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Brenner J, Joiner J, Schweller E, Ren E, Nasr K, Vaidya R. Femoral intramedullary nail extraction using the kissing nail technique when primary measures fail. OTA Int 2025; 8:e355. [PMID: 39711841 PMCID: PMC11661725 DOI: 10.1097/oi9.0000000000000355] [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: 03/26/2024] [Revised: 09/17/2024] [Accepted: 10/18/2024] [Indexed: 12/24/2024]
Abstract
Introduction Intramedullary femoral nails (IMFNs) need to be removed for subsequent joint replacement, refracture, nonunion, or infection. The tools used to extract newer IMFNs may not be suited for removal of older implants, especially if broken. The purpose of this study was to describe a novel technique in femoral nail extraction when primary measures fail and a report on 6 cases where it was used. Technical Procedure The technique is used after standard techniques including the Winquist set fail. A guide rod is passed through the center of the incarcerated nail (IN) to the distal end or to the proximal end if it is a retrograde nail. The femur is approached through a separate incision either through the knee for an antegrade nail or through the proximal femur for a retrograde nail. The guide rod is delivered through the opposite end by either hitting it through the end of the bone or breaching the end with a starting wire and starting reamer. The guide rod is then delivered into the field. Using flexible reamers over the delivered guide rod, the femur is reamed up to the IN. A second IMN slightly smaller in diameter is chosen and passed to touch the distal end of the IN, guided by the guide rod to keep the nails aligned. The second nail is impacted, which pushes the IN out its insertion point. Discussion Hardware extraction is difficult for any surgeon, and extraction of older or broken nails with lower grade material poses even greater challenges. This technique is meant as an extra tool for avoidance of corticotomy when primary means for nail extraction have failed. We present 6 cases with 5 successful results.
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Affiliation(s)
- Joseph Brenner
- University of Toledo College of Medicine and Life Sciences, Toledo, OH
| | - Jonathan Joiner
- Department of Orthopedic Surgery, McLaren Oakland Graduate Medical Education, Pontiac, MI
| | - Eric Schweller
- Department of Orthopedic Surgery, Community Garden City Hospital, Garden City, MI
| | - Emily Ren
- Department of Orthopedic Surgery, Detroit Medical Center, Detroit, MI
| | - Kerellos Nasr
- Department of Orthopedic Surgery, Detroit Medical Center, Detroit, MI
| | - Rahul Vaidya
- Department of Orthopedic Surgery, Detroit Medical Center, Detroit, MI
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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; 44:e957-e964. [PMID: 39087515 DOI: 10.1097/bpo.0000000000002780] [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: 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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Villatte G, Haverlan A, Le Baron M, Mulliez A, Boisgard S, Descamps S, Erivan R. Epidemiology of complications after non-compulsory planned hardware-removal after limbs fracture. Orthop Traumatol Surg Res 2024:104028. [PMID: 39433175 DOI: 10.1016/j.otsr.2024.104028] [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: 05/13/2024] [Revised: 08/27/2024] [Accepted: 09/18/2024] [Indexed: 10/23/2024]
Abstract
INTRODUCTION Removal of hardware (HR) following a fracture is a frequent question from patients. The incidence of this kind of intervention remains very variable depending on the healthcare systems and its interest is debated in view of the benefits and associated risks that remain poorly defined. Mandatory preoperative information cannot be given optimally in this context. OBJECTIVE To determine the rate of complications (major and minor) after non-compulsory planned hardware-removal following a limb fracture. HYPOTHESIS The rate of major complications was greater than 1%. METHODS A 10-year retrospective single-center study included 1990 patients who had undergone routine HR. Analysis of medical records, with a minimum of one year of follow-up, allowed us to collect: patient data, the type and anatomical location of the osteosynthesis material, as well as the occurrence of a postoperative complication, categorized as a major complication (resulting in either a new surgical procedure, re-hospitalization, or lasting functional impairment) or a minor complication. RESULTS Overall, 4.1% (79/1990) of patients experienced postoperative complications, including 1.56% (31/1990) major complications and 21 surgical revisions (1.06%). The time to onset of complications was 9.1 +/- 8.4 days. The most common complications were deep infections and impaired skin healing with superficial infection (55/79, 69.6%). Locations "around the knee" and "around the ankle" were at higher risk of complications (p < 0.01). Smoking was identified as a significant risk factor for complications, particularly deep infection (p = 0.004, OR = 8.7 [1.98; 38.11]). DISCUSSION Non-mandatory routine RH has a significant complication rate even in a healthy population. Preoperative information of the patient and the assessment of the benefit/risk balance are essential in this indication. This study also raises the question of mandatory smoking cessation preoperatively. LEVEL OF EVIDENCE IV; retrospective study.
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Affiliation(s)
- Guillaume Villatte
- Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, F-63000 Clermont-Ferrand, France; Service d'orthopédie-traumatologie, CHU Montpied Clermont-Ferrand, 63000 Clermont-Ferrand, France.
