMCID: PMC10726638 DOI: 10.1186/s13018-023-04444-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 12/05/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND Various fixation methods are available for tibiotalocalcaneal arthrodesis: nail, plate, or screws. An intramedullary bone stabilization system within a balloon catheter has not previously been used in tibiotalocalcaneal arthrodesis. The aim of this study was to compare the stability of these techniques. METHODS Twenty-four lower legs from fresh-frozen human cadavers were used. Tibiotalocalcaneal arthrodesis was performed with a retrograde nail, a lateral locking plate, three cancellous screws, or an intramedullary bone stabilization system. The ankles were loaded cyclically in plantarflexion and dorsiflexion. RESULTS For cyclic loading at 125 N, the mean range of motion was 1.7 mm for nail, 2.2 mm for plate, 6.0 mm for screws, and 9.0 mm for the bone stabilization system (P < .01). For cyclic loading at 250 N, the mean range of motion was 4.4 mm for nail, 7.5 mm for plate, 12.1 mm for screws, and 14.6 mm for the bone stabilization system (P < .01). The mean cycle of failure was 4191 for nail, 3553 for plate, 3725 for screws, and 2132 for the bone stabilization system (P = .10). CONCLUSIONS The stability of the tibiotalocalcaneal arthrodesis differs depending on the fixation method, with nail or plate showing the greatest stability and the bone stabilization system the least. When three screws are used for tibiotalocalcaneal arthrodesis, the stability is intermediate. As the biomechanical stability of the bone stabilization system is low, it cannot be recommended for tibiotalocalcaneal arthrodesis.
Collapse
Affiliation(s)
- Matthias Trost
- Department of Orthopaedics and Traumatology, Saint Josef Hospital, Ruhr University Bochum, Gudrunstrasse 56, 44791, Bochum, Germany.
| | - Suzan Yarkin
- Department of Orthopaedics and Traumatology, Protestant Hospital Cologne Weyertal, Cologne, Germany
| | - Matthias Knieps
- Department of Orthopaedics and Traumatology, Cologne University Hospital, Cologne, Germany
| | - Sönke Frey
- Department of Orthopaedics and Traumatology, Florence Nightingale Hospital, Düsseldorf, Germany
| | | | - Peer Eysel
- Department of Orthopaedics and Traumatology, Cologne University Hospital, Cologne, Germany
- Cologne Center for Musculoskeletal Biomechanics (CCMB), University of Cologne, Cologne, Germany
| | - Sascha Gick
- Department of Traumatology, Orthopaedics and Hand Surgery, Saint Vinzenz Hospital, Cologne, Germany
| | - Jens Dargel
- Department of Orthopaedics, Saint Josefs Hospital, Wiesbaden, Germany
| |
Collapse
|
2
|
Kucharik MP, Andrews R, John MP, Ohanisian L, Sullivan A, Chebli C. Operative Fixation of a Humeral Shaft Periprosthetic Fracture After IlluminOss: A Case Report. JBJS Case Connect 2023; 13:01709767-202312000-00017. [PMID: 37889990 DOI: 10.2106/jbjs.cc.23.00136] [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: 10/29/2023]
Abstract
CASE An 82-year-old man sustained a periprosthetic fracture after IlluminOss photodynamic bone stabilization system (PBSS) stabilization for an impending pathologic fracture. Nonoperative management was unsuccessful, and he subsequently underwent operative fixation, which featured lag screw fixation of the spiral distal humeral shaft fracture and osteotomy followed by plate fixation of the pathologic humeral shaft fracture. CONCLUSION This is the first article to report this complication with IlluminOss PBSS stabilization and details regarding revision surgery.
