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Der Unfallchirurg Nov 2018The new technology of motorized intramedullary telescopic nails has simplified the treatment for upper limb lengthening surgery. Improved patient comfort, low infection... (Review)
Review
The new technology of motorized intramedullary telescopic nails has simplified the treatment for upper limb lengthening surgery. Improved patient comfort, low infection rates and absence of fractures in the regenerated bone are contrasted by the limitations of the methods, such as a current maximum distraction of 5cm and the fact that they cannot be used when the growth plates are still open.
Topics: Arm; Bone Lengthening; Bone Nails; Growth Plate; Humans; Treatment Outcome
PubMed: 30178108
DOI: 10.1007/s00113-018-0542-3 -
ANZ Journal of Surgery Apr 2021This study focuses on (i) the length of the intraosseous part of the supraacetabular pin using the insertion technique from the spina iliaca anterior inferior to the...
BACKGROUND
This study focuses on (i) the length of the intraosseous part of the supraacetabular pin using the insertion technique from the spina iliaca anterior inferior to the cortical part of the incisura ischiadica major, (ii) the angle of insertion of the supraacetabular pin in the transversal plane and (iii) gender-specific differences of the measured results.
METHODS
Images of uninjured pelves from 49 patients (64-line computed tomography scanner) were evaluated, and virtual external fixator pins were positioned using a three-dimensional reconstructions of computed tomography scans. The length of the pins and the insertion angle were investigated. Descriptive statistics were used, and gender-specific differences were calculated. A P-value of <0.05 was considered statistically significant.
RESULTS
The results showed significant differences between male and female pelves concerning both pin length and insertion angel. For male pelves, the mean screw length was 82.7 mm (SD 5.1; range 72.9-94.3). For females, this was statistically significantly shorter (P ≤ 0.001), with an average of 74.1 mm (SD 5.0; range 63.1-81.9). In the male subgroup, the insertion angle was a mean of 22.6° (SD 3.4; range 12.4-31.8), and the female pelves had an average angle of 19.7° (SD 4.0; range 11.7-24.5). These values differed statistically significantly (P = 0.0032).
CONCLUSION
Based on our measurements, we can confirm that both the length of the Schanz screws and the angle of insertion for the supraacetabular external fixator show a statistically significant difference between males and females.
Topics: Bone Nails; Bone Screws; External Fixators; Female; Fracture Fixation; Humans; Ilium; Male
PubMed: 33734540
DOI: 10.1111/ans.16694 -
The Orthopedic Clinics of North America Jan 2020In situ pinning of slipped capital femoral epiphysis (SCFE) is a safe and effective treatment modality, but often results in residual deformity leading to... (Review)
Review
In situ pinning of slipped capital femoral epiphysis (SCFE) is a safe and effective treatment modality, but often results in residual deformity leading to femoroacetabular impingement, which may limit patient activities and predispose to early onset arthritis. Enhanced understanding of the implications of femoroacetabular impingement and new surgical techniques have prompted interest in treating post-slipped capital femoral epiphysis deformity to both improve current symptoms and delay or prevent hip arthrosis.
Topics: Arthroscopy; Bone Nails; Coxa Magna; Femoracetabular Impingement; Femur; Hip; Hip Dislocation; Humans; Orthopedic Procedures; Osteoarthritis, Hip; Osteotomy; Postoperative Care; Retrospective Studies; Slipped Capital Femoral Epiphyses; Treatment Outcome
PubMed: 31739878
DOI: 10.1016/j.ocl.2019.08.008 -
Veterinary and Comparative Orthopaedics... Mar 2021The aim of this study was to report the clinical experience with fluoroscopically guided tibial apophyseal percutaneous pinning (TAPP) for tibial tuberosity avulsion...
OBJECTIVE
The aim of this study was to report the clinical experience with fluoroscopically guided tibial apophyseal percutaneous pinning (TAPP) for tibial tuberosity avulsion fractures (TTAF).
STUDY DESIGN
This is a retrospective case series.
MATERIALS AND METHODS
Medical records of skeletally immature dogs ( = 25) were reviewed. The association of pin design [smooth (SP); negatively threaded (NTP)], pin insertion angles, TTAF-type, age and breed with various outcome variables was statistically evaluated. Long-term follow-up was assessed via direct examination, radiographs, questionnaires and videos.