| | - Arthur Haverlan
- Service d'orthopédie-traumatologie, CHU Montpied Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Marie Le Baron
- Service de chirurgie orthopédique, hôpital Nord, pôle locomoteur, Institut du mouvement et de l'appareil locomoteur, Assistance publique-Hôpitaux de Marseille, Marseille, France
| | - Aurélien Mulliez
- Department of Clinical Research and Innovation DRCI, CHU Montpied Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Stéphane Boisgard
- Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, F-63000 Clermont-Ferrand, France; Service d'orthopédie-traumatologie, CHU Montpied Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Stéphane Descamps
- Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, F-63000 Clermont-Ferrand, France; Service d'orthopédie-traumatologie, CHU Montpied Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Roger Erivan
- Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, F-63000 Clermont-Ferrand, France; Service d'orthopédie-traumatologie, CHU Montpied Clermont-Ferrand, 63000 Clermont-Ferrand, France
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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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Lause GE, Parker EB, Farid A, Smith JT, Chiodo CP, Martin EA, Bluman EM. Efficiency and perceived safety of foot and ankle procedures performed on the preoperative stretcher versus operating room table. J Perioper Pract 2024; 34:268-273. [PMID: 38149482 DOI: 10.1177/17504589231215939] [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] [Indexed: 12/28/2023]
Abstract
BACKGROUND Foot and ankle surgeons often perform minor surgeries on the preoperative stretcher instead of the operating room table. We examined whether stretcher-based and operating room table-based procedures differed with respect to operating room efficiency and staff perceptions. METHODS We retrospectively reviewed medical records of patients undergoing minor foot and ankle surgery at an ambulatory surgery centre. We collected 'time to start', the duration between patient arrival in the operating room and incision time, and 'time to exit', the duration between procedure end time and patient exit from the operating room. Staff were surveyed regarding their perceptions of stretcher-based and operating room table-based procedures. RESULTS 'Time to start' was significantly shorter for stretcher-based procedures, but 'time to exit' was not. Seventeen (81%) staff members thought stretcher-based procedures increased operating room efficiency. Thirteen (62%) thought stretcher-based procedures bettered staff safety. Nineteen (91%) thought stretcher-based procedures were equivalent to or better than operating room table-based procedures for patient safety. Most (67%) would recommend stretcher-based procedures. CONCLUSION We found small but significant time savings associated with stretcher-based procedures. Without adapting surgical scheduling practices, the impact of stretcher-based procedures on overall operating room efficiency is questionable. Nevertheless, the majority of OR staff think stretcher-based procedures increase OR efficiency and are safer for staff. LEVEL OF EVIDENCE Level IV, Retrospective case series.
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Affiliation(s)
- Gregory E Lause
- Department of Orthopaedic Surgery, Landstuhl Regional Medical Center, Landstuhl, Germany
| | - Emily B Parker
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Alexander Farid
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jeremy T Smith
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Christopher P Chiodo
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Elizabeth A Martin
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Eric M Bluman
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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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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Siebert MJ, Zhang E, Stephens SE, Wey AJ, Eppich K, Presson AP, Holmes SM, Makarewich CA. Screw Diameter and Use of a Washer Affect Symptomatic Implant Removal Rates in Pediatric Medial Epicondyle Fractures. J Pediatr Orthop 2024; 44:427-432. [PMID: 38651447 PMCID: PMC11236501 DOI: 10.1097/bpo.0000000000002693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
OBJECTIVE Medial epicondyle fractures are a common pediatric injury. When operative, cannulated partially threaded screws, with or without a washer, are commonly utilized. These implants may need to be removed after full healing if symptomatic. There is mixed evidence regarding the influence of a washer on rates of implant removal, and the influence of screw size has not been studied. We aim to determine the rate of symptomatic deep implant removal for each fixation type and identify factors associated with the need for removal. METHODS This was an IRB-reviewed, retrospective, case-cohort study. Patients treated at our institution between January 1, 2004 and December 31, 2019, age 18 years old or younger, with a medial epicondyle fracture managed operatively with 4.0 or 4.5 mm cannulated screws with or without washers were included. Patients with multiple operative ipsilateral elbow fractures and those who underwent implant removal for reasons other than pain or irritation were excluded. Removal rates were compared between screw sizes (4.0 vs 4.5 mm), as well as with and without a washer using a Cox proportional hazards model. RESULTS In total, 151 patients met the inclusion criteria, 54 with symptomatic hardware removed and 97 without symptomatic hardware removed. A significantly higher number of patients treated with 4.5 mm screws compared with 4.0 mm screws underwent removal of symptomatic deep implants (50% vs 30%, P = 0.033). In a multivariable Cox regression model adjusting for age and ulnar nerve status, when no washer was used, the hazard ratio (HR) for symptomatic hardware removal for 4.5 mm screws was 2.92 times the HR for 4.0 mm screws (95% CI: 1.35-6.29). When a 4.0 mm screw was used, the HR for symptomatic hardware removal for a washer was 3.24 times the HR without a washer (95% CI: 1.53-6.84). CONCLUSION Implant removal rates are influenced by screw size and the use of a washer. These results may help guide implant choice and counsel families regarding the rate of symptomatic implant removal. LEVEL OF EVIDENCE Level III-therapeutic level, case-control study.
