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The Journal of the American Academy of... Sep 2020Intramedullary limb lengthening (LL) is now achievable through motorized intramedullary devices. While this technology mitigates some complications of... (Review)
Review
Intramedullary limb lengthening (LL) is now achievable through motorized intramedullary devices. While this technology mitigates some complications of external-fixation-based lengthening, many complications common to all lengthening procedures persist. New challenges and complications exclusive to this newer technology are also presented. The LL surgeon should be aware of and ready to respond to complications involving device malfunctions, poor local bony and soft-tissue biology, patient compliance, neurovascular compromise, joint instability, regenerate problems, and others. While technology will continue to evolve, study of and adherence to foundational principles of LL will minimize risks and optimize patient outcomes.
Topics: Bone Lengthening; Bone Nails; Bone Regeneration; Connective Tissue; Equipment Failure; Extremities; Humans; Joint Instability; Patient Compliance; Risk
PubMed: 32520902
DOI: 10.5435/JAAOS-D-20-00064 -
Australian Veterinary Journal Jun 2021To identify whether a theoretical predictable safe corridor is available in cats for placement of trans-iliac pins without the use of fluoroscopy.
OBJECTIVE
To identify whether a theoretical predictable safe corridor is available in cats for placement of trans-iliac pins without the use of fluoroscopy.
METHODS
Twenty-one cats with straight orthogonal normal pelvic radiographs were included. Two start points were evaluated: a midpoint and a dorsal point. The midpoint was defined as midway between the dorsal lamina of the sacral vertebral canal and the cranial dorsal iliac spine. The dorsal start point was 2 mm ventral to the cranial dorsal iliac spine. The pin was assumed to be driven at 90 degrees to the lateral face of the ilium, and considered surgeon accuracy was ±4 degrees from the perpendicular. The angular range and the distance between the iliac wings from the ventrodorsal radiograph were used to calculate the possible cross-sectional area and pin exit location if driven from one iliac wing to the other. The corridor was then evaluated for repeatability in six randomly selected cats.
RESULTS
Vertebral foramina penetration risk was identified in some cats when using a 1.6 and 2 mm-diameter pin using the mid-iliac wing start point. The dorsal start point decreased the available pin placement area but reduced the risk of entering the hazardous zone for all pin sizes up to 2 mm.
CONCLUSION AND RELEVANCE
A theoretical defined safe corridor is available for trans-iliac pin placement in cats between 2.0 and 5.5 kg. A 1.2-mm pin is the safest if using the mid-iliac wing start point. A more dorsal start point can accommodate up to a 2.0-mm pin if correctly aligned to the sacrum.
Topics: Animals; Bone Nails; Bone Screws; Cats; Fluoroscopy; Ilium; Sacrum
PubMed: 33709406
DOI: 10.1111/avj.13062 -
Der Unfallchirurg Sep 2018
Review
Topics: Bone Nails; Fracture Fixation, Internal; Humans; Humeral Fractures; Humerus
PubMed: 30054647
DOI: 10.1007/s00113-018-0534-3 -
Der Unfallchirurg Feb 2019Intramedullary nailing was originally conceived for the stabilization of shaft fractures of long bones. Due to new nail designs and multiple interlocking possibilities,... (Review)
Review
Intramedullary nailing was originally conceived for the stabilization of shaft fractures of long bones. Due to new nail designs and multiple interlocking possibilities, the spectrum of nailing has significantly increased. Nailing of fractures beyond the isthmus is technically challenging because fractures need to be reduced before the nailing procedure starts. Indirect techniques of reduction include the use of an extension table, a large distractor or an external fixator. Direct reduction with pointed reduction forceps, lag screws, a cerclage wire or a short plate can optimize indirect reduction. The choice of the correct entry portal is of utmost importance for an optimal operative result. The location of the entry portal is dependent on the local anatomy and the bend of the nail. The optimal entry portal at the proximal tibia is directly behind the patellar tendon and accessible with the knee in more than 90° of flexion, alternatively through a suprapatellar approach with a slightly flexed knee joint. Insertion of the nail through the suprapatellar approach is possible without stress on the reduced fracture fragments. Blocking screws create an artificial isthmus in the metaphyseal area and force the guide wire in the desired direction. Blocking screws help to avoid axial malalignment during nail insertion. Interlocking of the nail with screws coming from different directions prevents secondary dislocation.