RESULTS
Mean age, weight and surgery times were 6.2 months, 9.6 kg and 21 minutes respectively. No major complications occurred among the 19 SP and 6 NTP; no pin broke. Seromas and patellar desmitis rates were higher with SP (11/19; 16/19) versus NTP (0/6; 2/6) ( = 0.02; 0.03). The median horizontal pin cross angles for cases without and with desmitis were 40 and 26 degrees respectively ( = 0.047). Explantation was needed in 5/19 SP and 0/6 NTP cases. The mean tibial plateau angle (TPA) changed significantly between initial (25.6 degrees) and follow-up (18.8 degrees) radiographs ( = 0.0002). Long-term outcome, obtained at a mean of 19.9 months, was excellent in all cases.
CONCLUSION
Tibial apophyseal percutaneous pinning can be considered to treat TTAF. Divergent pin placement and using NTP might reduce complications. Tibial plateau angle should be monitored until skeletal maturity has been reached. Long-term outcome post TAPP can be expected to be excellent.
Topics: Age Factors; Animals; Bone Nails; Dogs; Fluoroscopy; Fracture Fixation, Internal; Male; Radiography, Interventional; Retrospective Studies; Tibia; Tibial Fractures
PubMed: 33212512
DOI: 10.1055/s-0040-1719091 -
Veterinary and Comparative Orthopaedics... Sep 2021The aim of this study was to validate an imaging technique for evaluation of spinal surgery accuracy and to establish accuracy and safety of freehand technique in the...
OBJECTIVE
The aim of this study was to validate an imaging technique for evaluation of spinal surgery accuracy and to establish accuracy and safety of freehand technique in the thoracolumbar spine of large breed dogs.
STUDY DESIGN
After thoracolumbar spine computed tomography (CT), 26 drilling corridors were planned then drilled to receive 3.2 mm positive profile pins using a freehand technique. After pin removal, CT was repeated. All entry points, exit points and angles of the preoperative planned trajectories were compared with postoperative ones using an image registration and fusion technique by three observers. Corridor coordinates for entry and exit points were evaluated in three dimensions and angles were measured in one plane. Intraclass correlation coefficient (ICC) was used to establish the imaging technique reliability and descriptive statistics were used to report on the freehand technique accuracy. Safety was evaluated using a vertebral cortical breach grading scheme.
RESULTS
Intraclass correlation coefficient for the entry points, exit points and angle were 0.79, 0.96 and 0.92 respectively. Mean deviations for the entry points, exit points and angle were 3.1 mm, 6.3 mm and 7.6 degrees respectively. Maximum deviations were 6.3 mm, 11.0 mm and 16.4 degrees. Most deviations were lateral and caudal. All corridors were judged as safe.
CONCLUSION
The imaging technique reliability was good to excellent to study spinal surgery accuracy. Implant deviations should be anticipated when planning stabilization surgery in large breed dogs using the freehand-guided technique.
Topics: Animals; Bone Nails; Cadaver; Dog Diseases; Dogs; Reproducibility of Results; Spinal Fusion; Spine
PubMed: 34298579
DOI: 10.1055/s-0041-1731808 -
Journal of Feline Medicine and Surgery May 2019Traumatic stifle joint luxation is an uncommon but severe injury. There is usually rupture of several stabilising structures of the joint including the cruciate... (Review)
Review
PRACTICAL RELEVANCE
Traumatic stifle joint luxation is an uncommon but severe injury. There is usually rupture of several stabilising structures of the joint including the cruciate ligaments, collateral ligaments, joint capsule and menisci. Successful management of this condition requires good anatomical knowledge and repair or replacement of all damaged structures to achieve adequate joint reduction and stability. Better understanding of the treatment options available will aid clinical decision-making.
CLINICAL CHALLENGES
Due to the significant joint instability associated with these injuries, surgical repair is challenging. The use of a temporary transarticular pin to hold the stifle joint in anatomic reduction greatly aids ligament repair or replacement. Postoperative joint immobilisation has traditionally been recommended to protect the primary repair and aid periarticular fibrosis, but prolonged immobilisation can have deleterious long-term effects on the joint. Thus recommendations for the duration of postoperative immobilisation vary between 2 and 6 weeks. Also, due to their independent, outdoor lifestyle, affected cats may have been involved in a significant trauma with important concurrent injuries that need to be addressed prior to the orthopaedic repair.
EVIDENCE BASE
Published data is limited, with reports including only a small number of cats. The information and recommendations in this article have therefore been drawn from the available literature, the authors' experience and preliminary data from an ongoing multicentre retrospective study (unpublished).