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Affiliation(s)
- Matthew J Siebert
- Department of Orthopaedics, University of Utah, Salt Lake City, UT
- Primary Children's Hospital, Salt Lake City, UT
| | - Emily Zhang
- Department of Orthopaedics, University of Utah, Salt Lake City, UT
- Primary Children's Hospital, Salt Lake City, UT
| | - Senah E Stephens
- Department of Orthopaedics, University of Utah, Salt Lake City, UT
- Primary Children's Hospital, Salt Lake City, UT
| | - Aaron J Wey
- Department of Orthopaedics, University of Utah, Salt Lake City, UT
- Primary Children's Hospital, Salt Lake City, UT
| | - Kaleb Eppich
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT
| | - Angela P Presson
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT
| | - Stephanie M Holmes
- Department of Orthopaedics, University of Utah, Salt Lake City, UT
- Primary Children's Hospital, Salt Lake City, UT
| | - Christopher A Makarewich
- Department of Orthopaedics, University of Utah, Salt Lake City, UT
- Primary Children's Hospital, Salt Lake City, UT
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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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Wimmer SP, Wren TAL, Rethlefsen SA, Abousamra ON, Kay RM. Does Size Really Matter? Incidence of Periprosthetic Fractures After Femoral Osteotomy in Patients With Cerebral Palsy. J Pediatr Orthop 2024; 44:e452-e456. [PMID: 38506352 DOI: 10.1097/bpo.0000000000002663] [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: 03/21/2024]
Abstract
OBJECTIVE Of children, 30% to 35% with cerebral palsy (CP) develop hip subluxation or dislocation and often require reconstructive hip surgery, including varus derotation osteotomy (VDRO). A recent literature review identified postoperative fractures as the most common complication (9.4%) of VDROs. This study aimed to assess risk factors for periprosthetic fracture after VDRO in children with CP. METHODS A total of 347 patients (644 hips, 526 bilateral hips) with CP and hip subluxation or dislocation (129 females; mean age at index VDRO: 8.6 y, SD 3.4, range: 1.5 to 17.7; 2 Gross Motor Function Classification System (GMFCS) I, 35 GMFCS II, 39 GMFCS III, 119 GMFCS IV, 133 GMFCS V, 21 unavailable) were included in this retrospective, single-group intervention (VDRO) study at a tertiary referral center. Imaging and clinical documentation for patients age 18 years or younger at index surgery, treated with VDRO were reviewed to determine demographic data, GMFCS level, surgeon, type of hardware implanted, use of anticonvulsants and steroids, type of postoperative immobilization, presence of periprosthetic fractures, fracture location and mechanism, and time from surgery to fracture. Potential determinants of periprosthetic fractures were assessed using mixed effects logistic regression. RESULTS Of 644 hips, 14 (2.2%, 95% CI: 1.3%, 3.6%) sustained a periprosthetic fracture, at a median of 2.1 years postoperatively (interquartile range: 4.6 y, range: 1.2 mo to 7.8 y). Patients with a fracture had a median age at index surgery of 7.3 years (interquartile range: 4.3, range: 2.8 to 17.8; 1 GMFCS II, 6 GMFCS IV, 7 GMFCS V). Periprosthetic fractures were not significantly related to age at index surgery ( P = 0.18), sex ( P = 0.30), body mass index percentile ( P = 0.87), surgery side ( P = 0.16), anticonvulsant use ( P = 0.35), type of postoperative immobilization ( P = 0.40), GMFCS level ( P = 0.31), or blade plate size ( P = 0.17). Only surgeon volume significantly related to periprosthetic fracture (odds ratio = 5.03, 95% CI: 1.53, 16.56, P = 0.008), with the highest-volume surgeon also using smaller blade plates ( P < 0.01). CONCLUSIONS Periprosthetic fractures after VDRO surgery in children with CP are uncommon, and routine hardware removal appears unnecessary. The data suggest that the common dogma of putting in the largest blade plate possible to maximize fixation may increase the risk of periprosthetic fracture. Due to the overall low fracture rate, especially when contextualized relative to the risk of hardware removal, a reactive approach to hardware removal appears warranted. LEVEL OF EVIDENCE Level III-retrospective study (targeting varus derotational osteotomies in children with cerebral palsy).
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Affiliation(s)
- Sam P Wimmer
- Jackie and Gene Autry Orthopedic Center, Children's Hospital Los Angeles
| | - Tishya A L Wren
- Jackie and Gene Autry Orthopedic Center, Children's Hospital Los Angeles
- Keck School of Medicine, University of Southern California, Zonal Avenue, Los Angeles, CA
| | - Susan A Rethlefsen
- Jackie and Gene Autry Orthopedic Center, Children's Hospital Los Angeles
| | - Oussama N Abousamra
- Jackie and Gene Autry Orthopedic Center, Children's Hospital Los Angeles
- Keck School of Medicine, University of Southern California, Zonal Avenue, Los Angeles, CA
| | - Robert M Kay
- Jackie and Gene Autry Orthopedic Center, Children's Hospital Los Angeles
- Keck School of Medicine, University of Southern California, Zonal Avenue, Los Angeles, CA
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Leal J, Cullen MM, Bolognesi MP, Wellman SS, Ryan SP. Mixed Reality Navigation in Hip Fusion Conversion: A Novel Utilization of Advanced Technology: A Case Report. JBJS Case Connect 2024; 14:01709767-202406000-00057. [PMID: 38913787 DOI: 10.2106/jbjs.cc.24.00128] [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: 06/26/2024]
Abstract
CASE A 32-year-old woman with a history of hip fusion presented with significant lower back, hip, and knee pain as well as severely limited hip mobility and function. Single-stage fusion takedown and conversion to total hip arthroplasty (THA) was performed using augmented reality navigation. At 1 year, the patient was pain free with improved function. This study is the first to report the technique and outcomes of surgical fusion conversion to THA, using mixed reality navigation. CONCLUSION Mixed reality navigation in complex conversion THA can be useful for identifying the patient's true acetabulum and for patient-specific acetabular component placement to maximize outcomes.
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Affiliation(s)
- Justin Leal
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina
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Nelson CT, Reiter CR, Harris M, Edge C, Satalich J, O'Neill C, Cyrus J, Vap A. Femoral rotational osteotomy for femoroacetabular impingement: A systematic review. J Orthop 2024; 50:139-148. [PMID: 38283872 PMCID: PMC10818154 DOI: 10.1016/j.jor.2023.12.015] [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: 12/13/2023] [Accepted: 12/17/2023] [Indexed: 01/30/2024] Open
Abstract
Purpose To synthesize existing literature regarding the indications and outcomes of femoral rotational osteotomies (FDO) for femoroacetabular impingement (FAI) due to. Methods Medline, Cochrane, and Embase were searched using keywords "femoroacetabular impingement", "rotational osteotomy" and others to identify FAI patients undergoing FDO. Double-screened studies were reviewed by blinded authors according to inclusion criteria. Data from full texts was extracted including study type, number of patients, sex, mean age, surgical indication, type of dysplasia, associated pathology, surgical technique, follow-up, and pre-op/post-op evaluations of the following: impingement test, femoral version (FV), 'other angles measured', outcome scores, range of motion (ROM). Results 7 studies including 91 patients (97 FDO surgeries), 73 females (80 %) with mean age of 28.3 years, and follow-up mean of 2.44 ± 2.83 years. Pain or impingement was the most common clinical indication, while others included aberrant FV and ROM measurements for both anteverted and retroverted femurs. There were reports of FDO being performed with concomitant procedures addressing other pathology. Various outcome scores and ROM measurements showed postoperative improvement after FDO. Complication data was sparse, preventing aggregation. The rate of unplanned reoperation was 40 % (where reported), with 'hardware removal' being the most common. Conclusions FDO is effective in treating FAI due to increased FV, improving clinical symptoms, and potentially delaying articular degeneration. Hardware removal surgery remains an inherent risk in undergoing FDO. Further work is needed to discover indications warranting FDO as a primary treatment versus hip arthroscopy. Level of evidence This review contains 4 studies with Level IV evidence and 3 studies with Level III evidence.