Collapse
Affiliation(s)
- Michael P Kucharik
- Department of Orthopaedic Surgery, University of South Florida, Tampa, Florida
| | - Reed Andrews
- Department of Orthopaedic Surgery, University of South Florida, Tampa, Florida
| | - Mitchell P John
- Department of Orthopaedic Surgery, University of South Florida, Tampa, Florida
| | - Levonti Ohanisian
- Department of Orthopaedic Surgery, University of South Florida, Tampa, Florida
| | - Alex Sullivan
- Department of Orthopaedic Surgery, University of South Florida, Tampa, Florida
| | - Caroline Chebli
- Department of Orthopaedic Surgery, University of South Florida, Tampa, Florida
- Department of Orthopaedic Surgery, James A. Haley Veterans' Hospital, Tampa, Florida
| |
Collapse
|
3
|
Vemu SM, Farii HA, Bird JE, Lin PP, Lewis VO, Patel SS. The Use of Photodynamic Bone Stabilization to Tamponade Bleeding in a Pathologic Humeral Shaft Fracture: A Case Report. J Orthop Case Rep 2023; 13:137-143. [PMID: 37753123 PMCID: PMC10519327 DOI: 10.13107/jocr.2023.v13.i09.3906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/16/2023] [Indexed: 09/28/2023] Open
Abstract
Introduction Hypervascular tumors such as renal and thyroid carcinoma have a significant risk of intraoperative bleeding. To help mitigate bleeding, interventional preoperative embolization is traditionally used; however, it is success is highly variable. This is the first case report to discuss using expandable balloon implants with a minimally invasive approach to achieve fracture fixation and tamponade acute intraoperative bleeding. Case Report A 48-year-old male with clear-cell renal cell carcinoma presented with a left humeral shaft pathologic fracture. The patient was scheduled to undergo open biopsy, curettage of tumor, and fracture fixation with an intramedullary device. Intraoperatively, during open biopsy and curettage, brisk bleeding was encountered, which ceased after inserting an intramedullary photodynamic bone stabilization implant (IlluminOss). The implant's balloon expanded to the diameter of the humerus allowing for tamponade, fracture stability, and a minimally invasive approach. Conclusion We present a possible intraoperative option for achieving control of bleeding in pathologic long bone fractures by deploying a photodynamic stabilization device. The method described can have applications in specific patients and obviate the need for pre-operative embolization for highly vascular tumors due to the implant's ability to create tamponade within the bone.
Collapse
Affiliation(s)
- Sree M Vemu
- Department of Orthopedic Surgery, Houston Methodist, 6445 Main St #2500, Houston, Texas 77030, United States
| | - Humaid Al Farii
- Department of Orthopedic Surgery, University of Texas MD Anderson Cancer Center, P.O. Box 301402, Unit 1448 Houston, Texas 77230-1402, United States
| | - Justin E Bird
- Department of Orthopedic Surgery, University of Texas MD Anderson Cancer Center, P.O. Box 301402, Unit 1448 Houston, Texas 77230-1402, United States
| | - Patrick P Lin
- Department of Orthopedic Surgery, University of Texas MD Anderson Cancer Center, P.O. Box 301402, Unit 1448 Houston, Texas 77230-1402, United States
| | - Valerae O Lewis
- Department of Orthopedic Surgery, University of Texas MD Anderson Cancer Center, P.O. Box 301402, Unit 1448 Houston, Texas 77230-1402, United States
| | - Shalin S Patel
- Department of Orthopedic Surgery, University of Texas MD Anderson Cancer Center, P.O. Box 301402, Unit 1448 Houston, Texas 77230-1402, United States
| |
Collapse
|
4
|
Krumme JW, MacConnell AE, Adams BW, Jelinek JJ, Henshaw RM. Radiolucent Implants for Fixation of Impending and Pathologic Fractures. Orthopedics 2022; 45:e115-e121. [PMID: 35201938 DOI: 10.3928/01477447-20220217-02] [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: 02/03/2023]
Abstract
Radiolucent implants offer theoretical advantages of increased ability to evaluate the fracture site for healing and recurrence and potentially less effect on radiation treatment, avoiding scatter. Their clinical utility and outcomes have yet to be proven in a well-designed randomized trial or large cohort study, although studies based on other indications have shown relative safety and they are approved by the US Food and Drug Administration for treatment of pathologic fractures. Further research is necessary to better understand when and how these implants should be implemented in practice. [Orthopedics. 2022;45(3):e115-e121.].
