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Lu Y, Canavese F, Lin R, Pan Y, Pan N, Lai J, Chen S. Radiologic, clinical, and functional evaluation of children with displaced T-condylar fractures treated by closed reduction and percutaneous fixation using the Mayo Elbow Performance Score. Int Orthop 2024; 48:1471-1479. [PMID: 38117292 DOI: 10.1007/s00264-023-06058-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 11/30/2023] [Indexed: 12/21/2023]
Abstract
PURPOSE T-condylar (T-C) fractures of the distal humerus are rare in children. There is no accepted treatment for such an injury, and there is a lack of reports evaluating the outcome of T-C fractures treated by closed reduction and percutaneous fixation. The aim of this study was to evaluate the feasibility of closed reduction and percutaneous K-wire and screw (CRPKS) fixation in patients with type II and III T-C fractures according to the Toniolo-Wilkins classification modified by Canavese et al. (TWC classification). METHODS The clinical data of 12 consecutive patients (8 males, 4 females) who were younger than 14 years of age and who had a T-C fracture that was managed by CRPKS were retrospectively evaluated. Fractures were classified according to the TWC classification. The baseline information of the patients, carrying angle (CA) and Mayo Elbow Performance Score (MEPS) were used to evaluate clinical and functional outcomes; related complications were recorded. Statistical analysis was performed. RESULTS The mean age at the time of injury was 11.6 ± 1.8 years (range, 8-14). The time from injury to surgical treatment was 1.5 ± 1.0 days (range, 0-3), and the mean follow-up duration was 33.7 ± 12.3 months (range, 18-61). Surgery lasted 45.7 ± 7.6 min on average (range, 35-58). All fractures healed in 4.9 ± 1.0 weeks on average (range, 4-7). At the last follow-up visit, the CA was 12.6° ± 5.8° on the injured side and 13.8° ± 1.8° on the uninjured side (p=0.432). The MEPS was 100 (95, 100) on the injured side and 100 (100, 100) on the uninjured side (p=0.194). Three complications were recorded. CONCLUSION Good functional and radiological outcomes can be expected in pediatric patients with type II and III T-C fractures treated by CRPKS. The technique is relatively simple to perform and has a lower rate of complications.
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Affiliation(s)
- Yunan Lu
- Department of Paediatric Orthopaedics, Fuzhou Second Hospital, The Third Clinical Medicine College of Fujian Medical University, 47th Shangteng Road of Cangshan District, Fuzhou, 350007, Fujian Province, China
| | - Federico Canavese
- Department of Paediatric Orthopaedic Surgery, Jeanne de Flandre Hospital, Lille University Centre, Rue Eugène Avinée, 59000, Lille, France
| | - Ran Lin
- Department of Paediatric Orthopaedics, Fuzhou Second Hospital, The Third Clinical Medicine College of Fujian Medical University, 47th Shangteng Road of Cangshan District, Fuzhou, 350007, Fujian Province, China
| | - Yuchen Pan
- Department of Paediatric Orthopaedics, Fuzhou Second Hospital, The Third Clinical Medicine College of Fujian Medical University, 47th Shangteng Road of Cangshan District, Fuzhou, 350007, Fujian Province, China
| | - Nuoqi Pan
- Department of Paediatric Orthopaedics, Fuzhou Second Hospital, The Third Clinical Medicine College of Fujian Medical University, 47th Shangteng Road of Cangshan District, Fuzhou, 350007, Fujian Province, China
| | - Jinglin Lai
- Department of Paediatric Orthopaedics, Fuzhou Second Hospital, The Third Clinical Medicine College of Fujian Medical University, 47th Shangteng Road of Cangshan District, Fuzhou, 350007, Fujian Province, China
| | - Shunyou Chen
- Department of Paediatric Orthopaedics, Fuzhou Second Hospital, The Third Clinical Medicine College of Fujian Medical University, 47th Shangteng Road of Cangshan District, Fuzhou, 350007, Fujian Province, China.
- Fujian Provincial Clinical Medical Research Center for First Aid and Rehabilitation in Orthopaedic Trauma (2020Y2014), Fuzhou, 350007, China.
- Key Clinical Specialty of Fujian Province and Fuzhou City (20220104), Fuzhou, China.
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Öztürk V, Çelik M, Koluman AC, Duramaz A, Kural C, Bilgili MG. Fluroscopy-assisted transiliac antegrade lag screw placement technique in both columns of acetabulum: A novel procedure. Orthop Traumatol Surg Res 2024:103872. [PMID: 38548224 DOI: 10.1016/j.otsr.2024.103872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 02/09/2024] [Accepted: 03/21/2024] [Indexed: 04/05/2024]
Abstract
The use of pelvic osseous fixation corridors and lag screw fixation in acetabular and pelvic surgery has gained popularity, especially with the recent development of intraoperative imaging and navigation techniques. However, advanced intraoperative imaging and navigation techniques require technical equipment and are costly. Therefore, traditional fluoroscopic techniques still maintain their importance. In this article, we describe a novel pelvic osseous fixation corridor that traverses both columns of the acetabulum, along with the detailed methodology of its fluoroscopic imaging and the techniques for fluoroscopy-assisted screw placement. The technique of placing screws in this current fixation corridor is only under fluoroscopy assistance, without using any specially produced guide or navigation device. LEVEL OF PROOF: IV.
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Affiliation(s)
- Vedat Öztürk
- Bakırköy Dr. Sadi Konuk Education and Research Hospital, Department of Orthopedics and Traumatology, Tevfik Sağlam St. Number 11, 34147 Bakırköy/Istanbul, Turkey.
| | - Malik Çelik
- Bakırköy Dr. Sadi Konuk Education and Research Hospital, Department of Orthopedics and Traumatology, Tevfik Sağlam St. Number 11, 34147 Bakırköy/Istanbul, Turkey
| | - Ali Can Koluman
- Bakırköy Dr. Sadi Konuk Education and Research Hospital, Department of Orthopedics and Traumatology, Tevfik Sağlam St. Number 11, 34147 Bakırköy/Istanbul, Turkey
| | - Altuğ Duramaz
- Bakırköy Dr. Sadi Konuk Education and Research Hospital, Department of Orthopedics and Traumatology, Tevfik Sağlam St. Number 11, 34147 Bakırköy/Istanbul, Turkey
| | - Cemal Kural
- Bakırköy Dr. Sadi Konuk Education and Research Hospital, Department of Orthopedics and Traumatology, Tevfik Sağlam St. Number 11, 34147 Bakırköy/Istanbul, Turkey
| | - Mustafa Gökhan Bilgili
- Bakırköy Dr. Sadi Konuk Education and Research Hospital, Department of Orthopedics and Traumatology, Tevfik Sağlam St. Number 11, 34147 Bakırköy/Istanbul, Turkey
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Yin Y, Wang Z, Yi Z, Lim RQR, Chen S, Liu B. A comparative cadaveric study for percutaneous scaphoid fixation: robotic vs freehand. Int Orthop 2024; 48:521-527. [PMID: 37875659 DOI: 10.1007/s00264-023-06013-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 10/12/2023] [Indexed: 10/26/2023]
Abstract
PURPOSES To compare the robotic-assisted and the traditional freehand percutaneous scaphoid fixation in number of guidewire attempts, duration of fluoroscopy time, amount of radiation dose, and screw centrality. METHODS Twenty cadaveric specimens were randomized into either the robotic or freehand group. The scaphoids in both groups were fixed by either the same attending or resident from our hand surgery department. The operation duration, amount of radiation from intraoperative fluoroscopy, total fluoroscopy time, and the number of guidewire attempts were documented and compared. Postoperatively, all the specimens had a computed tomography (CT) scan performed, and the difference in the final position of the screw and the central axis of the scaphoid was examined. RESULTS In the robotic group, all the guide wires were satisfactorily positioned within a single attempt, while the median number of attempts in the traditional freehand group was 18 (quaternion 14-65). This also meant that the surgeon in the robotic group experienced significantly lower radiation exposure dose and time as compared to the freehand group. There were no significant differences in the final screw position as compared to the central axis of the scaphoid in both groups. Although there was no difference in surgeon performance in the robotic group, the operative time for the attending was significantly lower as compared to the resident in the freehand group. CONCLUSION Robotic-assisted surgery for scaphoid fracture fixation is superior to the traditional freehand method as it facilitates accurate screw placement with lower radiation exposure and fewer guide wire attempts.
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Affiliation(s)
- Yaobin Yin
- Department of Hand Surgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Zhixin Wang
- Department of Hand Surgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Zhe Yi
- Department of Hand Surgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Rebecca Qian Ru Lim
- Department of Hand & Reconstructive Microsurgery, Singapore General Hospital, Singapore, Singapore
| | - Shanlin Chen
- Department of Hand Surgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Bo Liu
- Department of Hand Surgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China.
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Lappalainen TA, Noponen NA, Kaarela OI, Klemola TM, Ohtonen PP, Leppilahti JI. Postoperative complications after displaced intra-articular calcaneal fracture operations. Foot Ankle Surg 2024:S1268-7731(24)00023-7. [PMID: 38262786 DOI: 10.1016/j.fas.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 01/11/2024] [Accepted: 01/13/2024] [Indexed: 01/25/2024]
Abstract
BACKGROUND The objective was to compare postoperative complications in the management of displaced intra articular calcaneal fractures (DIACF) between two groups; the open reduction and internal fixation (ORIF) group versus the percutaneous fixation (PF) group. METHODS A total of 243 DIACFs were diagnosed and 127 of them received operations either with ORIF 75 (59.1 %) or PF 52 (40.9 %) between 2004 and 2018. Postoperative complications, radiological Sanders's classification and improvement of Böhler's angle were analyzed. RESULTS Early complication rate (<6 weeks), rate of deep wound infections and wound edge necrosis were significantly better in PF than in ORIF patient group. There were no significant differences in late complications (>6 weeks from operation) nor in improvement of Böhler's angle. CONCLUSION Complication rate is lower when using PF technique while fracture reduction remains the same compared to the ORIF. LEVEL OF EVIDENCE IV retrospective cohort study at a single institution.
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Affiliation(s)
- Tuula A Lappalainen
- Translational Medicine Research Unit, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, 90014 Oulu, Finland.
| | - Noora A Noponen
- Translational Medicine Research Unit, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, 90014 Oulu, Finland
| | - Outi I Kaarela
- Translational Medicine Research Unit, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, 90014 Oulu, Finland
| | - Tero M Klemola
- Translational Medicine Research Unit, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, 90014 Oulu, Finland
| | - Pasi P Ohtonen
- Translational Medicine Research Unit, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, 90014 Oulu, Finland
| | - Juhana I Leppilahti
- Translational Medicine Research Unit, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, 90014 Oulu, Finland
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Ma HL, Sun XW, Liu F, Hua ZT, Sun J, Zhang SC. Kirschner wire reconstruction of medial and lateral column periosteal hinge in the treatment of multidirectionally unstable supracondylar fracture of the humerus in children. Eur J Med Res 2023; 28:585. [PMID: 38082369 PMCID: PMC10714489 DOI: 10.1186/s40001-023-01560-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 11/29/2023] [Indexed: 12/18/2023] Open
Abstract
AIM AND OBJECTIVE To compare the clinical effect of reconstruction of internal and lateral column periosteal hinge-assisted treatment with Kirschner wire and internal fixation with Kirschner wire in the treatment of multidirectional unstable supracondylar fractures of humerus in children. METHODS A retrospective cohort study was conducted to analyze the clinical data of 48 patients (31 male, 17 female; mean age: 6.7 ± 2.4 years old) with multidirectionally unstable supracondylar fractures of the humerus treated in our Hospital from August 2020 to August 2022. Twenty-five cases were treated with Kirschner wire reconstruction of the internal and lateral column periosteal hinge assisted by closed reduction and Kirschner wire internal fixation (study group). Twenty-three cases were treated with closed reduction and Kirschner wire internal fixation (control group). The operation time, intraoperative fluoroscopy times, percentage of patients who underwent open reduction after failure of closed reduction, fracture healing time, Baumann angle (BA), shaft-condylar angle (SCA), range of motion (ROM), and Flynn score of elbow at the last follow-up were compared between two groups. Complications such as infection and irritation of Kirschner wire tail were observed in two groups 2 months after the operation. RESULTS All patients were followed up for 10-22 months ([13.85 ± 2.89] months). The average operation time of the control group was 82.1 min, which was significantly longer than that of the study group 32.3 min (P < 0.05). The number of intraoperative fluoroscopy (29.4 ± 9.2) in the control group was significantly higher than that in the study group (15.2 ± 6.3) (P < 0.05). The incision rate of the control group was 17% while that of the study group was 0 (P < 0.05). According to Flynn score, the excellent and good rate of the elbow joint in the control group was 86.9% (20/23). The excellent and good rate of the elbow joint in the study group was 92.0% (23/25) (P > 0.05). There was no significant difference in fracture healing time, BA, SCA, and ROM between the two groups (P > 0.05). No infection or Kirschner wire tail irritation occurred in the two groups during the 2-month follow-up. CONCLUSION Reconstruction of internal and lateral periosteal hinges with Kirscher wire has similar effects to closed reduction and Kirschner wire fixation in the treatment of multidirectionally unstable supracondylar fractures of the humerus in children, but it can shorten the operation time and reduce intraoperative fluoroscopy times and incision rate.
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Affiliation(s)
- Hai-Long Ma
- Department of Pediatric Orthopedics, Anhui Provincial Children's Hospital (Children's Hospital of Anhui Medical University), No. 39 Wangjiang East Road, Hefei, 230051, Anhui, People's Republic of China
| | - Xi-Wei Sun
- Department of Pediatric Orthopedics, Anhui Provincial Children's Hospital (Children's Hospital of Anhui Medical University), No. 39 Wangjiang East Road, Hefei, 230051, Anhui, People's Republic of China
| | - Fang Liu
- Department of Pediatric Orthopedics, Anhui Provincial Children's Hospital (Children's Hospital of Anhui Medical University), No. 39 Wangjiang East Road, Hefei, 230051, Anhui, People's Republic of China
| | - Zhong Tuo Hua
- Department of Pediatric Orthopedics, Anhui Provincial Children's Hospital (Children's Hospital of Anhui Medical University), No. 39 Wangjiang East Road, Hefei, 230051, Anhui, People's Republic of China
| | - Jun Sun
- Department of Pediatric Orthopedics, Anhui Provincial Children's Hospital (Children's Hospital of Anhui Medical University), No. 39 Wangjiang East Road, Hefei, 230051, Anhui, People's Republic of China
| | - Si-Cheng Zhang
- Department of Pediatric Orthopedics, Anhui Provincial Children's Hospital (Children's Hospital of Anhui Medical University), No. 39 Wangjiang East Road, Hefei, 230051, Anhui, People's Republic of China.
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Kiepura S, Dutka J. Gartland type III extension supracondylar humerus fracture in a 10-year-old child. A surgical case report of an infrequent technique of medial and lateral column stabilization. Int J Surg Case Rep 2023; 113:109078. [PMID: 37992672 DOI: 10.1016/j.ijscr.2023.109078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 11/13/2023] [Accepted: 11/16/2023] [Indexed: 11/24/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Supracondylar humeral fractures in children are the most common fractures of the elbow accounting for 16 % of all pediatric fractures. The treatment depends on age, the degree of displacement, and the presence of additional injuries. PRESENTATION OF CASE A case reports a 10-year-old girl with a Gartland type III supracondylar humeral fracture accompanied by anterior interosseous nerve neurapraxia preoperatively. The patient was treated operatively with medial and lateral column cross-pinning using four K-wires due to unsatisfactory closed reduction and lateral pinning only. Follow-up examinations performed in 1 and 6 months postoperatively revealed a 10° flexion contracture of the elbow with good functional and radiological results otherwise. CLINICAL DISCUSSION The main intervention was not focused on the AIN neuropraxia itself but on unsatisfactory closed reduction followed by cross-fixation with lateral pinning only. A standard anterior approach to visualize the fracture line, free interposing tissues, and perform stabilization was utilized. The unusual use of an additional medial pin formed a cross-frame to adequately support the medial cortex. CONCLUSION Closed reduction and percutaneous pinning are the preferred treatment options for most displaced supracondylar fractures. The open reduction via anterior approach and pinning for Gartland type III fracture gives good outcomes. Medial pinning is mandatory in particular fracture patterns and in case of unsatisfactory closed reduction. In the presented case medial and lateral column cross-pinning technique using four K-wires guaranteed no subsequent displacement on follow-up assessment and good results.