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Affiliation(s)
- Chase T. Nelson
- Virginia Commonwealth University School of Medicine, Virginia Commonwealth University, VCU Medical Center, 1201 E Marshall St #4-100, Richmond, VA, 23298, USA
| | - Charles R. Reiter
- Virginia Commonwealth University School of Medicine, Virginia Commonwealth University, VCU Medical Center, 1201 E Marshall St #4-100, Richmond, VA, 23298, USA
| | - Matthew Harris
- Virginia Commonwealth University School of Medicine, Virginia Commonwealth University, VCU Medical Center, 1201 E Marshall St #4-100, Richmond, VA, 23298, USA
| | - Carl Edge
- Department of Orthopaedic Surgery, Virginia Commonwealth University Hospital, Box 980153, Richmond, VA, 23298-0153, USA
| | - James Satalich
- Department of Orthopaedic Surgery, Virginia Commonwealth University Hospital, Box 980153, Richmond, VA, 23298-0153, USA
| | - Conor O'Neill
- Department of Orthopaedic Surgery, Duke Health, 200 Trent Dr Ste 1F, Durham, NC, 27710, USA
| | - John Cyrus
- Health Sciences Library, MCV Campus at Virginia Commonwealth University, 509 N. 12th St., Box 980582, Richmond, VA, 23298-0582, USA
| | - Alexander Vap
- Department of Orthopaedic Surgery, Virginia Commonwealth University Hospital, Box 980153, Richmond, VA, 23298-0153, USA
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12
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Wongcharoenwatana J, Hamilton AA, Hoellwarth JS, Reif TJ, Fragomen AT, Rozbruch SR. Bilateral Distal Femoral Osteotomy for Valgus Knee Deformity May Result in Improved Patient-Reported Outcome Scores. HSS J 2024:15563316231214779. [PMID: 39564401 PMCID: PMC11572583 DOI: 10.1177/15563316231214779] [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: 06/21/2023] [Accepted: 09/07/2023] [Indexed: 11/21/2024]
Abstract
Background The lateral opening wedge distal femoral osteotomy (DFO) is an effective treatment for genu valgum to improve mechanical alignment, decrease lateral compartment loads, and decrease the risk of knee osteoarthritis. Multiple studies have utilized outcome scores assessing functional changes related to pain and joint stability, with a focus solely on knee pain and functional outcomes. Questions/purposes The primary aim of this study was to evaluate patient-reported outcome measures (PROMs) that assessed knee function, pain, patient's perception of body image, and limb deformity-related quality of life, both preoperatively and at least 1-year postoperatively. Methods In a retrospective review of nontraumatic genu valgum patients who underwent bilateral DFO, preoperative and postoperative radiographs were evaluated. Routinely collected preoperative and 1-year postoperative PROMs scores were analyzed, using the Knee Injury and Osteoarthritis Outcome Score Jr. (KOOS-JR) and the Limb Deformity-Modified Scoliosis Research Society (LD-SRS) score, in 72 limbs (36 patients): 7 men (19.44%) and 29 women (80.56%) with an average age of 35.34 ± 13.57 years. The mean follow-up time was 36.85 ± 24.43 months. Results Overall mechanical axis deviation, lateral distal femoral angle, and mechanical axis alignment angle were significantly improved after DFO in all patients. Both PROMs also improved significantly from preoperative to postoperative scores: LD-SRS (3.10 ± 0.56 vs 4.19 ± 0.44, respectively) and KOOS-JR (63.02 ± 19.25 vs 78.06 ± 16.29, respectively). Conclusion This retrospective review suggests that bilateral lateral opening-wedge DFOs in patients with symptomatic valgus knee deformity may be associated with improved overall knee health, limb deformity-related quality of life, and patients' body image. Further study is needed.