Collapse
|
5
|
Biomechanical comparison of different fixation methods in metatarsal shaft fractures: A cadaver study. Clin Biomech (Bristol, Avon) 2022; 92:105588. [PMID: 35121348 DOI: 10.1016/j.clinbiomech.2022.105588] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 01/23/2022] [Accepted: 01/25/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Various fixation methods are available for the operative treatment of metatarsal shaft fractures: Kirschner wire, Titanium elastic nail, plate, or an intramedullary bone stabilization system within a balloon catheter. The aim of this study was to compare the stability of these techniques. METHODS 72 metatarsals II to V from fresh frozen human cadaver feet were used. A shaft fracture was performed and fixed with a 1.6-mm Kirschner wire, a 1.5-mm Titanium elastic nail, a locking 6-hole-plate, or an intramedullary bone stabilization system. In a cantilever configuration, the head of the metatarsals was loaded statically (2 mm/min until failure; all groups) or cyclically (0 to 20 N for 1000 cycles with 10 mm/s, after 1000 cycles 2 mm/min until failure; plate and bone stabilization system). FINDINGS The mean failure strength for static loading was 17 N for Kirschner wire, 13 N for Titanium elastic nail, 73 N for plate and 34 N for the bone stabilization system (P < .01). For cyclic loading, the mean cycle of failure was 1000 for plate and 961 for the bone stabilization system (P = .76). The mean failure strength after cyclic loading was 73 N for plate and 48 N for the bone stabilization system (P = .03). INTERPRETATION Stability differs depending on the fixation method, with a plate showing the greatest stability and Kirschner wire or Titanium elastic nail the least. The stability of the bone stabilization system for fixing metatarsal shaft fractures is intermediate.
Collapse
|
6
|
Krumme J, MacConnell A, Wallace M, Aboulafia A, Jelinek J, Adams B, Henshaw R. Early Experience in Pathologic Humerus Fracture Treated With the Photodynamic Bone Stabilization System Shows Limitations Related to Patient Selection. Orthopedics 2021; 44:154-159. [PMID: 34039219 DOI: 10.3928/01477447-20210416-06] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Impending and complete pathologic fractures often necessitate surgical fixation. Traditional orthopedic implants are commonly used, achieving clinically acceptable outcomes, but their metallic composition can impair radiographic evaluation and affect radiation treatments. Recognition of these concerns led to the development of radiolucent implants such as the minimally invasive Photodynamic Bone Stabilization System (PBSS; IlluminOss Medical Inc), featuring a light cured polymer contained within an inflatable balloon catheter. Two participating hospitals in one health care system reviewed cases using the PBSS implant. Twenty-five patients with 29 impending or pathologic fractures in the proximal radius or humerus from metastatic carcinoma, myeloma, lymphoma, and melanoma were identified. Clinical charts and imaging were reviewed to determine the status of the implant at final follow-up as well as complications. For analysis, a chi-square test was used for nominal variables and a t test was used for continuous variables. Eleven of the 25 patients were alive with disease at the time of analysis. Eight of 29 (27.5%) implants failed. Five of 25 (20%) patients required repeat surgery due to complications, including 3 revision open reduction and internal fixations, 1 open reduction and internal fixation for a periprosthetic fracture, and 1 screw removal. Five of the 9 cases (56%) (P=.03) with lesions in the distal humeral shaft had breakage of the implant by final follow-up, compared with 3 of 20 cases (15%) (P=.03) elsewhere in the humerus; no failures were seen in the radius. One of 4 patients (25%) also had failure in the surgical neck, although this did not reach significance. Five patients were noted to have progression of disease on follow-up radiographs, with 4 failures in patients with progression. The PBSS implants potentially allow improved surveillance of fracture healing and tumor recurrence along with decreased scattering of radiation during treatment. Unfortunately, there may be a higher rate of mechanical failures, particularly for lesions involving the distal humerus. This may be due to decreased cross-sectional area of the implant in this region as compared with the metaphyseal and proximal regions. Caution should be exercised when treating distal humeral pathologic fractures with large lytic lesions where the underlying disease process is not well controlled. [Orthopedics. 2021;44(3):154-159.].