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Affiliation(s)
- S Kiepura
- Pediatric Surgery Department. Specialistic Hospital of Zeromski in Krakow, os. Na Skarpie 66, 31-913 Krakow, Poland.
| | - J Dutka
- Pediatric Surgery Department. Specialistic Hospital of Zeromski in Krakow, os. Na Skarpie 66, 31-913 Krakow, Poland; Orthopedic Surgery Department. Specialistic Hospital of Zeromski in Krakow, os. Na Skarpie 66, 31-913 Krakow, Poland
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Ruzon UG, Uliana CS, Tomazini GC, Filho JML, Mizerkowski M, Garcia RE, Abagge M. A standard canulated screw may not fit up to 1/3 of the patients treated percutaneously for anterior column acetabular fractures-A pilot study. Injury 2023; 54 Suppl 6:110723. [PMID: 38143141 DOI: 10.1016/j.injury.2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 04/03/2023] [Accepted: 04/11/2023] [Indexed: 12/26/2023]
Abstract
A proper evaluation of the narrowings and length of the anterior acetabular column would offer better predictability and precision for implant insertion in the case of an acetabular fracture. OBJECTIVE To determine the diameter and length of the safety corridor of the anterior column of the acetabulum in patients with available pelvic computed tomography (CT), analyze the obtained measurements against those of a standard 6.5-mm implant, and verify possible sex differences regarding these measurements. A secondary aim was to develop a method for measurement of the anterior column of the acetabulum based on CT images. MATERIALS AND METHODS In 200 CT scans of hemipelvises we measured the diameter of two areas of narrowing and the length of the safety corridor of the anterior column. The images were submitted to multiplanar reformatting adjusted to a plane orthogonal to the bone corridor, drawn at the level of the superior pubic ramus. RESULTS Measurement #1 had a mean value of 8.12 (2.27) mm in the overall sample and median values of 9.03 (7.76-10.48) mm in men and 6.77 (5.44-7.19) mm in women. Measurement #2 had a mean value of 7.29 (2.19) mm and median values of 8.23 (7.18-9.82) mm in men and 5.9 (4.65-7.19) mm in women. Measurement #3 had a mean value of 109.53 (13.66) mm in the overall sample and median values of 117.17 (112.9-122.9) mm in men and 100.91 (90.95-111.17) mm in women (p<0.001 all three measurements). Measurement #1 was smaller than 6.5 mm in 22.5% of the patients (of whom 90% were women). Measurement #2 was smaller than 6.5 mm in 35% of the patients (of whom 80% were women). CONCLUSIONS This study proposed an anatomic evaluation of the anterior column of the acetabulum using conventional CT images The areas of narrowing in the anterior column had an average of 8.12 mm at the level of the pubic tubercle and 7.29 mm at the level of the acetabular fossa. The mean length of the safety corridor was 109.53 mm. In 35% of the cases, a 6.5 mm percutaneous screw would have violated the cortical bone of the safety corridor.
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Affiliation(s)
- Uheyna Gancedo Ruzon
- Complexo Hospitalar do Trabalhador, Av. Rep. Argentina, 4406 - Novo Mundo, Curitiba, PR 81050-000, Brazil
| | - Christiano Saliba Uliana
- Complexo Hospitalar do Trabalhador, Av. Rep. Argentina, 4406 - Novo Mundo, Curitiba, PR 81050-000, Brazil.
| | - Gabriel Canto Tomazini
- Complexo Hospitalar do Trabalhador, Av. Rep. Argentina, 4406 - Novo Mundo, Curitiba, PR 81050-000, Brazil
| | - Jose Marcos Lavrador Filho
- Complexo Hospitalar do Trabalhador, Av. Rep. Argentina, 4406 - Novo Mundo, Curitiba, PR 81050-000, Brazil
| | - Mariana Mizerkowski
- Complexo Hospitalar do Trabalhador, Av. Rep. Argentina, 4406 - Novo Mundo, Curitiba, PR 81050-000, Brazil
| | - Rafael Eduardo Garcia
- Complexo Hospitalar do Trabalhador, Av. Rep. Argentina, 4406 - Novo Mundo, Curitiba, PR 81050-000, Brazil
| | - Marcelo Abagge
- Complexo Hospitalar do Trabalhador, Av. Rep. Argentina, 4406 - Novo Mundo, Curitiba, PR 81050-000, Brazil
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Boni G, Pires RE, Sanchez GT, Giordano V. Antegrade posterior column screw fixation for acetabular fractures: It's time to standardize the surgical technique. Injury 2023; 54 Suppl 6:110579. [PMID: 38143145 DOI: 10.1016/j.injury.2023.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 12/10/2022] [Accepted: 01/02/2023] [Indexed: 12/26/2023]
Abstract
Antegrade fixation of posterior column fractures of the acetabulum is challenging due to the narrow corridor and risk of screw misplacement. Although both antegrade and retrograde lag screws have been previously described for posterior column fracture fixation, the literature lacks a standardized technique for correct and safe screw placement, especially in an antegrade fashion. This technical note aims to optimize intraoperative images during posterior screw insertion using the antegrade technique, according to predetermined landmarks to save surgical time, decrease radiation exposition, and prevent surgical complications.
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Affiliation(s)
- Guilherme Boni
- Departamento de Ortopedia e Traumatologia, Universidade Federal de São Paulo, São Paulo (SP), Brazil
| | - Robinson Esteves Pires
- Departamento do Aparelho Locomotor, Universidade Federal de Minas Gerais, Belo Horizonte (MG), Brazil.
| | - Gustavo Tadeu Sanchez
- Departamento de Ortopedia e Traumatologia, Universidade Federal de São Paulo, São Paulo (SP), Brazil
| | - Vincenzo Giordano
- Serviço de Ortopedia e Traumatologia Professor Nova Monteiro, Hospital Municipal Miguel Couto, Rio de Janeiro (RJ), Brazil
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Schultz BJ, Mayer RM, Phelps KD, Saiz AM, Kellam PJ, Eastman JG, Routt ML, Warner SJ. Assessment of sacral osseous fixation pathways for same-level dual transiliac-transsacral screw insertion. Arch Orthop Trauma Surg 2023; 143:6049-6056. [PMID: 37103608 DOI: 10.1007/s00402-023-04892-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 04/16/2023] [Indexed: 04/28/2023]
Abstract
INTRODUCTION The purpose of this study is to (1) describe a pre-operative planning technique using non-reformatted CT images for insertion of multiple transiliac-transsacral (TI-TS) screws at a single sacral level, (2) define the parameters of a sacral osseous fixation pathway (OFP) that will allow for insertion of two TI-TS screws at a single level, and (3) identify the incidence of sacral OFPs large enough for dual-screw insertion in a representative patient population. METHODS Retrospective review at a level-1 academic trauma center of a cohort of patients with unstable pelvic injuries treated with two TI-TS screws in the same sacral OFP, and a control cohort of patients without pelvic injuries who had CT scans for other reasons. RESULTS Thirty-nine patients had two TI-TS screws at S1. Eleven patients, all with dysmorphic osteology, had two TI-TS screws at S2. The average pathway size in the sagittal plane at the level the screws were placed was 17.2 mm in S1 vs 14.4 mm in S2 (p = 0.02). Twenty-one patients (42%) had screws that were intraosseous and 29 (58%) had part of a screw that was juxtaforaminal. No screws were extraosseous. The average OFP size of intraosseous screws was 18.1 mm vs. 15.5 mm for juxtaforaminal screws (p = 0.02). Fourteen millimeters was used as a guide for the lower limit of the OFP for safe dual-screw fixation. Overall, 30% of S1 or S2 pathways were ≥ 14 mm in the control group, with 58% of control patients having at least one of the S1 or S2 pathways ≥ 14 mm. CONCLUSIONS OFPs ≥ 7.5 mm in the axial plane and 14 mm in the sagittal plane on non-reformatted CT images are large enough for dual-screw fixation at a single sacral level. Overall, 30% of S1 and S2 pathways were ≥ 14 mm and 58% of control patients had an available OFP in at least one sacral level.
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Affiliation(s)
- Blake J Schultz
- Department of Orthopedics, McGovern Medical School at UTHealth, 6400 Fannin St, Suite 1700, Houston, TX, 77030, USA.
| | - Ryan M Mayer
- Department of Orthopedics, McGovern Medical School at UTHealth, 6400 Fannin St, Suite 1700, Houston, TX, 77030, USA
| | - Kevin D Phelps
- Department of Orthopedics, Carolinas Medical Center, 1025 Morehead Medical Dr, Charlotte, NC, 28204, USA
| | - Augustine M Saiz
- Department of Orthopedics, McGovern Medical School at UTHealth, 6400 Fannin St, Suite 1700, Houston, TX, 77030, USA
| | - Patrick J Kellam
- Department of Orthopedics, McGovern Medical School at UTHealth, 6400 Fannin St, Suite 1700, Houston, TX, 77030, USA
| | - Jonathan G Eastman
- Department of Orthopedics, McGovern Medical School at UTHealth, 6400 Fannin St, Suite 1700, Houston, TX, 77030, USA
| | - Milton L Routt
- Department of Orthopedics, McGovern Medical School at UTHealth, 6400 Fannin St, Suite 1700, Houston, TX, 77030, USA
| | - Stephen J Warner
- Department of Orthopedics, McGovern Medical School at UTHealth, 6400 Fannin St, Suite 1700, Houston, TX, 77030, USA
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Chaniotakis C, Genetzakis V, Samartzidis K, Siligardou MR, Stavrakakis I. Percutaneous fixation of displaced intraarticular fractures of the calcaneus. A retrospective case series study and a review of the literature. Injury 2023; 54:110966. [PMID: 37549534 DOI: 10.1016/j.injury.2023.110966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/07/2023] [Accepted: 07/26/2023] [Indexed: 08/09/2023]
Abstract
PURPOSE To evaluate the outcome of displaced intraarticular calcaneal fractures (DIACFs) of a case series of patients who were treated with a percutaneous fixation technique. MATERIALS AND METHODS Eight patients were operated for DIACFs and they were evaluated for the outcome and complications in a mean follow up of 9 months (range: 6 - 12 months). At the last follow up the AOFAS score, the Boehlers' angle and the presence of any complication were noted. The time from injury to surgery was also reported. The correlation of the AOFAS score and the development of post traumatic subtalar arthritis to the type of fracture, to the post operative Boehler's angle and to the time from injury to surgery were investigated. RESULTS The overall mean AOFAS (Americal Orthopaedic Foot and Ankle Society) score was 84,625 (Range: 73 - 96). The mean AOFAS score of type II and type III fractures was 87,667 and 75,500 respectively. The mean AOFAS score for fractures with a postoperative Boehler's angle of less than 10° and more or equal to 10° was 76,750 and 92,500 respectively. This difference was found to be statistically significant. The mean AOFAS score for fractures who were treated less or equal to six days and more than six days post injury was 91,250 and 78 respectively. Two out of four patients with a post operative Boehler's angle less than 10° developed post traumatic subtalar arthritis. No patient out of four for whom a Boehler's angle of more than 10° has been achieved, developed subtalar arthritis. No infection occurred in any of the patients. CONCLUSION Percutaneous fixation is a safe and effective way of treating DIACFs. The outcome is directly related to the quality of reduction, which is significantly dependent to the timing of surgery. The earlier the fracture is operated the better the reduction by closed means is.
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Affiliation(s)
- Constantinos Chaniotakis
- General Hospital of Heraklion "Venizeleio and Pananio", Leoforos Knossou 44, 71409, Heraklion Crete, Greece
| | - Vassileios Genetzakis
- General Hospital of Heraklion "Venizeleio and Pananio", Leoforos Knossou 44, 71409, Heraklion Crete, Greece
| | - Kosmas Samartzidis
- General Hospital of Heraklion "Venizeleio and Pananio", Leoforos Knossou 44, 71409, Heraklion Crete, Greece
| | - Mikela-Rafaella Siligardou
- General Hospital of Heraklion "Venizeleio and Pananio", Leoforos Knossou 44, 71409, Heraklion Crete, Greece
| | - Ioannis Stavrakakis
- General Hospital of Heraklion "Venizeleio and Pananio", Leoforos Knossou 44, 71409, Heraklion Crete, Greece.
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11
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Tucker NJ, Scott BL, Heare A, Stacey SC, Mauffrey C, Parry JA. Nonoperative management of minimally displaced lateral compression type 1 (LC1) injuries with comminuted rami fractures is associated with late displacement. Eur J Orthop Surg Traumatol 2023:10.1007/s00590-023-03646-3. [PMID: 37542555 DOI: 10.1007/s00590-023-03646-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 07/11/2023] [Indexed: 08/07/2023]
Abstract
PURPOSE Rami comminution has been found to be predictive of lateral compression type 1 (LC1) injury instability on examination under anesthesia (EUA) and lateral stress radiographs (LSR). The purpose of this study was to evaluate how rami comminution and subsequent operative vs. nonoperative management impact the late displacement of these injuries. METHODS Retrospective review of a prospectively collected LC1 database was performed to identify all patients with minimally displaced LC1 injuries (< 1 cm) and follow-up radiographs over a four-year period (n = 125). Groups were separated based on the presence of rami comminution and subsequent management, including rami comminution/operative (n = 49), rami comminution/nonoperative (n = 54), and no comminution/nonoperative (control group, n = 22). The primary outcome was late fracture displacement, analyzed as both a continuous variable and as late displacement ≥ 5 mm. RESULTS As a continuous variable, late fracture displacement was lower in the comminuted rami/operative group as compared to the comminuted rami/nonoperative group (PD: -3.0 mm, CI: -4.8 to -1.6 mm, p = 0.0002) and statistically non-different from control. Late displacement ≥ 5 mm was significantly more prevalent in the comminuted rami/nonoperative group than in the comminuted rami/operative and no comminution/nonoperative groups (control)(PD: -33.9%, CI: -49.0% to -16.1%, p = 0.0002 and PD: -30.0%, CI: -48.2% to -6.5%, p = 0.02, respectively). CONCLUSION Late fracture displacement was greatest in the group with rami comminution/nonoperative management. Rami comminution, which has been previously associated with dynamic displacement on EUA and LSR, is also associated with a higher incidence of late displacement when managed nonoperatively. LEVEL OF EVIDENCE Level III, prognostic retrospective cohort study.
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Affiliation(s)
- Nicholas J Tucker
- Department of Orthopedics, Denver Health Medical Center, 777 Bannock St, MC 0188, Denver, CO, 80204, USA
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Bryan L Scott
- Department of Orthopedic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Austin Heare
- Department of Orthopedics, Denver Health Medical Center, 777 Bannock St, MC 0188, Denver, CO, 80204, USA
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Stephen C Stacey
- Department of Orthopedics, Denver Health Medical Center, 777 Bannock St, MC 0188, Denver, CO, 80204, USA
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Cyril Mauffrey
- Department of Orthopedics, Denver Health Medical Center, 777 Bannock St, MC 0188, Denver, CO, 80204, USA
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Joshua A Parry
- Department of Orthopedics, Denver Health Medical Center, 777 Bannock St, MC 0188, Denver, CO, 80204, USA.
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA.
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12
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Cellier N, Sleth C, Bauzou F, Kouyoumdjian P, Coulomb R. Arthroscopic reduction and internal fixation (ARIF) for talar body fractures: systematic review. SICOT J 2023; 9:20. [PMID: 37350674 DOI: 10.1051/sicotj/2023017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 06/03/2023] [Indexed: 06/24/2023] Open
Abstract
PURPOSE This study aimed to systematically assess the available literature on the technique and results of arthroscopic reduction - internal fixation for displaced fractures of the talar body. METHODS A systematic review was made of the available literature on MEDLINE, EMBASE, and the Cochrane Library database, including studies from January 1985 to July 2021. The literature search, data extraction, and quality assessment were conducted by two independent reviewers. Surgical technique, perioperative management, clinical outcome scores, radiographic outcomes, and complication rates were evaluated. RESULTS Out of 37 articles reviewed, 12 studies met the inclusion criteria. The studies included reported on the results of 22 patients. No complications were observed in any of the patients treated. CONCLUSIONS The included studies had too many weaknesses to allow the pooling of data or meta-analysis. However, percutaneous arthroscopic talar internal fixation appears to be a good option for uncomplicated displaced intra-articular talar fractures. Appropriately powered randomized controlled trials with long-term follow-ups are required to confirm the effectiveness of this technique. LEVEL OF EVIDENCE Level IV, a systematic review of Level IV studies.