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Affiliation(s)
- Jidapa Wongcharoenwatana
- Limb Lengthening and Complex Reconstruction Service, Hospital for Special Surgery, New York, NY, USA
- Department of Orthopaedic Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Amber A Hamilton
- Limb Lengthening and Complex Reconstruction Service, Hospital for Special Surgery, New York, NY, USA
| | - Jason S Hoellwarth
- Limb Lengthening and Complex Reconstruction Service, Hospital for Special Surgery, New York, NY, USA
| | - 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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13
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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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14
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Katayama H, Nakashima H, Takahara Y, Itani S, Iwasaki Y, Kato H, Uchida Y. Effect of hardware removal and second-look arthroscopy after open-wedge high tibial osteotomy. Arch Orthop Trauma Surg 2024; 144:73-79. [PMID: 37639045 DOI: 10.1007/s00402-023-05035-1] [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: 02/14/2023] [Accepted: 08/13/2023] [Indexed: 08/29/2023]
Abstract
INTRODUCTION Open-wedge high tibial osteotomy (OWHTO) is the standard and safe procedure for medial compartment osteoarthritis. Although hardware removal (HWR) is performed after post-OWHTO bone union, the effects of HWR on OWHTO have been rarely reported. We hypothesised that HWR would improve range of motion (ROM) and implant-related complications. Thus, this study aimed to investigate the effects of HWR on postoperative ROM, the Japan Orthopaedic Association (JOA) score/visual analogue scale (VAS) score and hardware-related complications after OWHTO. METHODS Patients who underwent OWHTO between January 2016 and June 2018 and HWR were retrospectively reviewed. To perform OWHTO, locking plates and prosthetic bone were used to achieve optimal stabilisation of biplanar osteotomy. HWR was performed after a second-look arthroscopy through the previous skin incision. For clinical evaluation, the JOA score, VAS score, and ROM were assessed before and 1 year after HWR using the Wilcoxon rank test. Logistic regression analysis was performed to identify the predictors of post-HWR improvement. RESULTS Of 98 knees examined (91 patients), 80 (73 patients; 39 men and 34 women) were included. At the time of OWHTO, mean age was 64.0 ± 9.7 years and body mass index, 25.5 ± 3.1 kg/m2; Kellgren-Lawrence (KL) grade 1 was seen in 20 cases, KL-2 in 46, and KL-3 in 14. Mean periods between OWHTO and HWR were 13.4 ± 2.0 months, and 11.9 ± 1.2 months between HWR and evaluation. The JOA score and flexion angle significantly improved after HWR (The JOA score: p = 0.026 flexion angle: p < 0.001); however, the VAS score and extension angle did not (VAS score: p = 0.162, extension angle: p = 0.934). Hardware irritation was observed in four cases (5%), which improved after HWR. Logistic regression analysis revealed that lower preoperative KL grade and flexion angle were predictors of improvement after HWR [KL grade: p = 0.008; odds ratio 3.244, 95% confidence interval (CI) 1.350-7.794; flexion angle: p < 0.001; odds ratio 1.150, 95% CI 1.062-1.245]. CONCLUSION HWR improves flexion angle, clinical outcomes and hardware-related complications after OWHTO. Preoperative KL grade and flexion angle are predictors of improvement after HWR in patients who have undergone OWHTO.
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Affiliation(s)
- Haruyoshi Katayama
- Department of Orthopedic Surgery, Nippon Kokan Fukuyama Hospital, 1844 Tsunoshita Daimon-cho, Fukuyama, Hiroshima, 721-0927, Japan
| | - Hirotaka Nakashima
- Department of Orthopedic Surgery, Nippon Kokan Fukuyama Hospital, 1844 Tsunoshita Daimon-cho, Fukuyama, Hiroshima, 721-0927, Japan
- Department of Orthopedic Surgery, Wakamatsu Hospital of University of Occupational and Environmental Health, Kitakyushu, Fukuoka, 808-0024, Japan
| | - Yasuhiro Takahara
- Department of Orthopedic Surgery, Nippon Kokan Fukuyama Hospital, 1844 Tsunoshita Daimon-cho, Fukuyama, Hiroshima, 721-0927, Japan.
| | - Satoru Itani
- Department of Orthopedic Surgery, Nippon Kokan Fukuyama Hospital, 1844 Tsunoshita Daimon-cho, Fukuyama, Hiroshima, 721-0927, Japan
| | - Yuichi Iwasaki
- Department of Orthopedic Surgery, Nippon Kokan Fukuyama Hospital, 1844 Tsunoshita Daimon-cho, Fukuyama, Hiroshima, 721-0927, Japan
| | - Hisayoshi Kato
- Department of Orthopedic Surgery, Nippon Kokan Fukuyama Hospital, 1844 Tsunoshita Daimon-cho, Fukuyama, Hiroshima, 721-0927, Japan
| | - Yoichiro Uchida
- Department of Orthopedic Surgery, Nippon Kokan Fukuyama Hospital, 1844 Tsunoshita Daimon-cho, Fukuyama, Hiroshima, 721-0927, Japan
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15
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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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16
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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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17
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Bragg JT, Masood RM, Spence SS, Citron JE, Moon AS, Salzler MJ, Ryan SP. Predictors of Hardware Removal in Orthopaedic Trauma Patients Undergoing Syndesmotic Ankle Fixation With Screws. FOOT & ANKLE ORTHOPAEDICS 2023; 8:24730114231198841. [PMID: 37724307 PMCID: PMC10505342 DOI: 10.1177/24730114231198841] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2023] Open
Abstract
Background Indications for removal of syndesmotic screws are not fully elucidated. This study aimed to determine factors related to elective syndesmotic screw removal. Methods Patients who underwent fixation of ankle syndesmotic injuries were included. Screw removal was offered after a minimum of 12 weeks after surgery for pain, stiffness or patient desire to remove painful or broken hardware. Patient demographics, surgical data, distance of the syndesmotic screw from the joint, location of the screw at the physeal scar, and number of syndesmotic screws placed were collected for all patients. Bivariate and multivariate analyses were performed to determine the relationship between patient characteristics and screw removal and independent predictors of hardware removal. Results Of 160 patients, 60 patients (38%) with an average age of 36.1 (range: 18-84) years underwent elective syndesmotic screw removal at a mean of 7 (range, 3-47) months after initial fixation. The most common reason for screw removal (50/60 patients) was ankle stiffness and pain (83%). Patients who underwent screw removal were more likely to be younger (36.1 years ± 13.0 vs 46.6 years ± 18.2, P < .001) and have a lower ASA score (2 ± 0.8 vs 2.1 ± 0.7, P = .003) by bivariate analysis. Of patients who underwent screw removal, 21.7% (13/60) had a broken screw at the time of removal. Whether the screw was placed at the physeal scar was not significantly associated with patient decision for hardware removal (P = .80). Conclusion Younger and healthier patients were more likely to undergo elective removal of syndesmotic hardware. Screw distance from joint and screw placement at the physeal scar were not significantly associated with hardware removal. Level of Evidence Level III, retrospective cohort study.