Collapse
|
7
|
The IlluminOss® photodynamic bone stabilization system for pathological osteolyses and fractures of the humerus: indications, advantages and limits in a series of 12 patients at 24 months of minimum follow-up. BMC Musculoskelet Disord 2021; 22:63. [PMID: 33430839 PMCID: PMC7798276 DOI: 10.1186/s12891-020-03927-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 12/26/2020] [Indexed: 12/01/2022] Open
Abstract
Background Locked titanium nails are considered the reference treatment for metastatic bone lesions of the humerus in patients with aggressive histotypes, high risk of fracture or when estimated survival is lower than 6 months.Nevertheless, they are responsible for CT and MRI artifacts which interfere with postoperative radiotherapy and follow-up.The IlluminOss® is an intramedullary stabilization system which is introduced inside the humeral canal in a deflated state, and is then distended with a monomer which hardens after exposure to blue light,stabilizing the segment; it does not cause artifacts, allowing easier and more effective radiotherapy and follow-up. The aim of this study is to report our experience, indications, possible advantages and limitations of this stabilization system at 24 months of minimum follow-up in a series of 12 patients affected by pathological fractures or impending fractures of the humerus. Methods This is a retrospective case-series that included all patients who underwent surgery with the IlluminOss® Photodynamic Bone Stabilization System for pathological osteolyses and fractures of the humerus. Intraoperative and postoperative complications were valued. Results 12 patients and 13 procedures were included in the study. All surgeries were performed without intraoperative complications. No early postoperative complications were noted. The wounds healed in all cases and stitches were removed at two weeks from surgery, so the patients were able to perform chemotherapy after three weeks. All patients except one had a painless active range of motion which reached 90°.The VAS score was 7 preoperatively and 2.6 at one month from surgery. Pain relief was also associated to radiotherapy and chemotherapy. Unfortunately, two nail ruptures were reported at 4 and 12 months of follow-up. No artifacts were noted in the postoperative CT scans so the radiotherapy plans were easily performed without the need of dose compensation. Conclusions The IlluminOss® intramedullary stabilization system can provide primary stability in humeral fractures and impending fractures;the surgical technique is easy and minimally invasive.Moreover,it does not present artifacts at postoperative imaging,probably giving a better chance to perform prompt radiotherapy and chemotherapy.However, randomized clinical studies are necessary to verify its potential strength and if precocious adjuvant radio- and chemotherapy are associated to a reduction of the local progression rate.
Collapse
|
8
|
Sabater González M, Calvo Carrasco D. Advances in Exotic Animal Osteosynthesis. Vet Clin North Am Exot Anim Pract 2019; 22:441-450. [PMID: 31395324 DOI: 10.1016/j.cvex.2019.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Exotic animal orthopedics has not incorporated the most recent progress made in small animal surgery or human medicine. Although minimally invasive osteosynthesis has been incorporated as a routinely used alternative in small animals, its use in exotic animals is still in its infancy. This article compliments the reviews of orthopedics in small mammals, birds, and reptiles in the previous issue. It reviews relevant recent studies performed in laboratory animals about new orthopedic materials and techniques showing potential to become incorporated into the routine orthopedic treatment of exotic animals in the coming years.
Collapse
|
9
|
Oikonomidis S, Alabsi A, Ashqar G, Graf M, Sobottke R. Intramedullary Stabilization of Pubic Ramus Fractures in Elderly Patients With a Photodynamic Bone Stabilization System (IlluminOss). Geriatr Orthop Surg Rehabil 2019; 10:2151459318824904. [PMID: 31041113 PMCID: PMC6484244 DOI: 10.1177/2151459318824904] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 12/06/2018] [Accepted: 12/07/2018] [Indexed: 01/13/2023] Open
Abstract
Introduction: A photodynamic bone stabilization system (PBSS) is a percutaneous operating method that provides intramedullary stabilization. The purpose of the study was to assess the clinical and radiological outcome after treatment of pubic ramus fractures with the PBSS. Materials and Methods: In a retrospective study, patients with osteoporotic pubic ramus fractures were included. The patients were treated with the PBSS in a percutaneous method. In the routine follow-up examination, pain was measured with the visual analog scale (VAS) and the type of mobilization was verified. Computer tomography of the pelvis was carried out in the follow-up examination (mean of 7.5 months after surgery) to investigate bone healing. Results: A total of 32 patients (25 females and 7 males) were included in the study. The average hospital stay was 16.5 ± 7.9 days (range: 5-37 days) and the mean operation time was 116.8 ± 47.1 minutes (range: 33-255 minutes). Two cases of wound infections and 1 case of misplacement of the PBSS implant with revision surgery have been documented. The mean VAS score for pelvic/hip pain at the day of inpatient discharge was 4.4 ± 1.4 (range: 2-7). A total of 25 patients could attend the follow-up examination 7.5 ± 1.7 months (range: 6-14) after the procedure, reporting a mean VAS for pelvic/hip pain of 3.0 ± 2.2 (range: 0-8). A total of 11 patients could walk without an orthopedic walking device, 7 patients needed underarm crutches, 6 patients used a walker-rollator, and 1 patient was immobilized. Consolidated pubis ramus fractures were described in 24 (96%) cases. Discussion: The results of our study reveal adequate clinical and radiological outcomes after treatment of osteoporotic pubic ramus fractures with the PBSS. This is the first study investigating the outcome after treating pubic ramus fractures with the PBSS. Conclusion: Based on our findings, the PBSS is an alternative to known techniques for the stabilization of the pubic ramus.