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Affiliation(s)
- Nicolas Cellier
- Orthopedic and Trauma surgery Department, Hospital and University Center of Caremeau Nîmes, Rue du Professeur Robert Debré, 30029 Nîmes, France
| | - Camille Sleth
- Clinique du Ter, 5 Allée de la Clinique du Ter, 56270 Ploemeur, France
| | - François Bauzou
- Orthopedic and Trauma surgery Department, Hospital and University Center of Caremeau Nîmes, Rue du Professeur Robert Debré, 30029 Nîmes, France
| | - Pascal Kouyoumdjian
- Orthopedic and Trauma surgery Department, Hospital and University Center of Caremeau Nîmes, Rue du Professeur Robert Debré, 30029 Nîmes, France - Université Montpellier 1, 2 Rue de l'École de Médecine, 34090 Montpellier, France - Laboratoire de Mécanique et Génie Civile (LMGC), CNRS-UM1, 860 Rue de St - Priest, 34090 Montpellier, France
| | - Remy Coulomb
- Orthopedic and Trauma surgery Department, Hospital and University Center of Caremeau Nîmes, Rue du Professeur Robert Debré, 30029 Nîmes, France - Université Montpellier 1, 2 Rue de l'École de Médecine, 34090 Montpellier, France
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13
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Zhao GZ. [Progress and choice of surgical methods for displaced intra-articular calcaneal fractures]. Zhongguo Gu Shang 2023; 36:299-301. [PMID: 37087615 DOI: 10.12200/j.issn.1003-0034.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Subscribe] [Scholar Register] [Indexed: 04/24/2023]
Affiliation(s)
- Guo-Zhi Zhao
- The Second Hospital of Tangshan, Tangshan 063000, Hebei, China
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14
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Wang M, Jacobs RC, Bartlett CS, Schottel PC. Iliac dysmorphism: defining radiographic characteristics and association with pelvic osseous corridor size. Arch Orthop Trauma Surg 2023; 143:1841-1847. [PMID: 35175374 DOI: 10.1007/s00402-022-04376-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 01/30/2022] [Indexed: 11/02/2022]
Abstract
INTRODUCTION Insertion of iliac wing implants requires understanding of the curvilinear shape of the ilium. This study serves to quantitatively identify the area of iliac inner-outer table convergence (IOTC), characterize the iliac wing osseous corridor, and define the gluteal pillar osseous corridor. METHODS Computed tomography scans of 100 male and 100 female hemipelves were evaluated. The iliac wing was studied using manual best-fit analysis of the bounds of the inner and outer cortices. The IOTC was defined as the location of the iliac wing with an intercortical width less than 5 mm. The shortest distance from the apex of the iliac crest to the superior border of the IOTC was defined as the iliac wing osseous corridor. Finally, the width of the gluteal pillar corridor from the gluteus medius tubercle to the ischial tuberosity was measured. RESULTS The IOTC is an elliptical area measuring 22.3 cm2. All ilia had an area where the inner and outer cortices converged to an intercortical width of less than 5 mm; 48% converged to a single cortex. The shortest mean distance from the superior edge of the iliac crest to the beginning of the IOTC was 20.3 mm in men and 13.8 mm in women (p < 0.001). The gluteal pillar diameter averaged 5.3 mm in men and 4.3 mm in women (p < 0.001). DISCUSSION All ilia converge to a thin and frequently unicortical central region. A 4.5 mm iliac wing lag screw will not breach the cortex if it remains within 20 mm or 14 mm distal to the cranial aspect of the iliac crest in males and females, respectively. Not only is the gluteal pillar smaller than previously thought, in 41% of males and 73% of females, it is not be large enough for 5 mm implants. CONCLUSION This study quantitatively assesses the dimensions of the IOTC, the iliac crest osseous corridor, and the gluteal pillar. Overall, our findings provide improved understanding of the limits for implant use in the iliac wing as well as better appreciation of the complex osteology of the ilium. This will help surgeons to identify safe areas for implant placement and avoid inadvertent cortical penetration.
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Affiliation(s)
- Miqi Wang
- Department of Orthopaedic Surgery, Duke University, DUMC Box 104002, Durham, NC, 27710, USA.
| | - Robert C Jacobs
- Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Ave South, R200, Minneapolis, MN, 55454, USA
| | - Craig S Bartlett
- Department of Orthopaedics & Rehabilitation, University of Vermont, 4th floor Safford Hall, 95 Carrigan Dr., Burlington, VT, 05405, USA
| | - Patrick C Schottel
- Department of Orthopaedics & Rehabilitation, University of Vermont, 4th floor Safford Hall, 95 Carrigan Dr., Burlington, VT, 05405, USA
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15
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Overman KL, Jabara JT, Gannon NP, Edwards KE, Kahat DH, Tatman LM, Agel J, Swiontkowski MF, Nguyen MP. Comparison of clinical and radiographic outcomes of arthroscopic-assisted percutaneous fixation versus open reduction internal fixation of lateral tibial plateau fractures. Int Orthop 2023; 47:1583-1590. [PMID: 36939872 DOI: 10.1007/s00264-023-05777-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 03/12/2023] [Indexed: 03/21/2023]
Abstract
PURPOSE Treatment for tibial plateau fractures continues to evolve but maintains primary objectives of anatomic reduction of the joint line and a rapid recovery course. Arthroscopic-assisted percutaneous fixation (AAPF) has been introduced as an alternative to traditional open reduction internal fixation (ORIF). The purpose of the study is to compare clinical and radiographic outcomes in patients with low-energy Schatzker type I-III tibial plateau fractures treated with AAPF versus ORIF. METHODS A retrospective chart review was performed at a level 1 trauma centre to compare outcomes of 120 patients (57 AAPF, 63 ORIF) with low-energy lateral Schatzker type I-III tibial plateau fractures who underwent tibial plateau fixation between 2009 and 2018. Demographic information, injury characteristics, and surgical treatment were recorded. The main outcome measurements included reduction step-off, joint space narrowing, time to weight bearing, and implant removal. RESULTS There was no difference in age, gender distribution, BMI, ASA, Schatzker classification distribution, initial displacement, blood loss, and reduction step-off between the two groups (p > 0.05). Shorter tourniquet time (74.1 ± 21.7 vs 100.0 ± 21.0 min; p < 0.001), shorter time to full weight bearing (47.8 ± 15.2 vs. 69.1 ± 17.2 days; p < 0.001), and lower rate of joint space narrowing (3.5% vs. 28.6% with more than 1 mm, p < 0.001) were associated with the AAPF cohort, with no difference in pain, knee range of motion, or implant removal rate between the two cohorts. CONCLUSION AAPF may be a viable alternative to ORIF for the management of low-energy tibial plateau fractures with outcomes not inferior compared to the traditional ORIF method.
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Affiliation(s)
- Kelsey L Overman
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Justin T Jabara
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Nicholas P Gannon
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Kelly E Edwards
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA
| | - David H Kahat
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Lauren M Tatman
- Department of Orthopaedic Surgery, Washington University in Saint Louis, Saint Louis, MO, USA
| | - Julie Agel
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Marc F Swiontkowski
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Mai P Nguyen
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA.
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16
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Zhong Z, Wei M, Jiang Z, Chen J, He Y, Lin K. Comparative effectiveness of three treatment options for slade and dodds grade III-IV scaphoid nonunion: a retrospective study. BMC Musculoskelet Disord 2023; 24:204. [PMID: 36932381 PMCID: PMC10022066 DOI: 10.1186/s12891-023-06320-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 03/14/2023] [Indexed: 03/19/2023] Open
Abstract
OBJECTIVE To compare the clinical efficacy of open debridement screw fixation combined with bone grafting, percutaneous screw fixation, and percutaneous screw fixation combined with injection of platelet-rich plasma (PRP) for the treatment of Slade and Dodds Grade III to IV scaphoid nonunion (SNU). METHODS This retrospective study included patients with Grade III (25 patients) and Grade IV (28 patients) SNU. They were treated with open surgery bone grafting and internal fixation (group A), percutaneous screw fixation (group B) or percutaneous screw fixation and PRP injection (group C) from January 2015 to May 2020. The fracture consolidation rate, VAS score, and Mayo wrist function score were compared across the three groups. RESULTS The consolidation rate was not significantly different among the three groups for both Grade III and IV SNU. However, patients in group C reported significantly less pain and better wrist function 7 days after surgery compared to group A and B, for both nonunion grades. At 3 months after surgery, group C had significantly better VAS and Mayo wrist scores compared to group A for both nonunion grades, and compared to group B for Grade IV SNU. At 6 and 12 months after surgery, patients with Grade IV SNU in groups A and C had significantly better VAS and Mayo wrist scores compared to group B. CONCLUSION This study suggests that percutaneous screw fixation with PRP injection could be a more effective method for treating Grade IV SNU. This approach may reduce postoperative wrist pain and improve wrist function in the early stages after surgery for patients with both Grade III and IV SNU. TYPE OF STUDY/LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Zhenye Zhong
- Department of Orthopedics, 900th Hospital of the Joint Logistic Support Force, 156 West 2nd Ring Road North, Fuzhou, Fujian, China
- Department of Orthopedics, Shengli Clinical Medical College of Fujian Medical University, 134 East Street, Fuzhou, Fujian, China
- Department of Orthopedics, Fujian provincial hospital, 134 East Street, Fuzhou, Fujian, China
| | - Meiyang Wei
- Department of Orthopedics, 900th Hospital of the Joint Logistic Support Force, 156 West 2nd Ring Road North, Fuzhou, Fujian, China
| | - Zhaoying Jiang
- Department of Obstetrics and Gynecology, The Fourth Affiliated Hospital, International Institutes of Medicine, Zhejiang University School of Medicine, Yiwu, Zhejiang, China
| | - Jinshui Chen
- Department of Orthopedics, 900th Hospital of the Joint Logistic Support Force, 156 West 2nd Ring Road North, Fuzhou, Fujian, China
| | - Yanda He
- Department of Orthopedics, 900th Hospital of the Joint Logistic Support Force, 156 West 2nd Ring Road North, Fuzhou, Fujian, China
- Department of Orthopedics, Hui 'an County Hospital, 184 Zhongshan North Street, Quanzhou, Fujian, China
| | - Kaifeng Lin
- Department of Orthopedics, 900th Hospital of the Joint Logistic Support Force, 156 West 2nd Ring Road North, Fuzhou, Fujian, China.
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17
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Finoco M, Dejean C, Giber D, Bastard C, Ferrero E, Dubory A, Khalifé M. Sagittal correction after short percutaneous fixation for thoracolumbar compression fractures: comparison of the combination of SpineJack® kyphoplasty and fractured vertebra screw fixation. Int Orthop 2023. [PMID: 36853432 DOI: 10.1007/s00264-023-05734-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 02/12/2023] [Indexed: 03/01/2023]
Abstract
PURPOSE The aim of this study was to compare two percutaneous pedicle fixations for the treatment of thoracolumbar fractures: one associating a jack kyphoplasty (SpineCut) and the other using intermediate screws (Trident). METHODS All adult patients treated for single-level Magerl/AO type A thoracolumbar traumatic fractures in four orthopaedic departments, with SpineCut or Trident, with a one year minimum follow-up, were retrospectively included. Neurological disorders and osteoporotic fractures were not included. The following data were collected: age, sex, Magerl/AO type, type of surgery, and complications. Radiological parameters were analyzed on pre-operative CT scan, and on standing X-rays before discharge, at three months and one year post-operative: vertebral wedge angle (VWA), regional kyphosis angle (RKA), and traumatic regional angulation (TRA: difference between RKA and physiological values for each vertebra). RESULTS Eighty patients were included, with 42 patients in SpineCut group and 38 in Trident group. Mean age was 41 ± 15.7 years. TRA correction did not differ between the groups: respectively 11.2 ± 8.1° in SpineCut versus 10.2 ± 9.1° in Trident group (p = 0.52). TRA loss of correction between early post-operative and three months was statistically higher in Trident group: -4 ± 5.1° versus -1.5 ± 3.8° (p = 0.03). After 3 months, TRA correction loss was comparable between the groups. Multivariate analysis demonstrated that pre-operative VWA was the only factor significantly associated with early TRA correction loss (p = 0.01). VWA correction and loss of correction did not differ significantly between the groups. No complications were observed. CONCLUSION Percutaneous pedicle fixations of traumatic thoracolumbar fractures associating jack kyphoplasty and intermediate screws are both safe and efficient techniques.
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Kassem E, Khaled SA, Karim MA, El-Hamalawy AG, Fahmy M. Does minimally invasive percutaneous transilial internal fixator became an effective option for sacral fractures? A prospective study with novel implantation technique. Eur J Trauma Emerg Surg 2023; 49:1535-1544. [PMID: 36693947 DOI: 10.1007/s00068-022-02212-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 12/25/2022] [Indexed: 01/26/2023]
Abstract
AIM To assess radiological and functional outcomes of transilial internal fixator (TIFI) for treatment of sacral complete transforaminal fractures with a novel implantation technique that decrease wound irritation problems in addition to facilitating easy application of reduction methods beside showing the best entry points, screw trajectories and angles. METHODS A Prospective case series from 2019 to 2021 was conducted at university hospital including 72 patients with Denis type 2 sacral fractures. The operative and fluoroscopy time, reduction, implantation techniques, postoperative radiological and functional data were collected and evaluated with minimum follow-up of 12 months. RESULTS The mean initial fracture displacement was 4.42 mm while mean postoperative maximum residual fracture displacement was 2.8 mm, Radiological outcome assessed using Matta's grading at the final follow-up visit with 63 cases scored as Excellent,7 cases as Good, 2 cases as fair. Functional outcome using Majeed scoring shows 64 cases of Excellent grading and 8 cases were Good. Short operative and fluoroscopy time, easy reduction techniques, few skin problems were recorded. CONCLUSION TIFI through a minimally invasive technique represents a valid method for dealing with transforaminal sacral fractures. TIFI provides a rigid fixation for posterior ring injuries with few risks regarding iatrogenic nerve injury, avoiding different variations of upper sacral osseous anatomy or sacral dysmorphism. In addition, there is no necessity for high quality fluoroscopy for visualization of sacral foramina intraoperatively, decreasing risk of radiation exposure, unlike other methods of fixation as iliosacral screws. Our novel modification for implantation technique provides few risks for postoperative and wound complications.
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Affiliation(s)
- Elsayed Kassem
- Pelvis Fractures and Arthroplasty Unit, Cairo University, Cairo, Egypt
| | - Sherif A Khaled
- Pelvis Fractures and Arthroplasty Unit, Cairo University, Cairo, Egypt
| | | | | | - Mahmoud Fahmy
- Pelvis Fractures and Arthroplasty Unit, Cairo University, Cairo, Egypt.
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Finoco M, Dejean C, Giber D, Ferrero E, Khalifé M. Implant removal after short percutaneous pedicle fixation associated with SpineJack ® kyphoplasty: is correction sustained? Arch Orthop Trauma Surg 2022:10.1007/s00402-022-04726-5. [PMID: 36529775 DOI: 10.1007/s00402-022-04726-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 12/01/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE This study objective was to evaluate sagittal correction loss after instrumentation removal in patients treated for thoracic or lumbar compression fractures treated with SpineJack® kyphoplasty associated with short percutaneous pedicle screw fixation. METHODS This retrospective multicenter study was carried out in three major French trauma centers. All patients with a single type A thoracic or lumbar fracture, treated by the studied technique between 2017 and 2020, have been included. Demographic data, fracture type, removal procedure achievement and term were collected. Radiological parameters were measured at five timepoints: pre-operative, intra-operative, immediate post-operative, early post-operative (< 3 months) and at follow-up (1 year). Vertebral wedge angle (angle between the two endplates of the fractured vertebra) and traumatic regional angulation (TRA-calculated by subtracting regional kyphosis from the physiological reference values). RESULTS 150 patients were included. Mean age was 48.6 ± 17.8 years. Average follow-up was 14.4 ± 3 months. 82 patients had secondary instrumentation removal. Mean time to removal was 6.4 ± 2.4 months. TRA correction loss between immediate post-operative and last follow-up was greater in removal group: 5.1 ± 5.6° versus 2.7 ± 4.7° (p = 0.01). Material was removed earlier in younger patients (p = 0.002). TRA correction loss was similar in the early and late removal groups (p = 0.83). Multivariate analysis identified only Magerl/AO A3 fractures as risk factor for loss of TRA correction (p = 0.007). CONCLUSION Instrumentation removal was associated with good radiological outcomes with a non-significant loss of vertebral wedge angle and tolerable loss of traumatic regional angulation (+ 2.4° compared to the no-removal group), even if performed early.