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Affiliation(s)
- Jack T. Bragg
- Department of Orthopaedic Surgery, Tufts Medical Center, Boston, MA, USA
| | | | | | | | - Andrew S. Moon
- Department of Orthopaedic Surgery, Tufts Medical Center, Boston, MA, USA
| | - Matthew J. Salzler
- Department of Orthopaedic Surgery, Tufts Medical Center, Boston, MA, USA
| | - Scott P. Ryan
- Department of Orthopaedic Surgery, Tufts Medical Center, Boston, MA, USA
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18
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Peterson DF, Schabel K. Cold Welding of the Synthes Femoral Neck System Encountered at Conversion to Arthroplasty: A Case Report. JBJS Case Connect 2023; 13:01709767-202309000-00008. [PMID: 37437052 DOI: 10.2106/jbjs.cc.22.00530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Abstract
CASE The Synthes Femoral Neck System (FNS) is a relatively new device available to the market in 2019 designed to reduce complication and revision rates after femoral neck fracture stabilization. We present a 77-year-old man with Parkinson disease and avascular necrosis after femoral neck fracture initially managed with the FNS. Subsequent challenges in device removal occurred because of its propensity for bony integration, plate and locking screw welding, and screw head recess destruction. CONCLUSION Surgeons must recognize the need for additional available equipment (e.g., burr or broken screw removal set) for successful extraction when FNS removal is required.
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Affiliation(s)
- Danielle F Peterson
- Department of Orthopaedics, Oregon Health and Science University, Portland, Oregon
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19
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Wijesekera MP, Martin E, Tang C, Chowdhury J, Sabouni MY, Foster P. Resource implications of managing paediatric femoral fractures in a major trauma centre: Analysis of 98 cases. Injury 2023; 54:110918. [PMID: 37421836 DOI: 10.1016/j.injury.2023.110918] [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: 03/19/2023] [Revised: 06/16/2023] [Accepted: 06/25/2023] [Indexed: 07/10/2023]
Abstract
INTRODUCTION The management of paediatric femoral shaft fractures is expensive and is guided by age and fracture characteristics. The primary aim of this study was to perform a cost evaluation for managing paediatric femoral shaft fractures. The secondary aim of this study was to perform and compare costs of the different techniques of managing paediatric femoral shaft fractures. METHODS Ninety-eight femoral shaft fractures in children aged ≤16 were identified between 01/06/2014-30/06/2019. Retrospective data of clinical complications were obtained on infection, malunion and non-union. Data on additional intervention, reoperations for complications and routine removal of metal work were obtained. Costing analysis was performed by a bottom-up calculation, and gathering Patient Level Information and Costing System (PLICS) data. RESULTS There were 41 hip spica casting (HSC), 21 flexible intramedullary nailing (FIN), 14 submuscular plating (SMP), 19 rigid intramedullary nailing (RIN) and 3 external fixation (EF). Complications observed were HSC 3(7%); FIN 8(38%); SMP 2(14%); RIN 1(5%); EF 2(67%). The total costs for managing femoral shaft fractures were £8,955pp the costs for the different managements were; HSC £3,442pp; FIN £7,739pp; SMP £6,953pp; RIN £8,925pp; EF £19,116pp. The additional costs incurred for managing complications and routine removal of metal work for the internal fixation methods were: HSC 0.7%, FIN 23.7%, SMP 16.3%, RIN 10.9%, EF 28.1%. CONCLUSION The operative management of paediatric femoral shaft fractures is associated with a high cost burden and this study demonstrates how financial data can be used to influence clinical management strategy. RIN carry a high initial implant cost however when considering the additional costs, such as treating complications it remains comparable to other modes of fixation. Our cost analysis did not demonstrate a significant difference between FIN, SMP and RIN. Due to the clinical complications observed and associated additional costs, we have discontinued the routine use of FIN for femoral shaft fractures at our centre. We recognise other centres may have a different complication and cost profile for each technique, but recommend they evaluate their practice given the potential economic benefit it has on the service provider.
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Affiliation(s)
- Maheshi P Wijesekera
- Trauma and Orthopaedics Department, Leeds Children's Hospital, Leeds LS1 3EX, United Kingdom
| | - Ellen Martin
- Trauma and Orthopaedics Department, Leeds Children's Hospital, Leeds LS1 3EX, United Kingdom
| | - Chun Tang
- Trauma and Orthopaedics Department, Leeds Children's Hospital, Leeds LS1 3EX, United Kingdom
| | - James Chowdhury
- Trauma and Orthopaedics Department, Leeds Children's Hospital, Leeds LS1 3EX, United Kingdom
| | - Mohamed Y Sabouni
- Trauma and Orthopaedics Department, Leeds Children's Hospital, Leeds LS1 3EX, United Kingdom
| | - Patrick Foster
- Trauma and Orthopaedics Department, Leeds Children's Hospital, Leeds LS1 3EX, United Kingdom.
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20
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Fu S, Ju G, Dai X, Li H, Huang A. Severe major vessel injury during peadicle screw removal: a case report. Front Surg 2023; 10:1187801. [PMID: 37383382 PMCID: PMC10293790 DOI: 10.3389/fsurg.2023.1187801] [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] [Received: 03/16/2023] [Accepted: 05/22/2023] [Indexed: 06/30/2023] Open
Abstract
Introduction Pedicle screw fixation (PSF) has been the standard therapy for the treatment of various spinal diseases. Although complications are identified regularly, iatrogenic vascular injury is one of the rare but life-threatening complications. In this literature, we describe the first case of inferior vena cava (IVC) injury during pedicle screw removal. Case description A 31-year-old man was treated by percutaneous pedicle screw fixation for an L1 compression fracture. After a year, the fracture healed well and hardware removal surgery was performed. During the procedure, the hardware on the right was removed unremarkably except for the L2 pedicle screw which slipped into the retroperitoneum because of the improper technique. The CT angiogram revealed the screw had breached the anterior cortex of the L2 vertebral body and penetrated the IVC. After multidisciplinary cooperation, the defect of IVC was reconstructed and the L2 screw was removed from the posterior approach in the end. Result The patient recovered well and was discharged after 3 weeks without further events. The removal of the contralateral implants was unremarkable at 7 months postoperatively. At the 3-year follow-up, the patient returned to his normal daily activity without any complaints. Conclusion Although pedicle screw removal is a rather simple procedure, severe complications may have occurred from this procedure. Surgeons should keep vigilant to avoid the complication noted in this case.