AIMS
The aims of this article are to give the reader as thorough a summary as possible of the diagnosis, treatment, outcome and complications of traumatic stifle luxation.
Topics: Animals; Bone Nails; Cats; External Fixators; Injury Severity Score; Joint Dislocations; Stifle; Tibial Meniscus Injuries
PubMed: 31018821
DOI: 10.1177/1098612X19843211 -
Journal of Feline Medicine and Surgery Oct 2022External skeletal fixation is an established technique in cats for biological fixation of long bone fractures, stabilisation of the joints, and treatment of shearing...
OBJECTIVES
External skeletal fixation is an established technique in cats for biological fixation of long bone fractures, stabilisation of the joints, and treatment of shearing injuries and angular deformities. As appropriate and accurate pin insertion is imperative for a successful outcome, knowledge of topographic anatomy and areas that are safe (safe corridors) for pin placement is integral to successful surgery. At present, however, safe corridors have not been determined fully in feline orthopaedics, with surgeons having to rely on knowledge based on canine orthopaedics. This study was performed to determine safe corridors for pin placement in feline long bones.
METHODS
The limbs of six feline cadavers were frozen. Only limbs with no history of orthopaedic conditions were used. Transverse sections through the limbs were examined, and anatomical structures were determined in relation to the bone. These structures were compared with those of the contralateral limbs, which were dissected for topographic assessment. Safe corridors were defined as topographic areas where no vital structures, muscles or joints were present.
RESULTS
Examination of the humerus revealed safe corridors at its proximal craniolateral aspect and on the medial and lateral humeral condyles. Safe corridors of the antebrachium were identified on the lateral aspect of the olecranon, the distal two-thirds of the medial antebrachium and the distal third of the lateral antebrachium. Safe corridors in the femur consisted of a small area lateral to and just below the major trochanter, and on the medial and lateral femoral condyles. Evaluation of the tibia revealed safe corridors on the medial aspect of the entire tibia, the cranial aspect of the proximal tibia on the tibial crest and the area just proximal to the lateral malleolus.
CONCLUSIONS AND RELEVANCE
Safe corridors for pin placement during external skeletal fixation in feline limbs differed from those in canine limbs. Knowledge of canine anatomy may be inapplicable to pin placement in feline limbs undergoing external skeletal fixation.
Topics: Animals; Bone Nails; Cats; Dogs; External Fixators; Fracture Fixation; Humerus; Tibia
PubMed: 34870491
DOI: 10.1177/1098612X211057329 -
The Journal of Hand Surgery Nov 2014
Topics: Algorithms; Bone Nails; Female; Finger Phalanges; Fracture Fixation; Fractures, Bone; Humans; Male
PubMed: 25442751
DOI: 10.1016/j.jhsa.2014.07.055 -
Journal of Orthopaedic Trauma Jun 2017
Topics: Bone Nails; Fracture Fixation, Intramedullary; Humans
PubMed: 28486282
DOI: 10.1097/BOT.0000000000000847 -
Expert Review of Medical Devices Sep 2017Lower and upper limb length discrepancy and deformity, congenital or acquired, are amongst the most common conditions in children for orthopaedic referral. Over the last... (Review)
Review
Lower and upper limb length discrepancy and deformity, congenital or acquired, are amongst the most common conditions in children for orthopaedic referral. Over the last twenty years, surgical techniques have evolved in an attempt to decrease Healing Index and minimise these complications. Areas covered: The flexible intramedullary nailing (FIN) is a minimally invasive intramedullary osteosynthesis. In combination with an external fixator, it is appropriated for pediatric bone lengthenings and lengthening of bones of small diameter in adults. In the study the Scopus and/or PubMed indexed publications about this combined technique were analyzed. Expert commentary: The use of titanium or stainless steel or hydroxyapatite-coated bent elastic nails is appropriate in limb lengthening for congenital and acquired limb length discrepancy. Hydroxyapatite-coated FIN should be applied for long-term reinforcement of lengthened bone in patients with metabolic bone disorders, skeletal dysplasias with compromised bone formation. Osteoinductive surface of nails is favorable for bone formation and as well as for stable position of nails without risks of migration in long-term follow-up. The FIN is an unique intramedullary fixation which respects the bone biology which is mandatory for a good bone consolidation.
Topics: Adult; Bone Lengthening; Bone Nails; Child; External Fixators; Humans; Osteogenesis
PubMed: 28817981
DOI: 10.1080/17434440.2017.1367284