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Affiliation(s)
- Mikael Finoco
- Orthopaedic Surgery Unit, Hôpital Européen Georges Pompidou, APHP, 20 Rue Leblanc, 75015, Paris, France.,Université de Paris Cité, Paris, France
| | - Charles Dejean
- Orthopaedic Surgery Unit, Hôpital Européen Georges Pompidou, APHP, 20 Rue Leblanc, 75015, Paris, France.,Université de Paris Cité, Paris, France
| | - David Giber
- Orthopaedic Surgery Unit, Hôpital Henri Mondor, APHP, 1 Rue Gustave Eiffel, 94000, Créteil, France
| | - Emmanuelle Ferrero
- Orthopaedic Surgery Unit, Hôpital Européen Georges Pompidou, APHP, 20 Rue Leblanc, 75015, Paris, France.,Université de Paris Cité, Paris, France
| | - Marc Khalifé
- Orthopaedic Surgery Unit, Hôpital Européen Georges Pompidou, APHP, 20 Rue Leblanc, 75015, Paris, France. .,Université de Paris Cité, Paris, France.
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Chen Z, Fan C, Zhang J, Zhao C, Du X, Huang W, Ni W, Luo G. A novel minimally invasive percutaneous treatment for Essex-Lopresti joint depression-type DIACFs by ligamentotaxis. BMC Surg 2022; 22:431. [PMID: 36527011 PMCID: PMC9756504 DOI: 10.1186/s12893-022-01868-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 11/25/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To compare the clinical efficacy of minimally invasive percutaneous treatment by ligamentotaxis with traditional open reduction and internal fixation in the treatment of Essex-Lopresti joint depression-type displaced intra-articular calcaneal fractures (DIACFs). METHODS The medical records of patients with calcaneal fractures admitted to our department from January 2016 to December 2020 were retrospectively analyzed, and patients who met the inclusion criteria were finally included for analysis. Twenty-one patients underwent minimally invasive percutaneous treatment by ligamentotaxis (Group A), while eighteen patients were treated by traditional open reduction and internal fixation through an extended lateral approach (Group B). The preoperative waiting time, operative time, hospital stay, radiologic parameters (calcaneal height, width, length, Böhler angle and Gissane angle), American Foot and Ankle Surgery Association (AOFAS) hindfoot scores, Maryland Foot Score (MFS), visual analogue scale (VAS), and incidence of complications of the included patients were all recorded and analysed. RESULTS Thirty-nine patients with Essex-Lopresti joint depression type DIACFs were finally included. According to the Sanders classification, 22 were type II, 12 were type III and 5 were type IV. The preoperative waiting time and the hospital stay of Group A were 3.7 ± 1.6 d and 7.2 ± 1.7 d, respectively, which were significantly shorter than those of Group B (6.9 ± 2.0 d and 12.4 ± 1.5 d) (P < 0.05). There was no significant difference in the operative time between the two groups (88.8 ± 9.8 min vs. 91.3 ± 12.1 min; P > 0.05). No significant differences were shown in the radiological parameters (calcaneal height, width, length, Böhler angle and Gissane angle) or the satisfactory rate of joint surface reduction (SRJSR) of the two groups immediately postoperatively. All patients were followed up for 14 to 56 months [(30.2 ± 10.4) months]. All fractures healed. At the final follow-up, there were no significant differences in the radiological parameters or the SRJSR between the two groups (P > 0.05). No significant differences were shown in the AOFAS scores, MFS or VAS scores between the two groups [(89.5 ± 8.2) vs. (89.4 ± 9.0), P > 0.05; (87.5 ± 8.3) vs. (86.3 ± 8.9), P > 0.05; and (2.1 ± 1.2) vs. (2.2 ± 1.2), P > 0.05]. The excellent and good rates of the AOFAS scores and MFS were 90.5% and 85.7%, respectively, in Group A and 88.9% and 88.9%, respectively, in Group B (P > 0.05). Four patients experienced wound complications, including 1 superficial incision infection, 2 skin necrosis around the incision edge and 1 deep infection in Group B, while there were no wound complications in Group A (P < 0.05). One patient in each group suffered traumatic arthritis (P > 0.05). CONCLUSIONS In the assessment of Essex-Lopresti joint depression type DIACFs, minimally invasive percutaneous treatment by ligamentotaxis has similar clinical outcomes to traditional open reduction and internal fixation through an extended lateral approach. However, the former has the advantages of shorter preoperative waiting time and hospital stay, and lower incidence of incision complications.
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Affiliation(s)
- Zhiguo Chen
- grid.452206.70000 0004 1758 417XDepartment of Orthopedics, Orthopedic Laboratory of Chongqing Medical University, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Rd, Chongqing, 400016 China
| | - Chongyin Fan
- grid.452206.70000 0004 1758 417XDepartment of Orthopedics, Orthopedic Laboratory of Chongqing Medical University, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Rd, Chongqing, 400016 China
| | - Jinsong Zhang
- grid.452206.70000 0004 1758 417XDepartment of Orthopedics, Orthopedic Laboratory of Chongqing Medical University, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Rd, Chongqing, 400016 China
| | - Chen Zhao
- grid.452206.70000 0004 1758 417XDepartment of Orthopedics, Orthopedic Laboratory of Chongqing Medical University, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Rd, Chongqing, 400016 China
| | - Xin Du
- grid.452206.70000 0004 1758 417XDepartment of Orthopedics, Orthopedic Laboratory of Chongqing Medical University, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Rd, Chongqing, 400016 China
| | - Wei Huang
- grid.452206.70000 0004 1758 417XDepartment of Orthopedics, Orthopedic Laboratory of Chongqing Medical University, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Rd, Chongqing, 400016 China
| | - Weidong Ni
- grid.452206.70000 0004 1758 417XDepartment of Orthopedics, Orthopedic Laboratory of Chongqing Medical University, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Rd, Chongqing, 400016 China
| | - Gang Luo
- grid.452206.70000 0004 1758 417XDepartment of Orthopedics, Orthopedic Laboratory of Chongqing Medical University, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Rd, Chongqing, 400016 China
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Qoreishy M, Movahedinia M, Maleki A, Kazemi S. Safe Corridor for Sacroiliac Screw Insertion Can Be Found Quickly Without the Use of the Lateral Sacral View. Arch Bone Jt Surg 2022; 10:959-963. [PMID: 36561220 PMCID: PMC9749119 DOI: 10.22038/abjs.2022.60025.2956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 03/14/2022] [Indexed: 12/24/2022]
Abstract
Background Studies have proved that in addition to the inlet and outlet views, the intraoperative lateral sacral view is required to ensure the correct entry point, reduce operating time, and lower radiation exposure. Considering the complex anatomy of the sacrum, we showed a safe corridor for sacroiliac joint (SIJ) screw insertion that was accessible using only inlet and outlet fluoroscopic views. Methods From 2013 to 2020, we enrolled 215 patients who underwent percutaneous SIJ screw insertion. Our experience in SIJ screw insertion is presented using only two views (inlet and outlet). We reported on the radiation exposure time, operating time, rate of screw malposition, neurologic injury, and revision surgery. Results The screw malposition rate was 5.5%, including 11 foraminal perforations and one perforated anterior sacral cortex. Paresthesia after the surgery was observed in six patients (2.8%). No revision surgery or screw removal was performed. The radiation exposure and operation time for each screw were 21 ± 4.5 s and 13.5 min, respectively. Conclusion The most anterior and the lowest part of the S1 vertebra can be easily found using intraoperative inlet and outlet views. It is a safe corridor for SIJ screw insertion with low radiation time, neurologic injury, and revision rates.
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Affiliation(s)
- Mohamad Qoreishy
- Department of Orthopedics, Medical school, Shahid Beheshti University of medical sciences, Tehran, Iran
| | - Mohamad Movahedinia
- Bone Joint and Related Tissues Research Center, Akhtar Orthopedic Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arash Maleki
- Department of Orthopedics, Medical school, Shahid Beheshti University of medical sciences, Tehran, Iran
| | - Seyyedmorteza Kazemi
- Bone Joint and Related Tissues Research Center, Akhtar Orthopedic Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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22
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Alsheikh KA, Alzahrani AM, Alshehri AS, Alzahrani FA, Alqahtani YS, Alhumaidan MI, Alangari HS. Clinical outcomes of percutaneous screw fixation of acetabular fracture: A minimally invasive procedure. J Taibah Univ Med Sci 2022; 18:279-286. [PMID: 36817219 PMCID: PMC9926199 DOI: 10.1016/j.jtumed.2022.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 08/24/2022] [Accepted: 09/15/2022] [Indexed: 11/06/2022] Open
Abstract
Objective Open reduction with internal fixation is the surgical intervention of choice for acetabular fractures (AFs). Percutaneous screw fixation for AFs is a new procedure that is desirable because of the complex anatomy of the pelvis. In this study, we aimed to assess the functional outcomes, mobility, healing, and distal neurovascular abnormalities in patients who underwent percutaneous retrograde screw fixation. Methods Our study included 36 patients with AFs treated with percutaneous screw fixation between January 2016 and June 2021. There were 18 cases with anterior column AF, 7 cases with transverse AF, and 11 cases with associated AF, 6 of which had a T-shaped AF. Frequencies and percentages were used to describe characteristics and clinical outcomes. Mean and standard deviation were used for continuous variables. SPSS version 23 (IBM Corporation, Armonk, NY, USA) was used for statistical analysis. Results The average time to regain full mobility with full weight bearing was 12.9 ± 5.4 weeks, and approximately 11.1 ± 2.8 weeks was required for patients to be pain-free with satisfactory fracture healing. Only a minority (8.3%) of patients had abnormalities affecting the distal neurovascular system, and 11.1% experienced sexual dysfunction. Pain severity was assessed with a visual analogue scale. The average pain severity on the first and third post-operative days was 4 ± 2.4 and 3.8 ± 2.6, respectively. However, the average pain intensity before discharge was 1.7 ± 2.6. Conclusion Percutaneous screw fixation is the most efficient surgical choice for most pelvic/AFs.
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Affiliation(s)
- Khalid A. Alsheikh
- Department of Surgery, Ministry of National Guard-Health Affairs, Riyadh, KSA
- King Abdullah International Medical Research Center, Medical Research Core Facility and Platforms, Riyadh, KSA
- King Saud bin Abdulaziz University for Health Science, College of Medicine, Riyadh, KSA
| | - Abdullah M. Alzahrani
- Department of Surgery, Ministry of National Guard-Health Affairs, Riyadh, KSA
- King Abdullah International Medical Research Center, Medical Research Core Facility and Platforms, Riyadh, KSA
- King Saud bin Abdulaziz University for Health Science, College of Medicine, Riyadh, KSA
| | - Ali S. Alshehri
- Department of Surgery, Ministry of National Guard-Health Affairs, Riyadh, KSA
- King Abdullah International Medical Research Center, Medical Research Core Facility and Platforms, Riyadh, KSA
| | - Faisal A. Alzahrani
- Department of Surgery, Ministry of National Guard-Health Affairs, Riyadh, KSA
- King Abdullah International Medical Research Center, Medical Research Core Facility and Platforms, Riyadh, KSA
| | - Yousef S. Alqahtani
- Department of Surgery, Ministry of National Guard-Health Affairs, Riyadh, KSA
- King Abdullah International Medical Research Center, Medical Research Core Facility and Platforms, Riyadh, KSA
| | - Mohammed I. Alhumaidan
- King Abdullah International Medical Research Center, Medical Research Core Facility and Platforms, Riyadh, KSA
- King Saud bin Abdulaziz University for Health Science, College of Medicine, Riyadh, KSA
| | - Hussam S. Alangari
- Department of Surgery, Ministry of National Guard-Health Affairs, Riyadh, KSA
- King Abdullah International Medical Research Center, Medical Research Core Facility and Platforms, Riyadh, KSA
- King Saud bin Abdulaziz University for Health Science, College of Medicine, Riyadh, KSA
- Corresponding address: King Abdullah International Medical Research Center, Medical Research Core Facility and Platforms, King Saud bin Abdelaziz University for Health Science, College of Medicine, Department of Surgery, Ministry of National Guard-Health Affairs Riyadh, 11564, KSA.
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Liu Y, Shi W, Zhao H, Li Y, Li J, Xun F, Canavese F, Xu H. Closed reduction and percutaneous pinning versus open reduction and internal fixation for Jakob type 3 lateral condyle fractures in children. Int Orthop 2022; 46:2291-2297. [PMID: 35723700 DOI: 10.1007/s00264-022-05476-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 06/06/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE The management of type 3 lateral condyle fractures (LCFs) remains controversial. The main goal of this study was to evaluate the feasibility of closed reduction and percutaneous pinning (CRPP) in patients with type 3 LCFs and to assess the outcome of such injuries according to the type of treatment, CRPP, or open reduction and internal fixation (ORIF). METHODS This is a retrospective review of prospectively enrolled children with type 3 LCF managed by CRPP or ORIF between 2018 and 2021. All patients were followed for at least 12 months. Patients were divided into two groups according to the type of treatment, CRPP or ORIF. Demographic characteristics were recorded for all patients. Standard radiographs were used to identify, evaluate, and classify each fracture and to detect the presence of other concomitant bone lesions. The clinical outcome was assessed according to the Hardacre et al. criteria. RESULTS Seventy-eight children with type 3 LCF were included; 42 were treated by CRPP (53.8%) and 36 by ORIF (46.2%); the mean follow-up time was 17.7 months (range, 12.3-40.9). The baseline characteristics did not differ between the two groups of patients. Overall, successful CRPP could be achieved in 39 out of 42 patients (92.9%). The mean surgical time was 63.4 and 84.5 min in patients treated by CRPP and ORIF, respectively (p = 0.01). Fluoroscopy time was significantly shorter in patients managed by ORIF than in those treated by CRPP (12 versus 40 s, respectively; p < 0.001). Clinical outcome according to the Hardacre et al. criteria was excellent in 37 out of 39 (94.4%) and in 35 out of 36 patients (97.2%) treated by CRPP and ORIF, respectively (p = 0.09). CONCLUSIONS CRPP management of paediatric type 3 LCF has clinical and radiographic outcomes similar to ORIF; if satisfactory reduction cannot be achieved by CRPP, conversion to ORIF should be considered.
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Affiliation(s)
- Yanhan Liu
- Department of Pediatric Orthopedics, GuangZhou Women and Children's Medical Center, Guangzhou, 510623, China
| | - Weizhe Shi
- Department of Pediatric Orthopedics, GuangZhou Women and Children's Medical Center, Guangzhou, 510623, China
| | - Hai Zhao
- Department of Pediatric Orthopedics, Chenzhou No.1 People's Hospital, Chenzhou, 423000, China
| | - Yiqiang Li
- Department of Pediatric Orthopedics, GuangZhou Women and Children's Medical Center, Guangzhou, 510623, China
| | - Jingchun Li
- Department of Pediatric Orthopedics, GuangZhou Women and Children's Medical Center, Guangzhou, 510623, China
| | - Fuxin Xun
- Department of Pediatric Orthopedics, GuangZhou Women and Children's Medical Center, Guangzhou, 510623, China
| | - Federico Canavese
- Department of Pediatric Orthopedic Surgery, Lille University Hospital and Faculty of Medicine, Av. Eugene Avinée, 59000, Lille, France
| | - Hongwen Xu
- Department of Pediatric Orthopedics, GuangZhou Women and Children's Medical Center, Guangzhou, 510623, China.