Topics: Bone Nails; Bone Plates; Fracture Fixation, Internal; Fracture Fixation, Intramedullary; Humans; Tibial Fractures
PubMed: 30276432
DOI: 10.1007/s00113-018-0560-1 -
Open Veterinary Journal Jan 2020During tibial plateau leveling osteotomy (TPLO), a TPLO jig is often used. For placement of the jig, one of the pins is placed slightly distal to the joint line....
BACKGROUND
During tibial plateau leveling osteotomy (TPLO), a TPLO jig is often used. For placement of the jig, one of the pins is placed slightly distal to the joint line. Erroneous pin placement may lead to intra-articular damage; however, the path of the pin tract has not been thoroughly investigated.
AIM
To document the rate and identify potential risk factors of intra-articular jig pin placement in dogs undergoing TPLO with the use of a TPLO jig.
METHODS
Medical records and pre- and postoperative radiographs (2007-2017) of 696 dogs with TPLO performed with a jig were reviewed. Primary surgeon and tibial plateau angles (TPA) were recorded. Postoperative radiographs were evaluated and classified according to intra-articular jig pin placement. Medial tibial plateau jig pin placement was defined as a radiolucent tract on the osteochondral junction of the medial tibial plateau. Lateral tibial plateau placement was defined as a radiolucent tract within 3 mm of the medial tibial plateau with a pin trajectory penetrating the lateral tibial plateau. Rates of intra-articular jig pin placement were calculated, and associations between intra-articular jig pin placement and surgeon experience and TPA were assessed with a chi-squared test.
RESULTS
Thirty-seven (5.32%) dogs had intra-articular placement of the jig pin. Seven dogs had medial tibial plateau jig placement, and 30 had lateral tibial plateau placement. There was no relationship between the TPA or surgeon level of experience and intra-articular placement of the pin.
CONCLUSION
This study serves as a reminder to be cautious when placing the proximal jig pin during TPLO to avoid intra-articular placement. In addition, guidelines for evaluating proximal jig pin placement on postoperative radiographs are provided.
Topics: Animals; Bone Nails; Dogs; Female; Knee Joint; Male; Osteotomy; Postoperative Period; Radiography; Retrospective Studies; Tibia
PubMed: 32042656
DOI: 10.4314/ovj.v9i4.11 -
Journal of Pediatric Orthopedics. Part B Nov 2023Current literature on pin migration is inconsistent and its significance is not understood. We aimed to investigate the incidence, magnitude, predictors, and...
Current literature on pin migration is inconsistent and its significance is not understood. We aimed to investigate the incidence, magnitude, predictors, and consequences of radiographic pin migration after pediatric supracondylar humeral fractures (SCHF). We retrospectively reviewed pediatric patients treated with reduction and pinning of SCHF at our institution. Baseline and clinical data were collected. Pin migration was assessed by measuring the change in distance between pin tip and humeral cortex on sequential radiographs. Factors associated with pin migration and loss of reduction (LOR) were assessed. Six hundred forty-eight patients and 1506 pins were included; 21%, 5%, and 1% of patients had pin migration ≥5 mm, ≥10 mm, and ≥20 mm respectively. Mean migration in symptomatic patients was 20 mm compared to a migration of 5 mm in all patients with non-negligible migration ( P < 0.001). Pin migration > 10 mm was strongly associated with LOR [odds ratio (OR) = 6.91; confidence interval (CI), 2.70-17.68]. Factors associated with increased migration included increased days to pin removal ( β = 0.022; CI, 0.002-0.043), migration outwards versus inwards ( = 1.02; CI, 0.21-1.80), and BMI > 95th percentile (OR = 1.63; [1.06-2.50]). Factors not associated with migration included cross-pinning, number of pins, and fracture grade. In summary, we identified a 5% incidence of radiographic pin migration ≥ 10 mm and determined the factors associated with it. Pin migration became radiographically significant at >10 mm where it was strongly associated with LOR. Our findings contribute to the understanding of pin migration and suggest that interventions targeting pin migration may decrease the risk of LOR. Level of Evidence: Level III - Retrospective Cohort Study.
Topics: Child; Humans; Retrospective Studies; Incidence; Humeral Fractures; Bone Nails; Risk Factors; Treatment Outcome
PubMed: 36892011
DOI: 10.1097/BPB.0000000000001069 -
JPMA. the Journal of the Pakistan... Aug 2021To evaluate the difference in the infection rates between Ilizarov wires and half-pins in routine practice. (Observational Study)
Observational Study
OBJECTIVE
To evaluate the difference in the infection rates between Ilizarov wires and half-pins in routine practice.