Collapse
Affiliation(s)
- Stavros Oikonomidis
- Department of Orthopaedics and Trauma Surgery, University Hospital Cologne, Cologne, Germany.,Department of Orthopaedics and Trauma Surgery, Rhein-Mass Klinikum, Wuerselen, Germany
| | - Ahmad Alabsi
- Department of Orthopaedics and Trauma Surgery, University Hospital Cologne, Cologne, Germany
| | - Ghazi Ashqar
- Department of Orthopaedics and Trauma Surgery, University Hospital Cologne, Cologne, Germany
| | - Markus Graf
- Department of Orthopaedics and Trauma Surgery, University Hospital Cologne, Cologne, Germany
| | - Rolf Sobottke
- Department of Orthopaedics and Trauma Surgery, University Hospital Cologne, Cologne, Germany.,Department of Orthopaedics and Trauma Surgery, Rhein-Mass Klinikum, Wuerselen, Germany
| |
Collapse
|
10
|
Rosa N, Marta M, Vaz M, Tavares SMO, Simoes R, Magalhães FD, Marques AT. Intramedullary nailing biomechanics: Evolution and challenges. Proc Inst Mech Eng H 2019; 233:295-308. [DOI: 10.1177/0954411919827044] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
This article aims to review the biomechanical evolution of intramedullary nailing and describe the breakthrough concepts which allowed for nail improvement and its current success. The understanding of this field establishes an adequate background for forthcoming research and allows to infer on the path for future developments on intramedullary nailing. It was not until the 1940s, with the revolutionary Küntscher intramedullary nailing design, that this method was recognized as a widespread medical procedure. Such achievement was established based on the foundations created from intuition-based experiments and the first biomechanical ideologies. The nail evolved from allowing alignment and stability through press-fit fixation with nail-cortical wall friction to the nowadays nail stability achieved through interlocking screws mechanical linkage between nail and bone. Important landmarks during nail evolution comprise the introduction of flexible reaming, the progress from slotted to non-slotted nails design, the introduction of nail ‘dynamization’ and the use of titanium alloys as a new nail material. Current biomechanical improvement efforts aim to enhance the bone–intramedullary nail system stability. We suggested that benefit would be attained from a better understanding of the ideal mechano-biological environment at the fracture site, and future improvements will emerge from combining mechanics and biological tools.
Collapse
Affiliation(s)
- Natacha Rosa
- Department of Mechanical Engineering, Faculty of Engineering, University of Porto, Porto, Portugal
| | - Miguel Marta
- Department of Orthopaedics, Centro Hospitalar de São João, Porto, Portugal
| | - Mário Vaz
- Department of Mechanical Engineering, Faculty of Engineering, University of Porto, Porto, Portugal
- INEGI, Faculty of Engineering, University of Porto, Porto, Portugal
| | | | - Ricardo Simoes
- Polytechnic Institute of Cávado and Ave, Barcelos, Portugal
- Institute for Polymers and Composites IPC/I3N, University of Minho, Guimarães, Portugal
| | - Fernão D Magalhães
- LEPABE–Faculdade de Engenharia, Universidade do Porto, Rua Dr. Roberto Frias, Portugal
| | - Antonio Torres Marques
- Department of Mechanical Engineering, Faculty of Engineering, University of Porto, Porto, Portugal
| |
Collapse
|