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Tsumura T, Matsumoto T, Imanaka T, Kishimoto K, Ito H. Comparison of conventional and transtrapezial palmar approaches for screw fixation of scaphoid waist fractures: a clinical study. J Hand Surg Eur Vol 2022; 47:915-920. [PMID: 35473412 DOI: 10.1177/17531934221095435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We investigated two palmar approaches for screw fixation of acute scaphoid waist fractures: the conventional percutaneous or transtrapezial approach. Thirty cases who underwent operation from 2013 to 2021 were reviewed (conventional group, 15; transtrapezial approach group, 15). Cross-sections were constructed along the long axis of the scaphoid on postoperative computed tomography to evaluate the screw position, relative to the centre point in the distal-third, midwaist and proximal-third of the bone. The screw could be inserted centrally in the proximal and distal regions using the transtrapezial approach. In the conventional approach, the screw was inserted radially in the distal region, but tended to be positioned centrally in the midwaist and proximal regions. As central placement of the screw in the proximal fragment offers a biomechanical advantage, both approaches can be options for some fracture patterns, while for others, the fracture pattern could influence which approach is better.Level of evidence: IV.
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Affiliation(s)
- Takuya Tsumura
- Department of Orthopaedic Surgery, Kurashiki Central Hospital, Kurashiki, Japan
| | - Taiichi Matsumoto
- Department of Orthopaedic Surgery, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Toshihide Imanaka
- Department of Orthopaedic Surgery, Kurashiki Central Hospital, Kurashiki, Japan
| | - Katsuma Kishimoto
- Department of Orthopaedic Surgery, Kurashiki Central Hospital, Kurashiki, Japan
| | - Hiromu Ito
- Department of Orthopaedic Surgery, Kurashiki Central Hospital, Kurashiki, Japan
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Wang M, Jacobs RC, Bartlett CS, Schottel PC. Supraacetabular osseous corridor: defining dimensions, sex differences, and alternatives. Arch Orthop Trauma Surg 2022; 142:1429-34. [PMID: 33507379 DOI: 10.1007/s00402-021-03786-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 01/08/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The supraacetabular (SA) corridor extends from the anterior inferior iliac spine to the posterior ilium and can safely accommodate implants to stabilize pelvic and acetabular fractures. However, quantitative analysis of its dimensions and characteristics have not been thoroughly described. This study seeks to define the dimensions, common constriction points, and any alternative trajectories that would maximize the corridor diameter. METHODS Computed tomography of 100 male and 100 female hemipelves without osseous trauma were evaluated. The corridor boundaries were determined through manual best-fit analysis. The largest intercortical cylinder within the pathway was created and measured. Alternative trajectories were tested within the SA boundaries to identify another orientation that maximized the diameter of the intercortical cylinder. RESULTS The traditional SA corridor had a mean diameter of 8.3 mm in men and 6.2 mm in women. This difference in diameter is due to a more S-shaped ilium in women. A larger alternative SA corridor was found that had a less limited path through the ilium and measured 11.3 mm in men and 9.9 mm in women. These dimensions are significantly different compared to those of the traditional SA corridor in both men and women. CONCLUSIONS In men, the SA corridor allows for the safe passage of most hardware used in pelvic and acetabular fractures. However, in women, the SA corridor is restricted by a more S-shaped ilium. An alternative trajectory was found that has a significantly larger mean diameter in both sexes. Ultimately, the trajectory of hardware will be dictated by the clinical scenario. When large implants are needed, especially in women, we recommend considering the alternative SA corridor.
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Luo G, Fan C, Gao P, Huang W, Ni W. An evaluation of the efficacy of percutaneous reduction and screw fixation without bone grafting in Sanders Type-II and Type-III displaced intra-articular calcaneal fractures. BMC Musculoskelet Disord 2022; 23:562. [PMID: 35689229 PMCID: PMC9188138 DOI: 10.1186/s12891-022-05515-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 04/21/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this retrospective monocentric study was to investigate the clinical efficacy of percutaneous reduction and screw fixation without bone grafting in Sanders Type-II and Type-III displaced intra-articular calcaneal fractures (DIACFs). METHODS The medical records of calcaneal fractures patients who were admitted to our department from January 2018 to January 2020 were retrospectively reviewed, and those meeting the inclusion criteria were fnally included for analysis. All patients were treated with percutaneous reduction and screw fixation, and no patients received bone grafting. The radiologic parameters evaluated included the BÖhler angle and the calcaneal height. In addition, the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot scores, Maryland Foot Score (MFS), and visual analog scale (VAS) score were determined. RESULTS Thirty-eight patients with Sanders Type-II and Type-III DIACFs were finally included, including 30 males and 8 females aged 21 to 61 years [(42.6 ± 9.6) years]. According to the Essex-Lopresti classification, 27 of the fractures were the tongue type, and 11 were the joint compression type. According to the Sanders classification, 27 of the fractures were type II, and 11 were type III. Immediately postoperatively, the calcaneal height had recovered to 39.8 ± 2.1 mm, the BÖhler angle had recovered from 4.2° ± 13.6° preoperatively to 27.2° ± 3.4° (P = 0.000). All patients were followed up for 18-42 months [(25.2 ± 9.5) months]. All fractures healed. No differences were found in the outcome measures six-months postoperatively (BÖhler angle, p = 0.24; calcaneal height, p = 0.82) or at final follow-up (BÖhler angle, p = 0.33; calcaneal height, p = 0.28) compared to the immediately postoperative values. At the final follow-up, the AOFAS score was 91.7 ± 7.4 points, with an excellent and good rate of 92.1%; the MFS was 90.3 ± 7.8 points, with an excellent and good rate of 92.1%; and the VAS score was 2.2 ± 1.5 points. None of the patients had incision complications, and one patient developed traumatic arthritis. CONCLUSION Percutaneous reduction and screw fixation without bone grafting in Sanders Type-II and Type-III DIACFs can achieve good recovery and maintenance of the BÖhler angle and calcaneal height. Moreover, it has the advantage of a low complication rate.
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Affiliation(s)
- Gang Luo
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Rd, Chongqing, 400016, China.
| | - Chongyin Fan
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Rd, Chongqing, 400016, China
| | - Peili Gao
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Rd, Chongqing, 400016, China
| | - Wei Huang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Rd, Chongqing, 400016, China
| | - Weidong Ni
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Rd, Chongqing, 400016, China.
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Toro G, Braile A, De Cicco A, Pezzella R, Ascione F, Cecere AB, Schiavone Panni A. Fragility Fractures of the Acetabulum: Current Concepts for Improving Patients' Outcomes. Indian J Orthop 2022; 56:1139-1149. [PMID: 35813545 PMCID: PMC9232661 DOI: 10.1007/s43465-022-00653-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 05/04/2022] [Indexed: 02/04/2023]
Abstract
The incidence of fragility fractures of the acetabulum (FFA) is constantly increasing. Generally, these fractures are related to a fall on the greater trochanter involving the anterior column. The management of FFA is extremely difficult considering both patients' comorbidities and poor bone quality. Both non-operative and several operative treatment protocols are available, and the choice among them is still ambiguous. The proposed surgical techniques for FFA [namely open reduction and internal fixation (ORIF), percutaneous fixation and total hip arthroplasty (THA)] are associated with a high complication rate. The treatment with the higher early mortality is the ORIF + THA, while the one with the lowest is the non-operative. However, at longer follow-up, this difference dreadfully change is becoming the opposite. Frequently ORIF, percutaneous fixation, and non-operative treatment need a subsequent re-operation through a THA. This latter could be extremely difficult, because of poor bone quality, acetabular mal union/non-union, bone gaps and hardware retention. However, the outcomes of each of the proposed treatment are mostly poor and controverted; therefore, a comprehensive patient evaluation and an accurate fracture description are required to appropriately manage acetabular fracture in the elderly.
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Affiliation(s)
- Giuseppe Toro
- grid.9841.40000 0001 2200 8888Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy ,grid.6530.00000 0001 2300 0941Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Adriano Braile
- grid.9841.40000 0001 2200 8888Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Annalisa De Cicco
- grid.9841.40000 0001 2200 8888Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Raffaele Pezzella
- Unit of Orthopedics and Traumatology, AORN San Giuseppe Moscati, 83100 Avellino, Italy
| | - Francesco Ascione
- grid.461850.eDepartment of Orthopaedic and Traumatology Surgery, Ospedale Buon Consiglio Fatebenefratelli, 80123 Naples, Italy
| | - Antonio Benedetto Cecere
- grid.9841.40000 0001 2200 8888Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Alfredo Schiavone Panni
- grid.9841.40000 0001 2200 8888Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
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Neeley OJ, Kafka B, Tecle NE, Shi C, El Ahmadieh TY, Sagoo NS, Davies M, Johnson Z, Caruso JP, Hoeft J, Stutzman SE, Vira S, Hunt Batjer H, Bagley CA, Whitworth L, Aoun SG. Percutaneous screw fixation versus open fusion for the treatment of traumatic thoracolumbar fractures: A retrospective case series of 185 Patients with a single-level spinal column injury. J Clin Neurosci 2022; 101:47-51. [PMID: 35533611 DOI: 10.1016/j.jocn.2022.04.045] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 04/21/2022] [Accepted: 04/30/2022] [Indexed: 11/28/2022]
Abstract
STUDY DESIGN Retrospective Single-Center Review of Data at a Level 1 Trauma Center. OBJECTIVE Compare deformity correction and surgical outcomes of percutaneous instrumentation and open fusion in traumatic thoracolumbar fractures. METHODS In our retrospective study, all patients undergoing elective spine surgery for TL fractures at a Level 1 trauma center between 2000 and 2017 were reviewed. Patients who underwent percutaneous fixation were given the option of hardware removal after the fracture had healed. RESULTS A total of 185 patients were included in the study, with 109 treated with an open fusion, and 76 with percutaneous fixation. Twenty-five patients in the latter group had the instrumentation removed after the fracture had healed. None of them required reoperation. In the open fusion group 54.1% of patients required a decompressive laminectomy. Percutaneous fixation patients had a shorter operative time (98.3 min vs 214 min, p < 0.0001), shorter length of stay (9.8 days vs 13.5 days, p = 0.04), and less blood loss (68.4 cc vs 691 cc, p < 0.001). They also had a better correction of their traumatic kyphosis after surgery (p = 0.005). CONCLUSION Percutaneous fixation is a valuable option for the treatment of TL fractures in cases without evidence of neural compression. It is still unclear whether hardware removal helps prevent adjacent segment degeneration. Percutaneous fixation could allow for better reduction of the fracture with improvement of postoperative alignment.
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Affiliation(s)
- Om J Neeley
- UT Southwestern, Department of Neurological Surgery, United States
| | - Benjamin Kafka
- UT Southwestern, Department of Neurological Surgery, United States
| | - Najib El Tecle
- St Louis University Hospital, Department of Neurological Surgery, United States
| | - Chen Shi
- UT Southwestern, Department of Neurological Surgery, United States
| | | | - Navraj S Sagoo
- UT Southwestern, Department of Orthopedic Surgery, United States
| | - Matthew Davies
- UT Southwestern, Department of Neurological Surgery, United States
| | - Zachary Johnson
- UT Southwestern, Department of Neurological Surgery, United States
| | - James P Caruso
- UT Southwestern, Department of Neurological Surgery, United States
| | - Jennifer Hoeft
- UT Southwestern, Department of Neurological Surgery, United States
| | - Sonja E Stutzman
- UT Southwestern, Department of Neurological Surgery, United States
| | - Shaleen Vira
- UT Southwestern, Department of Orthopedic Surgery, United States
| | - H Hunt Batjer
- UT Southwestern, Department of Neurological Surgery, United States
| | - Carlos A Bagley
- UT Southwestern, Department of Neurological Surgery, United States; UT Southwestern, Department of Orthopedic Surgery, United States
| | - Louis Whitworth
- UT Southwestern, Department of Neurological Surgery, United States
| | - Salah G Aoun
- UT Southwestern, Department of Neurological Surgery, United States.
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Wang J, Qin S, Wang T, Liu J, Wang Z. Comparison of the Curative Effect of Percutaneous Reduction with Plastic Calcaneal Forceps Combined with Medial External Fixation in the Treatment of Intra-Articular Calcaneal Fractures. Orthop Surg 2021; 13:2344-2354. [PMID: 34767310 PMCID: PMC8654646 DOI: 10.1111/os.13118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 04/28/2021] [Accepted: 05/26/2021] [Indexed: 11/30/2022] Open
Abstract
Objective To compare the clinical efficacy of percutaneous minimally invasive reduction combined with external fixation and a tarsal sinus approach to treat Sanders type II and III intra‐articular calcaneal fractures. Methods The clinical data of 64 patients with Sanders type II and III calcaneal fractures admitted to our hospital from January 2010 to January 2016 were retrospectively analyzed; data includedage, sex, body mass index. According to the surgical method, they were divided into the percutaneous minimally invasive reduction with internal and external fixation group (30 cases) and the tarsal sinus approach group (34 cases).The two groups of patients were compared in terms of the time tosurgery, length of hospital stay, intraoperative blood loss, operative duration, complications, radiographic features, including the heel bone length, width, height, Bohlerangle, Gissane angle, and calcaneal varus angle, and clinical efficacy indicators, including the American Orthopedic Foot and Ankle Society (AOFAS) score, the visual analog scale (VAS) pain score, health survey profile (SF‐36) score and Maryland ankle function score. Results Patients in both groups were followed up for 12 to 50 months, with an average of 24.8 months.Bony union was achieved in all cases. The time to surgery, length of hospitalstay, intraoperative blood loss and incidence of incision‐related complications were significantly lower in the percutaneous minimally invasive medial external fixation group than in the tarsal sinus group (P < 0.01). At the last follow‐up, the calcaneal length, width, and height, Bohler angle, Gissane angle, and varus angle were significantly increased in both groups (P < 0.01), the calcaneal width was significantly lower after than before surgery (P < 0.01), and there were no statistically significant differences between the two groups (P > 0.05). As measures of clinical efficacy, the AOFAS, VAS, SF‐36 and Maryland scores were 85.28 ± 8.21, 0.84 ± 1.21, 82.95 ± 3.25 and 83.56 ± 3.32, respectively, at the last follow‐up in the percutaneous minimally invasive medial external fixation group and 83.32 ± 7.69, 1.85 ± 1.32, 80.71 ± 5.42, and 81.85 ± 2.41 in the tarsal sinus group, respectively, with no significant differences between the two groups (P > 0.05). Conclusion Under the condition of a good command of surgical indications and surgical skills, the use of plastic calcaneal forceps for percutaneous minimally invasive reduction combined with medial external fixation for the treatment of Sanders type II and III intra‐articular calcaneal fractures can achieve similar clinical effects as the tarsal sinus approach. However, the use of plastic calcaneal forceps for percutaneous minimally invasive reduction combined with internal and external fixation has advantages, such as fewer complications, less bloodloss, and a shorter operation, and thus has good safety and is worthy of clinical promotion.
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Affiliation(s)
- Jianchuan Wang
- Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Song Qin
- Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Tienan Wang
- Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Jibin Liu
- Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Zongpu Wang
- Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
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Lorente R, Palacios P, Vaccaro A, Mariscal G, Diamantopoulus J, Lorente A. Safety and utility of implant removal after percutaneous osteosynthesis of type A thoracolumbar and lumbar fracture. Orthop Traumatol Surg Res 2021; 107:102740. [PMID: 33187867 DOI: 10.1016/j.otsr.2020.08.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 06/21/2020] [Accepted: 08/21/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Implant removal represents almost one third of all elective surgeries in orthopedics. There is no consensus regarding the time and need to remove the implants after vertebral fractures consolidation. The aim of this study was to assess the clinical and radiological effects of implant removal in patients with vertebral type A fracture who underwent a percutaneous intervention. MATERIAL AND METHODS We evaluated 31 patients (mean age of 38.2±7.5 years) with thoracolumbar vertebral fracture (T11-L5) who underwent implant removal surgery after 24 months of fracture first surgery by a percutaneous approach. Inclusion criteria focused on patients' preferences. The radiological parameters included fracture angle, initial sagittal index, compression percentage, degree displacement and deformation angle. The clinical variables included Visual Analog Scale and Oswestry Disability index. RESULTS There was no significant correction loss after removal surgery (before surgery and after 24 months): Fracture angle (16.8±0.5 vs 17.1±0.5; p˃0.05), initial sagittal index (12.5±0.5 vs 12.7±0.5; p˃0.05), kyphotic deformity (17.5±0.6 vs 17.8±0.7; p˃0.05), compression percentage (35.6±0.8 vs 36.0±0.7; p˃0.05), degree displacement (4.4±0.4 vs 4.5±0.3; p˃0.05) and deformation angle (23.0±0.7 vs 23.1±0.7; p˃0.05). Patients who presented symptoms before the surgery showed better Visual Analog Scale (1.2±0.6 pre vs 0.6±0.3 post, p˂0.05) and Oswestry Disability Index (20.1±6.8 pre vs 15.7±0.5, p˂0.05). No complications were reported. DISCUSSION Routine implant removal in patients undergoing a percutaneous approach to vertebral type A fracture is a safe technique and is associated with good clinical results without loss of radiological correction. In addition, this procedure could be indicated to patients who manifest symptoms since there is a clinical-radiological benefit. LEVEL OF PROOF II; A multicenter prospective cohort study.