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Affiliation(s)
- ShengYu Fu
- Department of Orthopaedic, The Affiliated Taizhou People’s Hospital of Nanjing Medical University, Taizhou, China
- Postgraduate School, Dalian Medical University, Dalian, China
| | - Gang Ju
- Department of Orthopaedic, The Affiliated Taizhou People’s Hospital of Nanjing Medical University, Taizhou, China
| | - Xiang Dai
- Department of Vascular Surgery, The Affiliated Taizhou People's Hospital of Nanjing Medical University, Taizhou, China
| | - Haijun Li
- Department of Orthopaedic, The Affiliated Taizhou People’s Hospital of Nanjing Medical University, Taizhou, China
| | - Aibing Huang
- Department of Orthopaedic, The Affiliated Taizhou People’s Hospital of Nanjing Medical University, Taizhou, China
- Postgraduate School, Dalian Medical University, Dalian, China
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21
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Schlund M, Dartus J, Defrançois S, Ferri J, Delattre J, Blanchemain N, Woisel P, Lyskawa J, Chai F. In Vitro and In Vivo Evaluation of a Bio-Inspired Adhesive for Bone Fixation. Pharmaceutics 2023; 15:pharmaceutics15041233. [PMID: 37111718 PMCID: PMC10146643 DOI: 10.3390/pharmaceutics15041233] [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: 02/24/2023] [Revised: 04/07/2023] [Accepted: 04/11/2023] [Indexed: 04/29/2023] Open
Abstract
Compared to metallic hardware, an effective bone adhesive can revolutionize the treatment of clinically challenging situations such as comminuted, articular, and pediatric fractures. The present study aims to develop such a bio-inspired bone adhesive, based upon a modified mineral-organic adhesive with tetracalcium phosphate (TTCP) and phosphoserine (OPS) by incorporating nanoparticles of polydopamine (nPDA). The optimal formulation, which was screened using in vitro instrumental tensile adhesion tests, was found to be 50%molTTCP/50%molOPS-2%wtnPDA with a liquid-to-powder ratio of 0.21 mL/g. This adhesive has a substantially stronger adhesive strength (1.0-1.6 MPa) to bovine cortical bone than the adhesive without nPDA (0.5-0.6 MPa). To simulate a clinical scenario of autograft fixation under low mechanical load, we presented the first in vivo model: a rat fibula glued to the tibia, on which the TTCP/OPS-nPDA adhesive (n = 7) was shown to be effective in stabilizing the graft without displacement (a clinical success rate of 86% and 71% at 5 and 12 weeks, respectively) compared to a sham control (0%). Significant coverage of newly formed bone was particularly observed on the surface of the adhesive, thanks to the osteoinductive property of nPDA. To conclude, the TTCP/OPS-nPDA adhesive fulfilled many clinical requirements for the bone fixation, and potentially could be functionalized via nPDA to offer more biological activities, e.g., anti-infection after antibiotic loading.
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Affiliation(s)
- Matthias Schlund
- Univ. Lille, Inserm, CHU Lille, U1008-Controlled Drug Delivery Systems and Biomaterials, 59000 Lille, France
- Univ. Lille, Inserm, CHU Lille, Service de Chirurgie Maxillo-Faciale et Stomatologie, 59000 Lille, France
- Univ. Bordeaux, CHU Bordeaux, Service de Chirurgie Maxillo-Faciale et Stomatologie, 33000 Bordeaux, France
| | - Julien Dartus
- Univ. Lille, Inserm, CHU Lille, U1008-Controlled Drug Delivery Systems and Biomaterials, 59000 Lille, France
| | - Sarah Defrançois
- Univ. Lille, UMET, CNRS, INRAE, Centrale Lille, UMR 8207-UMET, 59000 Lille, France
| | - Joël Ferri
- Univ. Lille, Inserm, CHU Lille, U1008-Controlled Drug Delivery Systems and Biomaterials, 59000 Lille, France
- Univ. Lille, Inserm, CHU Lille, Service de Chirurgie Maxillo-Faciale et Stomatologie, 59000 Lille, France
| | - Jérôme Delattre
- Univ. Lille, Univ. Littoral Côte d'Opale, CHU Lille, ULP 4490-MABLab-Adiposité Médullaire er Os, 59000 Lille, France
| | - Nicolas Blanchemain
- Univ. Lille, Inserm, CHU Lille, U1008-Controlled Drug Delivery Systems and Biomaterials, 59000 Lille, France
| | - Patrice Woisel
- Univ. Lille, UMET, CNRS, INRAE, Centrale Lille, UMR 8207-UMET, 59000 Lille, France
| | - Joël Lyskawa
- Univ. Lille, UMET, CNRS, INRAE, Centrale Lille, UMR 8207-UMET, 59000 Lille, France
| | - Feng Chai
- Univ. Lille, Inserm, CHU Lille, U1008-Controlled Drug Delivery Systems and Biomaterials, 59000 Lille, France
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22
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McKibben NS, Zingas NH, Healey KM, Benzel CA, Stockton DJ, Demyanovich H, Slobogean GP, O'Toole RV, Sciadini MF, O'Hara NN. Does iliosacral screw removal reduce postoperative pain in unstable pelvic fracture patients? A matched prospective cohort study. Injury 2023; 54:954-959. [PMID: 36371316 PMCID: PMC10845944 DOI: 10.1016/j.injury.2022.11.005] [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: 05/16/2022] [Revised: 08/29/2022] [Accepted: 11/02/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND To compare pain and function in patients with unstable posterior pelvic fractures stabilized with posterior fixation who undergo iliosacral screw removal versus those who retain their iliosacral screws. METHODS A prospective observational cohort study identified 59 patients who reported pain at least 4 months after iliosacral screw fixation of an unstable posterior pelvic ring fracture from 2015-2019. The primary intervention was iliosacral screw removal versus a matched iliosacral screw retention control group. Patient-reported pain was measured with the 10-point Brief Pain Inventory, and patient-reported function was measured with the Majeed Pelvic Outcome Score. Both measured within 6 months of the intervention. RESULTS Before iliosacral screw removal, the mean pain was 4.7 (SD, 3.0) compared with 4.7 (SD, 3.0) in the matched control group. Following iliosacral screw removal, the average pain in the screw removal group was 3.7 (SD, 2.7) and 3.3 (SD, 2.5) in the matched control group. We found no evidence that iliosacral screw removal reduced pain in this population (mean difference, 0.2 points; 95% CI, -1.0 to 1.5; p = 0.71). In addition, the improvement in function after iliosacral screw removal was not statistically indistinguishable from zero (mean difference, 3.1 points; 95% CI, -4.6 to 10.9; p = 0.42). CONCLUSIONS The results suggest that iliosacral screw removal offers no significant pelvic pain or function benefit when compared with a matched control group. Surgeons should consider these data when managing patients with pelvic pain who are candidates for iliosacral screw removal.