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Affiliation(s)
- Rafael Lorente
- Complejo Hospitalario Universitario de Badajoz, Badajoz, Spain
| | | | | | - Gonzalo Mariscal
- Institute for Research on Musculoskeletal Disorders, School of Medicine, Valencia Catholic University, Valencia, Spain.
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31
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Arzac Ulla I. Persistent instability in pure ligamentous Lisfranc joint injuries. Foot Ankle Surg 2021; 27:793-8. [PMID: 33183982 DOI: 10.1016/j.fas.2020.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/21/2020] [Accepted: 10/18/2020] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Lisfranc injuries refer to a specific group of injuries which lead to instability of the tarsalmetatarsal joint. Our hypothesis is that persistent instability is permanent and asymptomatic in subtle unstable injuries of the medial column which have been fixed percutaneously. OBJECTIVE To describe the persistent instability of pure ligamentous Lisfranc joint injuries treated with anatomic reduction and percutaneous screws fixation by comparative radiographs of both feet. MATERIALS AND METHODS Between 2014 and 2018, 14 patients diagnosed with subtle unstable Lisfranc injury were evaluated. Indications for surgery included widening (diastasis) greater than 2mm between the first and second metatarsal bases, and subluxation greater than 1mm of a metatarsal base from its respective tarsal bone. RESULTS Persistent instability was found on the stress radiographs of 11 patients (78.57% 95% CI: 48.60-95.07%) but without clinical connotations. The average AOFAS score evaluated at 18 months post-operatively was of 97.14 (SD±4.68) points. The median follow-up was 24 (RIQ: 18-24) months. In all patients, anatomical reduction on radiographs was evident. CONCLUSION We observed a persistent instability of the Lisfranc joint, without clinical connotations. Subtle unstable Lisfranc injuries treated with percutaneous screw fixation have a good clinical and functional outcome. LEVEL OF EVIDENCE IV.
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Prost S, Boudissa M, Fuentes S, Tropiano P, Tonetti J, Blondel B. Minimally invasive triangular lumboiliac and iliosacral fixation of posterior pelvic ring injuries with vertical instability: Technical note. Orthop Traumatol Surg Res 2021; 107:102993. [PMID: 34186218 DOI: 10.1016/j.otsr.2021.102993] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 12/08/2020] [Accepted: 01/18/2021] [Indexed: 02/03/2023]
Abstract
To date, no strong consensus exists on the best way to treat posterior pelvic ring injuries when there is no neurological deficit. Various fixation methods have been described; more recently, constructs that combine lumboiliac and iliosacral fixation have been introduced. This type of fixation is mainly indicated in cases of spinopelvic dissociation with large displacement of fracture fragments in the sagittal plane. However, these techniques are associated with postoperative complications, particularly infections and severe skin complications. This led us to propose a minimally invasive lumboiliac and iliosacral fixation technique for posterior pelvic ring injuries. The procedure is done with the patient prone. It consists of pedicle screw insertion into L4 or L5 and screw fixation of the ilium with fluoroscopy guidance; intraoperative distraction can be done depending on the amount of displacement. An iliosacral screw is then inserted percutaneously to allow reduction in the transverse plane and yield a triangular construct. In the five patients that we have operated using this technique, the mean preoperative vertical displacement was 11.9±6.9mm (SD) (min 1.3, max 19.7) versus 3.7±3.2mm (min 0.3, max 6.7) postoperatively and the mean preoperative frontal displacement was 7.5±3.7mm (min 4.2, max 12.4) versus 2.5±2.0mm (min 0.3, max 4.3) postoperatively. Minimally invasive iliosacral and lumboiliac fixation is an option for treating posterior pelvic ring fractures free of neurological deficit and especially spinopelvic dissociation.
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Abstract
Treatment of calcaneal fractures has to be tailored to the individual pathoanatomy. If operative treatment is chosen, anatomic reconstruction of the calcaneal shape and joint surfaces is mandatory. For most of the displaced, intraarticular fractures, this can be achieved by less invasive reduction and fixation via a sinus tarsi approach, which may be extended along the "lateral utility" line for calcaneocuboid joint involvement or calcaneal fracture-dislocations. Purely percutaneous fixation is the treatment of choice for displaced extraarticular fractures and simple intraarticular fractures with adequate control of joint reduction. Specific approaches are used for rare calcaneal fracture variants.
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Affiliation(s)
- Stefan Rammelt
- University Center of Orthopaedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus at TU Dresden, Fetscherstrasse 74, Dresden 01307, Germany.
| | - Michael P Swords
- Michigan Orthopedic Center, Sparrow Hospital, 2815 S. Pennsylvania Avenue, Suite 204 Lansing, MI 48910, USA
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34
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Lo CH, Chen CH. Comparison of minimally invasive percutaneous fixation and open reduction internal fixation for patella fractures: a meta-analysis. J Orthop Surg Res 2021; 16:506. [PMID: 34404423 PMCID: PMC8369684 DOI: 10.1186/s13018-021-02612-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 07/12/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Open reduction internal fixation (ORIF) has long been the conventional procedure for managing displaced patella fracture. This surgical approach has certain drawbacks, which might affect clinical outcomes and patient prognosis. Minimally invasive percutaneous fixation (MIPF) was proposed to overcome these disadvantages. Few in-depth investigations have been performed to determine the superiority of MIPF over ORIF. The aim of this study was to compare the efficacies of MIPF and ORIF for patella fractures. METHODS The PubMed, Cochrane Library, Embase, and Scopus databases were searched for relevant studies from November 26 to December 17, 2020. Non-English publications and pediatric orthopedic articles were excluded. Statistical analysis was performed using Review Manager, version 5.4, with mean differences (MDs), standardized mean differences (SMDs), odds ratios (ORs), and respective 95% confidence intervals (CIs) calculated using a random effects model. The primary outcomes were the pain score, knee range of motion, and joint functionality. The secondary outcomes were the surgical time, complications, and implant removal rate. RESULTS Six articles with a total of 304 patients were included in the meta-analysis. Pooled analysis revealed that patients with MIPF had a significantly reduced pain score (MD = - 1.30, 95% CI = - 1.77 to -0.82; p < 0.00001) and increased knee extension angles (MD = 0.72, 95% CI = 0.18 to 1.25; p = 0.009) at 3-month follow-up. Furthermore, knee flexion angles (MD = 8.96, 95% CI = 5.81 to 12.1; p < 0.00001) and joint functionality (SMD = 0.54, 95% CI = 0.21 to 0.86; p = 0.001) had statistically improved at 2 years. However, no difference was observed between MIPF and ORIF with regard to the surgical time. The risk of complications (OR = 0.10, 95% CI = 0.05 to 0.18; p < 0.00001) and implant removal rate (OR = 0.20, 95% CI = 0.07 to 0.57; p = 0.003) were significantly lower with MIPF than with ORIF. CONCLUSIONS MIPF is more favorable than ORIF in terms of the pain score, knee range of motion, joint functionality, complications, and implant removal rate. Thus, it can be adopted as an alternative to ORIF.
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Affiliation(s)
- Chun-Hong Lo
- Department of Primary Medicine, Taipei Medical University Shuang Ho Hospital, New Taipei City, Taiwan
| | - Chih-Hwa Chen
- Department of Orthopedics, Taipei Medical University Shuang Ho Hospital, New Taipei City, Taiwan. .,School of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan. .,Research Center of Biomedical Device, Taipei Medical University, Taipei, Taiwan. .,School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
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35
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Gan DH, Fang MZ, Xue HP, Tan GQ, Li NH, Li ZC, Xu ZW. Clinical Observations of Kümmell Disease Treatment Through Percutaneous Fixation Combined with Vertebroplasty. Orthop Surg 2021; 13:1505-1512. [PMID: 34075704 PMCID: PMC8313159 DOI: 10.1111/os.12935] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 11/25/2020] [Accepted: 12/27/2020] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To explore the safety and efficacy of percutaneous pedicle screw fixation combined with vertebroplasty for the treatment of stage III Kümmell disease. METHODS The clinical data and follow-up results of 22 patients with Kümmell disease who were admitted to our department from 2014 to 2018 were analyzed. There were 14 females and eight males, and the Age range was 58-81 years. All patients were followed up for 24 months. The treatment method was percutaneous pedicle screw fixation combined with vertebroplasty. The patient general information such as age, gender, bedrest time and location of fracture vertebrae were recorded. The clinical symptoms and imaging data of visual analogue scale (VAS), bone cement leakage, Oswestry Disability Index (ODI), Cobb angle, anterior, middle and posterior height of the diseased vertebral body, and complications were recorded before operation and during follow-up. RESULTS For patients enrolled, no bone cement leakage was observed during the operation; no patients developed infections after operation. The operation was safe and resulted in a short bedrest time. The VAS score and ODI index at 3 and 24 months postoperative (2.86 ± 0.83, 31.68% ± 6.21%; 3.0 ± 0.82, 32.78% ± 6.05%) were significantly lower than that recoded preoperatively (7.59 ± 0.59, 71.5% ± 8.84%) (P < 0.05). Additionally, there was no significant difference between the records at 3 and 24 months after operation (P > 0.05). Imaging data showed that the bone cement and screws were in good position and did not move during postoperative and follow-up. The anterior, middle and posterior height of the diseased vertebral body measured 2 days after surgery (23.46 ± 4.72, 23.12 ± 3.05, 25.81 ± 2.22) and at last follow-up (20.83 ± 4.48, 21.78 ± 2.74, 24.74 ± 1.93) were higher than that recorded preoperatively (13.08 ± 4.49, 12.93 ± 3.53, 19.32 ± 2.73) (P < 0.05), and the Cobb angle measured 2 days and 24 months after operation (9.57 ± 4.63, 10.68 ± 3.97) were lower than that recorded preoperatively (28.24 ± 8.95) (P < 0.05), and no significant difference was found between the values recorded at 2 days and 24 months after operation (P > 0.05). Follow-up for 24 months, there was no re-fracture of the diseased vertebrae and internal fixation loosening, but two cases of adjacent vertebral refracture complications occurred, and the effect was good after PVP treatment. CONCLUSION Short-segment percutaneous pedicle screw fixation combined with vertebroplasty in the treatment of stage III Kümmel disease can effectively restore the height of the diseased vertebrae, kyphosis correction, reduce trauma, prevent the diseased vertebral body from collapsing again, and effectively improves clinical symptoms.
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Affiliation(s)
- Dong-Hao Gan
- First College of Clinical Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Meng-Ze Fang
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Hai-Peng Xue
- First College of Clinical Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China.,Department of Orthopedics, Affilited Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Guo-Qing Tan
- Department of Orthopedics, Affilited Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Nian-Hu Li
- Department of Orthopedics, Affilited Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Zhi-Chao Li
- First College of Clinical Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Zhan-Wang Xu
- First College of Clinical Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China.,Department of Orthopedics, Affilited Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
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36
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Levin S, Krumins R, Shaath MK, Avilucea FR. Clinical outcomes in prone positioning for percutaneous fixation of posterior column acetabular fractures. Eur J Trauma Emerg Surg 2021; 48:3721-3727. [PMID: 33740064 DOI: 10.1007/s00068-021-01636-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 03/03/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Percutaneous retrograde fixation of posterior column acetabular fractures is becoming a commonly practiced technique. Prone positioning provides reliably reproducible intraoperative fluoroscopic images necessary for precise preparation of the osseous fixation corridor necessary for accurate and safe implant placement. Additionally, the prone position facilitates an open posterior approach if an open reduction is necessary. The purpose of this study was to analyze the radiographic and clinical outcomes of retrograde posterior column fixation utilizing the prone position. METHODS From 2017 to 2020, 41 patients were included in the retrospective study. Clinical outcomes were collected for a minimum of 6 months. Implant placement was assessed on post-operative pelvic computed tomography (CT) scans and fracture union was assessed on routine follow-up radiographs. RESULTS All (100%) cases achieved union by 4 months, with an average time to union of 3.2 months. Every post-operative CT scan demonstrated screw placement contained throughout the posterior column with no intrusion into the hip joint or sciatic notch. Clinically, one patient reported pain with sitting. No patients required additional surgical intervention. CONCLUSION Prone positioning is a versatile and effective approach for retrograde percutaneous fixation of posterior column acetabular fractures. This study is the first to report clinical outcomes utilizing this technique and contributes to a growing body of the literature supporting the value and safety of percutaneous fixation of acetabular fractures appropriate for this fixation strategy.
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Affiliation(s)
- Samantha Levin
- Department of Orthopaedics, Orlando Health, Orlando Health Orthopaedic Institute, 1222 South Orange Avenue, MP 43, Orlando, FL, 32806, USA.
| | - Ryan Krumins
- Florida State University College of Medicine, 1115 West Call Street, Tallahassee, FL, 32306, USA
| | - M Kareem Shaath
- Level One Orthopedics, Orlando Health, Orlando Health Orthopaedic Institute, 1222 South Orange Avenue, MP 43, Orlando, FL, 32806, USA
| | - Frank R Avilucea
- Level One Orthopedics, Orlando Health, Orlando Health Orthopaedic Institute, 1222 South Orange Avenue, MP 43, Orlando, FL, 32806, USA
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Stirling PHC, Broll RD, Molyneux SG, Oliver CW, McQueen MM, Duckworth AD. Percutaneous fixation of acute scaphoid waist fractures: Long-term patient-reported functional outcomes and satisfaction at a mean of 11 years following surgery. Hand Surg Rehabil 2021; 40:293-298. [PMID: 33652139 DOI: 10.1016/j.hansur.2021.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 02/14/2021] [Accepted: 02/23/2021] [Indexed: 10/22/2022]
Abstract
The aim of this study was to report the long-term functional outcomes and complication rates following early percutaneous fixation of acute fractures of the scaphoid. A trauma database was searched to identify all skeletally-mature patients with an undisplaced or minimally-displaced scaphoid waist fracture managed with early percutaneous retrograde screw fixation over a thirteen-year period from 1997-2010. Medical records were retrospectively reviewed, and complications documented. Long-term follow-up was by a questionnaire-based review. The Patient-Rated Wrist Evaluation (PRWE) was the primary outcome measure. Secondary outcomes included the Quick version of the Disability of the Arm, Shoulder and Hand score (QuickDASH), the EuroQol 5-dimensions score (EQ-5D-5L), and complications. During the study period 114 patients underwent this procedure. The mean age was 28 years (range 17-62) and 97 patients (85%) were male. The median time from injury to surgery was nine days (range 1-27). Twelve patients (11%) reported a complication, all of whom required repeat surgical intervention (six revision ORIF for non-union, five elective removal of hardware, one early revision fixation due to screw impingement). Long-term outcome data was available for 77 patients (68%) at mean follow-up of 11.4 years (range 6.4-19.8). The median PRWE was 0 (IQR 0-7.5), median QuickDASH 0 (IQR 0-4.5) and median EQ-5D-5L 1.0 (IQR 0.837-1.0). There were 97% (n = 74) patients satisfied with their outcome. Early percutaneous fixation of acute non-displaced or minimally displaced scaphoid fractures results in good long-term patient reported outcomes and health-related quality of life. Although comparable with previous studies, the overall surgical reintervention rate is notable and can result in inferior outcomes. LEVEL OF EVIDENCE: Therapeutic level III (Retrospective Cohort Study).
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Affiliation(s)
- P H C Stirling
- Edinburgh Orthopaedics - Trauma, Royal Infirmary of Edinburgh, 51 Little France Cres, Edinburgh EH16 4SA, United Kingdom
| | - R D Broll
- Edinburgh Orthopaedics - Trauma, Royal Infirmary of Edinburgh, 51 Little France Cres, Edinburgh EH16 4SA, United Kingdom
| | - S G Molyneux
- Edinburgh Orthopaedics - Trauma, Royal Infirmary of Edinburgh, 51 Little France Cres, Edinburgh EH16 4SA, United Kingdom
| | - C W Oliver
- Edinburgh Orthopaedics - Trauma, Royal Infirmary of Edinburgh, 51 Little France Cres, Edinburgh EH16 4SA, United Kingdom
| | - M M McQueen
- Edinburgh Orthopaedics - Trauma, Royal Infirmary of Edinburgh, 51 Little France Cres, Edinburgh EH16 4SA, United Kingdom
| | - A D Duckworth
- Edinburgh Orthopaedics - Trauma, Royal Infirmary of Edinburgh, 51 Little France Cres, Edinburgh EH16 4SA, United Kingdom; Usher Institute, University of Edinburgh, NINE Edinburgh BioQuarter, Edinburgh.
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van Hasselt AJ, Hooghof JT, Huizinga MR, van Raay JJAM. Intrathoracic migration of a K-wire after percutaneous fixation of a proximal humerus fracture. Trauma Case Rep 2021; 32:100425. [PMID: 33665318 PMCID: PMC7907529 DOI: 10.1016/j.tcr.2021.100425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2021] [Indexed: 12/02/2022] Open
Abstract
Proximal humerus fractures are common in elderly patients. Not all patient are fit for major surgery. Percutaneous fixation can be a suitable option though surgeons should be aware of the risks and complications. This case is about a 90-year-old woman with a proximal humerus fracture. After closed anatomical reduction we performed percutaneous K-wire fixation of the humerus fracture with a single K-wire. Five days postoperatively the patient experienced increased pain and dyspnea due to a pneumothorax caused by intrathoracic migration of the K-wire. Percutaneous fixation can be a suitable treatment for low-maintenance and fragile patients but surgeons should act with caution. Multiple threaded K-wires with a bend-free end should be used to reduce the risk for loss of repositioning or migration of the K-wire.
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Affiliation(s)
- A J van Hasselt
- Department of Orthopaedic Surgery, Martini Hospital, Groningen, the Netherlands
| | - J Th Hooghof
- Department of Orthopaedic Surgery, Martini Hospital, Groningen, the Netherlands
| | - M R Huizinga
- Department of Orthopaedic Surgery, Martini Hospital, Groningen, the Netherlands
| | - J J A M van Raay
- Department of Orthopaedic Surgery, Martini Hospital, Groningen, the Netherlands
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Debuka E, Kumar G, Dalal N, Kalra S. Fracture characteristics and outcomes of acetabular fracture management with minimally invasive approach and percutaneous fixation. Eur J Orthop Surg Traumatol 2021; 31:1363-1368. [PMID: 33512590 DOI: 10.1007/s00590-021-02886-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 01/18/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim was to assess acetabular fracture outcomes of percutaneous fixation (PF) with or without minimally invasive surgery (MIS). METHODS Between July 2011 and October 2016, acetabular fractures fixed with PF with or without MIS were included. Data collected are demographics, mechanism of injury, associated injuries, time to surgery, American Society of Anesthesiologists grade, fracture characteristics, surgical techniques, fracture reduction, secondary osteoarthritis (OA), revision surgery, patient survival and complications. RESULTS Of 26 patients with a mean age of 56 years (19-86) (22 males and 4 females), 11 were < 50 years age (U50) and 15 were > 50 years (A50). Most common pattern was anterior column with posterior hemi-transverse. Three out of 11 U50 were minimally displaced and had PF only; the rest had MIS and PF. All had good fracture reduction, but 2 had secondary OA at follow-up but no further surgery. Eight out of 26 had secondary OA but only 3 needed surgery. Three (A50 with PF) with fair/poor reduction (deemed unfit for open reduction) had secondary OA but no further intervention. Three more (A50 with MIS + PF) had secondary OA treated with primary total hip replacement (THR). Complications were as follows: one foot drop recovered after immediate repositioning of screw, one cardiac event and one pulmonary embolism. CONCLUSION Fracture mal-reduction predicts secondary OA, but good fracture reduction does not prevent secondary OA. MIS and PF in elderly are useful even with suboptimal reduction as it sets the bed for a non-complex THR. Despite MIS surgery, medical complications are potentially significant.
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Affiliation(s)
- Ekansh Debuka
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.
| | | | - Neel Dalal
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Sanjay Kalra
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
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Gao X, Fan HY, Huang R, Sui YQ, Li F, Yin HL. Management of Open Calcaneal Fractures with Medial Wounds by One-Stage Sequential Reduction and Frame Structure Fixation Using Percutaneous Kirschner Wires. Orthop Surg 2021; 13:225-236. [PMID: 33403804 PMCID: PMC7862139 DOI: 10.1111/os.12902] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 11/16/2020] [Accepted: 11/22/2020] [Indexed: 12/02/2022] Open
Abstract
Objective To assess the clinical outcomes of open calcaneal fractures with medial wounds treated with one‐stage management, including early modern wound care, sequential reduction, and frame structure fixation using percutaneous Kirschner wires. Methods A total of 19 patients with open calcaneal fractures admitted to our hospital from May 2016 to March 2019 were selected in this study. Twelve type‐II and seven type‐IIIA medial open injuries were identified according to the classification of Gustilo and Anderson. Fractures were stratified by Sanders classification, including nine type‐II fractures, seven type‐III fractures, and three type‐IV fractures. All patients accepted one‐stage irrigation and debridement, sequential reduction of calcaneal fractures through the open medial wound, percutaneous Kirschner wire fixation, and primary closure of wounds covered with vacuum‐assisted closure (VAC) device. The Bohler angle, the Gissane angle, and the width of the calcaneus were compared before and after surgery. The functional results were evaluated according to the Paley and Hall score system, visual analogue scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot score, Maryland Foot Score, and related complications. Results The follow‐up duration for all patients ranged from 14 to 28 months (mean, 22.7 months). The angle of Bohler and Giasane was increased from (−7.6° ± 15.0°) and (96.6° ± 7.6°) before surgery to (23.7° ± 6.1°) and (124.1° ± 7.1°) postoperatively (P < 0.05), respectively. Three cases of superficial infection and two cases of wound dehiscence were observed in our study, which were then successfully treated with wound debridement, VAC replacement, appropriate use of antibiotics, and delayed closure. The last follow‐up revealed three cases of lateral wall expansion and six cases of mild‐to‐moderate subtalar arthritis based on the Paley and Hall scoring system. According to the AOFAS ankle and hindfoot score, one case showed excellent results, 14 cases exhibited good results, and four cases displayed fair results, with the mean of 80.7 ± 6.7 points (range, 70–90). The Maryland Foot Score revealed one case of excellent outcomes, nine cases of good outcomes, and nine cases of fair outcomes with an average of 76.8 ± 8.6 points (range, 62–90). The mean VAS for pain was 1.8 ± 1.5 (range, 0–5), and a total of 14 patients complained of mild‐to‐moderate pain when walking for a more extended period. Severe complications, such as deep infection, osteomyelitis, and soft tissue necrosis, were not observed during follow‐up. Conclusions Collectively, one‐stage management allowed the direct restoration of calcaneal morphology with a minimal invasion of soft tissues in most open calcaneal fractures with medial wounds, and the functional outcomes were comparable to previous data.
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Affiliation(s)
- Xu Gao
- Department of Orthopaedic Surgery, Qingdao University, Qingdao, China
| | - Hai-Yu Fan
- Department of Burn and Plastic Surgery, No. 971 Hospital of the People's Liberation Army (PLA), Qingdao, China
| | - Rui Huang
- Department of Second Orthopaedic Surgery, No. 971 Hospital of the People's Liberation Army (PLA), Qingdao, China
| | - Yong-Qiang Sui
- Department of State Key Laboratory for Marine Corrosion and Protection, Luoyang Ship Material Research Institute, Qingdao, China
| | - Fei Li
- Department of Second Orthopaedic Surgery, No. 971 Hospital of the People's Liberation Army (PLA), Qingdao, China
| | - Hai-Lei Yin
- Department of Second Orthopaedic Surgery, No. 971 Hospital of the People's Liberation Army (PLA), Qingdao, China
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Collinet A, Charles YP, Ntilikina Y, Tuzin N, Steib JP. Analysis of intervertebral discs adjacent to thoracolumbar A3 fractures treated by percutaneous instrumentation and kyphoplasty. Orthop Traumatol Surg Res 2020; 106:1221-1226. [PMID: 32888918 DOI: 10.1016/j.otsr.2020.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 04/29/2020] [Accepted: 05/20/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Percutaneous instrumentation and kyphoplasty can be used to treat A3 fractures at T12-L1. However, the effect on adjacent intervertebral discs remains controversial. The purpose of this retrospective study was to analyze the degeneration of the discs adjacent to the fracture and to determine its relationship with age, vertebral body deformity and clinical scores. MATERIALS AND METHODS Twenty-nine patients (11 females, 18 males; average age 47 years, 27-63 years) were examined at 2.2 years' follow-up (2.0-2.5). Radiographic measurements were taken preoperatively, postoperatively, at follow-up: regional and local kyphosis, sagittal index, vertebral body compression ratio, and disc height index. The Pfirrmann grade was determined on an MRI taken at the final assessment. Clinical scores were the pain level (VAS), EQ-5D-3L, and ODI. The relationships between Pfirrmann grades, age and radiographic parameters were analyzed. RESULTS Local kyphosis decreased from 12.4° to 7.3° postoperatively (p<0.0001), increased to 8.4° after instrumentation removal (p=0.139) and remained stable at the last follow-up (p=0.891). The sagittal index decreased from 12.3° to 7.3° postoperatively (p<0.0001) increased to 8.3° before the instrumentation was removed (p=0.764) and increased to 10.6° (p<0.05) at the last follow-up. The vertebral body compression ratio decreased from 23% to 14% postoperatively (p<0.0001) and remained stable at 17% at the last follow-up (p=0.310). The cranial disc height index was 32% preoperatively, 31% postoperatively (p=0.073), 29% at 1year (p=0.650), and decreased again to 23% at 2 years (p<0.0001). There was a significant relationship between disc degeneration and age (p=0.015), local kyphosis (p=0.008) and vertebral body compression ratio (p=0.002). The disc adjacent to the fracture was more likely to have a higher Pfirrmann grade than the control disc above it (OR=269.5). At the final assessment, the average pain level was 2.3, the EQ-5D-3L was 0.862, and the ODI was 11.8%. There was no significant relationship between the Pfirrmann grades and the clinical scores. CONCLUSION The risk for cranial disc degeneration after percutaneous instrumentation and kyphoplasty of A3 fractures is low. The height of the cranial disc decreased after the instrumentation was removed. The risk for disc degeneration is related to age and vertebral body deformity. Disc degeneration does not appear to impact quality of life.
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Affiliation(s)
- Arnaud Collinet
- Spine surgery department, hôpitaux universitaires de Strasbourg, hôpital Hautepierre 2, 1, avenue Molière, 67200 Strasbourg, France.
| | - Yann Philippe Charles
- Spine surgery department, hôpitaux universitaires de Strasbourg, hôpital Hautepierre 2, 1, avenue Molière, 67200 Strasbourg, France
| | - Yves Ntilikina
- Spine surgery department, hôpitaux universitaires de Strasbourg, hôpital Hautepierre 2, 1, avenue Molière, 67200 Strasbourg, France
| | - Nicolas Tuzin
- Public health department, hôpitaux universitaires de Strasbourg Strasbourg, France
| | - Jean-Paul Steib
- Spine surgery department, hôpitaux universitaires de Strasbourg, hôpital Hautepierre 2, 1, avenue Molière, 67200 Strasbourg, France
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Abstract
Scaphoid fractures are common injuries in athletes. Most can be treated with cast immobilization, with an expected rate of union of 90% to 95%. Cast treatment, however, has the disadvantages of longer immobilization time, joint stiffness, reduced grip strength, and longer time to return to manual work or athletics. Closed reduction and percutaneous screw fixation generally are preferred in athletes to allow a quicker return to sport; if closed reduction cannot be obtained, open reduction and internal fixation may be required.
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Affiliation(s)
- William J Weller
- Department of Orthopaedic Surgery & Biomechanical Engineering, University of Tennessee-Campbell Clinic, Memphis, TN, USA
| | - Norfleet B Thompson
- Department of Orthopaedic Surgery & Biomechanical Engineering, University of Tennessee-Campbell Clinic, Memphis, TN, USA.
| | - Sierra G Phillips
- Department of Orthopaedic Surgery & Biomechanical Engineering, University of Tennessee-Campbell Clinic, Memphis, TN, USA
| | - James H Calandruccio
- Department of Orthopaedic Surgery & Biomechanical Engineering, University of Tennessee-Campbell Clinic, Memphis, TN, USA
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Bitar RC, Nishikawa DRC, de Cesar Netto C, Godoy-Santos AL, Pires RES. A short single-incision approach for antiglide plate fixation of oblique fractures of the lateral malleolus: a technical tip. Eur J Orthop Surg Traumatol 2020; 31:407-412. [PMID: 32804290 DOI: 10.1007/s00590-020-02771-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 08/12/2020] [Indexed: 11/28/2022]
Abstract
Displaced fractures (> 2 mm) of the lateral malleolus, without medial or syndesmotic injuries, are often the subject of controversy regarding the best treatment option. In the past, these fractures were usually treated conservatively using a cast for 6 to 8 weeks without weightbearing. Currently, most of the patients desire a quick return to their previous activities, what makes surgical treatment a reasonable choice. It has benefits as earlier ankle mobilization and weightbearing. It also restores ankle biomechanics, preventing secondary osteoarthritis. However, postoperative complications with the standard lateral incision exist such as implant discomfort, dehiscence and infection. Minimally invasive techniques have been described to help avoiding these complications. This technical note described a short single-incision approach for the surgical treatment of displaced oblique fibular fractures type AO/OTA 44-B1 with an antiglide plate that presents the advantage of less risk of damaging the soft tissues, periosteal stripping and disturbance of the fracture hematoma.
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Affiliation(s)
- Rogério Carneiro Bitar
- Department of Orthopaedics, Foot and Ankle Surgery, University of São Paulo (HC FMRP-USP), Ribeirão Preto, SP, Brazil
| | - Danilo Ryuko Cândido Nishikawa
- Department of Orthopaedics, Foot and Ankle Surgery, Hospital of the Municipal Public Servant of São Paulo (HSPM), São Paulo, SP, Brazil.
| | - Cesar de Cesar Netto
- Department of Orthopaedics, Foot and Ankle Surgery, University of Iowa, Iowa City, IA, USA
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Safaee MM, Shah V, Tenorio A, Uribe JS, Clark AJ. Minimally Invasive Pedicle Screw Fixation With Indirect Decompression by Ligamentotaxis in Pathological Fractures. Oper Neurosurg (Hagerstown) 2020; 19:210-217. [PMID: 32255471 DOI: 10.1093/ons/opaa045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 01/13/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The spine is the most common site of bony metastases. Associated pathological fractures can result in pain, neurological deficit, biomechanical instability, and deformity. OBJECTIVE To present a minimally invasive technique for indirect decompression by ligamentotaxis in pathological fractures. METHODS A minimally invasive approach was utilized to perform percutaneous pedicle screw fixation in patients who required stabilization for pathological fractures. Preoperative and postoperative computed tomography and magnetic resonance imaging were used to compare spinal canal area and midsagittal canal diameter. RESULTS Two patients with newly diagnosed pathological fractures underwent minimally invasive treatment. Each presented with minimal epidural disease and a chief complaint of intractable back pain without neurological deficit. They underwent minimally invasive pedicle screw fixation with indirect decompression by ligamentotaxis. In each case, postoperative imaging demonstrated an increase in spinal canal area and midsagittal canal diameter by an independent neuroradiologist. There were no perioperative complications, and each patient was neurologically stable without evidence of hardware failure at their 5- and 6-mo follow-up visits. CONCLUSION Minimally invasive percutaneous fixation can be used to stabilize pathological fractures and provide indirect decompression by ligamentotaxis. This procedure is associated with minimal blood loss, low morbidity, and rapid initiation of radiation therapy. Only patients with minimal epidural disease, stenosis caused primarily by bony retropulsion, and mild-to-moderate deformity should be considered candidates for this approach.