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Affiliation(s)
- Natasha S McKibben
- R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Nicolas H Zingas
- R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Kathleen M Healey
- R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Caroline A Benzel
- R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - David J Stockton
- R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Haley Demyanovich
- R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Gerard P Slobogean
- R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Robert V O'Toole
- R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Marcus F Sciadini
- R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Nathan N O'Hara
- R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA.
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23
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Martin MP, Patel AH, Cole MW, Gadinsky NE, Collins L, Sherman WF. A Rare Case of a Lisfranc Ligament Transection. Orthop Rev (Pavia) 2023; 15:56664. [PMID: 36776274 PMCID: PMC9907328 DOI: 10.52965/001c.56664] [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: 01/29/2023] Open
Abstract
Ligamentous Lisfranc injuries, which mimic a surgical transection are rare. Left untreated or missed, these injuries may result in severe complications including long-term disability. The present case describes a unique mechanism of injury via a sharp object puncture through the plantar surface of the midfoot. It highlights the utility of planning staged procedures to remove a large foreign body object, reports notable intraoperative techniques, and provides a decision management guide for treating this type of injury. Extensive surgical planning may be required when encountering similar cases and knowledge of this may be useful to providers.
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Affiliation(s)
| | - Akshar H Patel
- Orthopaedic Surgery Tulane University School of Medicine
| | - Matthew W Cole
- Orthopaedic Surgery Tulane University School of Medicine
| | | | - Lacee Collins
- Orthopaedic Surgery Tulane University School of Medicine
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24
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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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25
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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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26
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Stürznickel J, Delsmann MM, Jungesblut OD, Stücker R, Knorr C, Rolvien T, Kertai M, Rupprecht M. Magnesium-based biodegradable implants in children and adolescents. Injury 2022; 53:2382-2383. [PMID: 35193753 DOI: 10.1016/j.injury.2022.02.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/14/2022] [Indexed: 02/02/2023]
Affiliation(s)
- Julian Stürznickel
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maximilian M Delsmann
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Oliver D Jungesblut
- Department of Pediatric Orthopaedics Surgery, Children's Hospital Hamburg-Altona, Bleickenallee 38, Hamburg 22763, Germany; Department of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ralf Stücker
- Department of Pediatric Orthopaedics Surgery, Children's Hospital Hamburg-Altona, Bleickenallee 38, Hamburg 22763, Germany; Department of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Knorr
- Department of Pediatric Surgery, Klinik St. Hedwig, University Medical Center Regensburg, Regensburg, Germany
| | - Tim Rolvien
- Department of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Kertai
- Department of Pediatric Surgery, Klinik St. Hedwig, University Medical Center Regensburg, Regensburg, Germany.
| | - Martin Rupprecht
- Department of Pediatric Orthopaedics Surgery, Children's Hospital Hamburg-Altona, Bleickenallee 38, Hamburg 22763, Germany; Department of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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27
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Ley C, Martin RK, Pareek A, Groll A, Seil R, Tischer T. Machine learning and conventional statistics: making sense of the differences. Knee Surg Sports Traumatol Arthrosc 2022; 30:753-757. [PMID: 35106604 DOI: 10.1007/s00167-022-06896-6] [Citation(s) in RCA: 62] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 01/13/2022] [Indexed: 11/24/2022]
Abstract
The application of machine learning (ML) to the field of orthopaedic surgery is rapidly increasing, but many surgeons remain unfamiliar with the nuances of this novel technique. With this editorial, we address a fundamental topic-the differences between ML techniques and traditional statistics. By doing so, we aim to further familiarize the reader with the new opportunities available thanks to the ML approach.
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Affiliation(s)
- Christophe Ley
- Department of Mathematics, University of Luxembourg, Esch-sur-Alzette, Luxembourg.
| | - R Kyle Martin
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Ayoosh Pareek
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Andreas Groll
- Department of Statistics, TU Dortmund University, Dortmund, Germany
| | - Romain Seil
- Department of Orthopaedic Surgery, Centre Hospitalier Luxembourg and Luxembourg Institute of Health, Luxembourg, Luxembourg
| | - Thomas Tischer
- Department of Orthopaedic and Traumatologic Surgery, Waldkrankenhaus, Erlangen, Germany
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