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Affiliation(s)
- Michael M Safaee
- Department of Neurological Surgery, University of California-San Francisco, San Francisco, California
| | - Vinil Shah
- Division of Neuroradiology, Department of Radiology, University of California-San Francisco, San Francisco, California
| | - Alexander Tenorio
- Department of Neurological Surgery, University of California-San Francisco, San Francisco, California
| | | | - Aaron J Clark
- Department of Neurological Surgery, University of California-San Francisco, San Francisco, California
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Jianchuan W, Song Q, Tienan W, Zongpu W, Chongjun X, Dewei Z. Calcaneus traction compression with orthopaedic reduction forceps combined with percutaneous minimally invasive treatment of intra-articular calcaneal fractures: An analysis of efficacy. Biomed Pharmacother 2020; 128:110295. [PMID: 32554224 DOI: 10.1016/j.biopha.2020.110295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/14/2020] [Accepted: 05/20/2020] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND The treatment of displaced calcaneal fractures is controversial.Open reduction and internal fixation are widely described as the gold standard in the literature,but these technique shave many complications,including skin necrosis,internal fixation leakage and deep infection and wound healing problems.Percutaneous reduction and unilateral external fixation have received increasing attention because they can provide a good, stable reduction and reduce the soft tissue complications caused by open surgery(such as deep infection and delayed wound healing).The purpose of this retrospective study was to evaluate the reduction imaging and clinical results of calcaneus traction compressionwith orthopaedic compression reduction forceps combined with percutaneous minimally invasive external fixation for intra-articular calcaneal fractures. METHODS This was a retrospective analysis. A total of 35 patients with unilateral calcaneal fractures were divided into two groups: 1) the open reduction, internal fixation group (19 feet)and 2) the percutaneous minimally invasive, closed reduction external fixation group (16 feet).Evaluation of the reduction include dimaging measurements of the calcaneus length,width,and height,and the Bohler angle and Gissane angle before and after surgery.Clinical outcomes included the time of surgery,length of hospital stay,operation time,wound-related complications,the American Orthopaedic Foot and Ankle Society hindfoot score,the visual analogue score for pain, and the SF-36 score. RESULTS The average follow-up time was 25.52 ± 1.68 months.There was no significant difference in reduction between the open group and the closed group (P > 0.05).The operation time of the open group was significantly longer than that of the closed group(P = 0.0001).The length of hospitalization and waiting time for surgery in the open reduction group were significantly longer than those in the closed reduction group (P < 0.05).Incidence-related complications in the open group and closed group were 21.1 %(4/19) and 6.3 %(1/16),respectively (P = 0.0001).The American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot scores in the open and closed groups were 81.35 ± 5.25 and 82.52 ± 4.78, respectively (P = 0.0875). The visual analogues cale (VAS) scores of the open group and the closed group were 1.81 ± 1.32 and 0.78 ± 0.91, respectively (P = 0.0412).The SF-36 scores were 80 ± 4.5 and 79 ± 4.2, respectively. CONCLUSION Our research shows that for various types of intra-articular calcaneal fractures compared with open reduction,internal plate fixation,calcaneus traction compression with orthopaedic reduction forceps combined with percutaneous minimally invasive external fixation is a simple and effective method for treating calcaneal fractures; not only can the calcaneus be corrected, but it can also provide notable imaging and clinical results.
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Affiliation(s)
- Wang Jianchuan
- Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian 116001, China
| | - Qin Song
- Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian 116001, China.
| | - Wang Tienan
- Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian 116001, China
| | - Wang Zongpu
- Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian 116001, China
| | - Xia Chongjun
- Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian 116001, China
| | - Zhao Dewei
- Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian 116001, China
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Erichsen CJ, Heyde CE, Josten C, Gonschorek O, Panzer S, von Rüden C, Spiegl UJ. Percutaneous versus open posterior stabilization in AOSpine type A3 thoracolumbar fractures. BMC Musculoskelet Disord 2020; 21:74. [PMID: 32024494 PMCID: PMC7003397 DOI: 10.1186/s12891-020-3099-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 01/29/2020] [Indexed: 11/23/2022] Open
Abstract
Background The purpose of this retrospective cohort study was to compare treatment strategies of two level-one trauma centers regarding clinical and radiological outcomes focusing on non-osteoporotic AOSpine type A3 fractures of the thoracolumbar spine at levels T11 to L2. Methods Eighty-seven patients between 18 and 65 years of age that were treated operatively in either of two trauma centers were included. One treatment strategy includes open posterior stabilization whereas the other uses percutaneous posterior stabilization. Both included additional anterior fusion if necessary. Demographic data, McCormack classification, duration of surgery, hospital stay and further parameters were assessed. Owestry Disability Index (ODI), Visual Analog Scale (VAS) and SF-36 were measured for functional outcome. Bisegmental kyphosis angle, reduction loss and sagittal alignment parameters were assessed for radiological outcome. Follow up was at least 24 months. Results There was no significant difference regarding our primary functional outcome parameter (ODI) between both groups. Regarding radiological outcome kyphosis angle at time of follow up did not show a significant difference. Reduction loss at time of follow up was moderate in both groups with a significantly lower rate in the percutaneously stabilized group. Surgery time was significantly shorter for posterior stabilization and anterior fusion in the percutaneous group. Time of hospital stay was equal for posterior stabilization but shorter for anterior fusion in the open stabilized group. Conclusion Both treatment strategies are safe and effective showing only minor loss of reduction. Clinical relevant differences in functional and radiographic outcome between the two surgical groups could not be demonstrated. Trial registration It was conducted according to ICMJE guidelines and has been retrospectively registered with the German Clinical Trials Registry (identification number: DRKS00015693, 07.11.2018).
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Affiliation(s)
- Christoph J Erichsen
- Department of Trauma Surgery, BG Trauma Center Murnau, Professor-Küntscher Str. 8, 82418 Murnau, Murnau am Staffelsee, Germany.
| | - Christoph-Eckhard Heyde
- Department of Orthopaedics, Trauma Surgery and Reconstructive Surgery, University of Leipzig, Leipzig, Germany
| | - Christoph Josten
- Department of Orthopaedics, Trauma Surgery and Reconstructive Surgery, University of Leipzig, Leipzig, Germany
| | - Oliver Gonschorek
- Department of Trauma Surgery, BG Trauma Center Murnau, Professor-Küntscher Str. 8, 82418 Murnau, Murnau am Staffelsee, Germany
| | - Stephanie Panzer
- Department of Radiology, BG Trauma Center Murnau, Murnau am Staffelsee, Germany.,Institute for Biomechanics, Paracelsus Medical University, Salzburg, Austria
| | - Christian von Rüden
- Department of Trauma Surgery, BG Trauma Center Murnau, Professor-Küntscher Str. 8, 82418 Murnau, Murnau am Staffelsee, Germany.,Institute for Biomechanics, Paracelsus Medical University, Salzburg, Austria
| | - Ulrich J Spiegl
- Department of Orthopaedics, Trauma Surgery and Reconstructive Surgery, University of Leipzig, Leipzig, Germany
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Park SW, Ko MJ, Kim YB, Le Huec JC. Correction of marked sagittal deformity with circumferential minimally invasive surgery using oblique lateral interbody fusion in adult spinal deformity. J Orthop Surg Res 2020; 15:13. [PMID: 31941529 PMCID: PMC6964077 DOI: 10.1186/s13018-020-1545-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 01/05/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Spinal surgery performed entirely with minimally invasive surgery is referred to as circumferential MIS (cMIS). However, cMIS still has a limited sagittal correction capability for adult spinal deformity (ASD) with a marked sagittal deformity. We investigated the effectiveness of cMIS using oblique lateral interbody fusion (OLIF) and percutaneous posterior spine fixation in correcting marked sagittal deformity. METHODS This study retrospectively evaluated 23 patients with ASD with marked sagittal deformity who underwent cMIS using OLIF without osteotomy and were followed-up for at least 24 months (whole group). The whole group was divided into the following two groups according to the type of interbody fusion at L5-S1: the OLIF51 group (n = 13) underwent OLIF at L1-L5 and L5-S1 and the TLIF51 group (n = 10) underwent OLIF at L1-L5 and transforaminal lumbar interbody fusion (TLIF) at L5-S1. RESULTS Sagittal vertebral axis (SVA; 125.7 vs. 29.5 mm, p < 0.001), lumbar lordosis (LL; 18.2° vs. 51.7°, p < 0.001), and pelvic incidence-LL mismatch (PI-LL, 35.5° vs. 5.3°) significantly improved postoperatively in the whole group. The OLIF51 group showed significantly higher postoperative LL than the TLIF51 group (55.5° vs. 46.9°, p < 0.001). OLIF yielded a significantly greater disc angle at L5-S1 than did TLIF (18.4° vs. 6.9°, p < 0.001). Proximal junctional kyphosis occurred significantly earlier in the OLIF51 group than in the TLIF51 group (8.6 vs. 26.3 months, p < 0.001). CONCLUSION Successful sagittal correction in ASD patients with marked sagittal deformity was achieved with cMIS using OLIF. OLIF at L5-S1 showed a synergistic effect in sagittal deformity correction by cMIS.
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Affiliation(s)
- Seung Won Park
- Department of Neurosurgery, College of Medicine, Chung-Ang University, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, Republic of Korea.
| | - Myeong Jin Ko
- Department of Neurosurgery, College of Medicine, Chung-Ang University, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, Republic of Korea
| | - Young Baeg Kim
- Department of Neurosurgery, College of Medicine, Chung-Ang University, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, Republic of Korea
| | - Jean Charles Le Huec
- Head Department of Orthopedic surgery, Polyclinique Bordeaux Nord Aquitaine, 15-35 Rue Claude Boucher, 33300, Bordeaux, France
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Li ZX, Wong KPL, Wong JLY, Lim KBL, Mahadev A. The utility of mini C-arm in the fixation of unstable paediatric supracondylar humeral fractures. Injury 2019; 50:1992-1996. [PMID: 31526599 DOI: 10.1016/j.injury.2019.09.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 08/28/2019] [Accepted: 09/08/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Pediatric supracondylar humerus fractures have traditionally been reduced and fixed with conventional C-arm (CCA) fluoroscopy guidance. With the increase in popularity of the newer mini C-arm (MCA) system within other fields of surgery due to its ease of use and lower radiation emission, the same adoption should be explored in pediatric orthopedic surgeries. The purpose of this study is to compare the MCA and CCA primarily in reduction and fixation outcomes and secondarily in other perioperative parameters. METHODS Retrospective analysis of 193 patients who underwent surgical fixation for displaced supracondylar humerus fractures. 44 and 149 cases were performed with the MCA and CCA respectively. Baumann's angle and the intersection of anterior humeral line (AHL) were assessed on postoperative anterior posterior and lateral radiographs and adequate reduction was defined by an angle between 64 and 81˚, and AHL intersecting middle third of the capitellum. Surgical time, fluoroscopy duration, number of images and radiation exposure were obtained from the surgical notes. RESULTS Amongst the CCA cases, there were greater satisfactory coronal plane reduction (p < 0.05), while no difference in sagittal plane accuracy (p > 0.05) was seen. In MCA group, longer surgical (p < 0.05) and fluoroscopy times (p < 0.05), and greater number of shots (p < 0.05) was noted. However overall radiation exposure in the MCA group was still lower (p < 0.05). CONCLUSION The MCA system is potentially less accurate in coronal plane reduction and more challenging to use. However, pitfalls can easily be avoided. Usage should be advocated as overall radiation exposure can be reduced. LEVEL OF EVIDENCE Level III retrospective comparative study.
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Affiliation(s)
- Zong Xian Li
- Department of Orthopedic Surgery, KK Women's and Children's Hospital, Singapore.
| | | | | | | | - Arjandas Mahadev
- Department of Orthopedic Surgery, KK Women's and Children's Hospital, Singapore
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Stavrakakis IM, Magarakis GE, Christoforakis Z. Percutaneous fixation of Lisfranc joint injuries: A systematic review of the literature. Acta Orthop Traumatol Turc 2019; 53:457-462. [PMID: 31575479 PMCID: PMC6939019 DOI: 10.1016/j.aott.2019.08.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 05/27/2019] [Accepted: 08/22/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The aim of this systematic review was to present the outcome of Lisfranc joint injuries treated with closed reduction and screw percutaneous fixation. METHODS We searched in Pubmed and Google Scholar Databases for articles regarding screw percutaneous fixation of Lisfranc injuries. Seven studies in total were found to be compatible to our search, according to PRISMA guidelines. Four of those met the criteria of the review and they were included in the meta-analysis. A total number of 106 patients were separated into five groups according to the type of injury and the mean AOFAS score of each group was calculated. Cases in which percutaneous fixation was converted to open treatment due to poor reduction were not included in the study. In addition we compared the outcome score between types of injury according to Myerson classification as well as between purely ligamentous and osseoligamentous injuries. The characteristics of all seven selected studies, such as kind of screw used for fixation, post operative protocol, complications and outcome are mentioned as well. RESULTS Average AOFAS score was 86,2 for type A, 87,54 for type B, and 85 for type C injuries respectively. In pure dislocation group the average AOFAS score was 86,43 and in fracture dislocation group was 87,36. Good to excellent outcome can be expected in patients with different types of injury according to Myerson classification following percutaneous fixation of lisfranc joint injury. Patients with type B injury or a fracture dislocation injury might have better outcome, although this difference was not found to be statistically significant. CONCLUSION Percutaneous fixation of tarsometatarsal joint injuries is a relatively simple and safe method of treatment, leading to a good functional outcome, especially for Myerson type B as well as for fracture dislocation type of injuries, provided that an anatomical reduction has been achieved. LEVEL OF EVIDENCE Level III, Therapeutic Study.
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Affiliation(s)
| | - George E Magarakis
- Department of Orthopaedics, Venizeleio General Hospital of Heraklion, Greece
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Caruso G, Gildone A, Lorusso V, Lombardi E, Andreotti M, Gerace E, Massari L. Percutaneous fixation and balloon kyphoplasty for the treatment of A3 thoracolumbar fractures. J Clin Orthop Trauma 2019; 10:S163-7. [PMID: 31695276 DOI: 10.1016/j.jcot.2018.12.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 04/14/2017] [Accepted: 12/29/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Despite a long history of descriptive and clinical series, there is still no consensus in the treatment of traumatic thoracolumbar fractures. It is now widely accepted that percutaneous surgery in thoracolumbar spine trauma management can achieve the same results as conventional treatment but less morbidity but it is still not clear which are the best indications for these minimal invasive procedures. METHODS Thirty-two adult patients with single type A3 thoracolumbar burst fractures without neurologic deficits were included in this retrospective review of clinical and radiological outcomes after surgical management. All patients underwent combined percutaneous kyphoplasty and short fixation with screws in the vertebral pedicles above and below the fracture. Radiographic evaluation of segmental kyphosis and local kyphotic corrections were made preoperatively, 3 days postoperatively, 12 months post-operatively and at the last follow-up (the mean last follow-up was 41 months post-operatively). Clinical outcomes were determined by SF-36® Health Survey and Oswestry Disability Index scores at 3-month and 12-month follow-ups. RESULTS Clinical assessments suggested good outcomes as early as the third postoperative month. The clinical outcomes were sustained at one year follow-up. At the last follow-up the segmental kyphosis correction and local kyphotic correction were maintained. CONCLUSIONS Our analysis demonstrates that minimally invasive kyphoplasty and percutaneous short fixation applied to thoracolumbar A3 burst fractures without neurological deficit may achieve results comparable to nonsurgical or open surgical treatment, but with less morbidity and complication, and should be considered as a valid treatment option.
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