METHODS
This was an observational, prospective; single-centre study approved by the institutional ethics committee. Hundred cases were treated from June 2014 to May 2018 at Ilizarov Surgery Unit, Department of Orthopaedic Surgery & Traumatology Liaquat University of Medical & Health Sciences Jamshoro Sindh Pakistan. All patients were subjected to an evaluation of half-pins and Ilizarov wires. Patients with monolateral fixators were excluded from the study. The demographic data included patient's age and sex, surgical indication, application and removal of Ilizarov fixator, follow-up duration and type of pin (transverse wire or half pin) used. Non probability consecutive sampling technique was used and sample size was calculated randomly.
RESULTS
Of the total 100 cases, 79(79%) were male and 21(21%) were female with a mean age of 42.8±8.2 years. A total of 890 pins were applied in 100 patients with 170(19.10%) Half pins and 720(80.89%) wires. The transverse wire's infection rate according to Paley's grading system of Pin tract infection was, 46(53.48%), 25(29.06%) and 15(17.44%) in Grade I, Grade II and Grade III respectively. In case of half pin's infection, the majority of the cases were categories in grade II 22(55.0%) followed by Grade I 12(30.0%) and Grade III 06(15.0%).
CONCLUSIONS
The tensioned transverse wires had a significantly low infection rate as compared to half pins.
Topics: Adult; Bone Nails; Bone Wires; Equipment Design; External Fixators; Female; Humans; Male; Middle Aged; Prospective Studies
PubMed: 34634017
DOI: No ID Found -
Injury Nov 2018Supracondylar humerus fractures are the most common elbow injuries in children. The widely adopted approach for Gartland III extension type consists of closed reduction... (Review)
Review
INTRODUCTION
Supracondylar humerus fractures are the most common elbow injuries in children. The widely adopted approach for Gartland III extension type consists of closed reduction and percutaneous pinning; the pin configuration can be lateral or crossed in relationship with the habit of the surgeons. Iatrogenic injury of the ulnar nerve is the most common risk during the insertion of the medial pin. The aim of this study was to analyze advantages and disadvantages of percutaneous pinning with the patient in prone position.
MATERIALS AND METHODS
A literature review of the period 2005-2017 was carried out; four medical search engine (Pubmed, Cochrane Library, ISI Web of Science and Scopus) were consulted using the review's filter and the key words "Ulnar nerve AND supracondylar humerus fractures". The total number of patients were analyzed for: ulnar nerve injuries, anesthesiologic management, time of surgery.
RESULTS
Twenty-nine papers were read, 23 regarding cross pinning in supine position and 6 in prone position. On one hand, 1529 children were treated with closed reduction and cross pinning in supine position; 69 of these patients (4.5%) suffered from iatrogenic ulnar nerve injury. On the other hand, 579 patients underwent the same treatment in prone position; no ulnar nerve lesions were reported in this group. Only one article compared both groups of children in supine and prone position regarding time of anesthesia which is slightly higher in the prone group. There were no differences between supine and prone positions regarding x-ray exposition, time of surgery, closed reduction manoeuvers, pin positioning, x-ray results, clinical and functional results.
DISCUSSION AND CONCLUSIONS
The ulnar nerve in children is hypermobile in the cubital tunnel and tends to dislocate anteriorly over the medial epicondyle, especially when the elbow is in hyperflexion. This may be the reason of the increased risk of nerve injury during the insertion of the medial pin in supine position and, instead, an advantage of the prone position. The insertion of both pins from the lateral side could reduce this complication. Larger studies need to be carried out regarding the reported higher duration of anesthesia in prone position.
Topics: Bone Nails; Child; Elbow Joint; Fracture Fixation, Intramedullary; Humans; Humeral Fractures; Iatrogenic Disease; Manipulation, Orthopedic; Prone Position; Treatment Outcome; Ulnar Nerve
PubMed: 30286976
DOI: 10.1016/j.injury.2018.09.046 -
Clinical Orthopaedics and Related... Sep 2014
Topics: Bone Nails; Femoral Fractures; Fracture Fixation, Intramedullary; Fracture Healing; Humans
PubMed: 24874114
DOI: 10.1007/s11999-014-3676-9 -
ACS Biomaterials Science & Engineering Sep 2021Bone fractures are in need of rapid fixation methods, but the current strategies are limited to metal pins and screws, which necessitate secondary surgeries upon...
Bone fractures are in need of rapid fixation methods, but the current strategies are limited to metal pins and screws, which necessitate secondary surgeries upon removal. New techniques are sought to avoid surgical revisions, while maintaining or improving the fixation speed. Herein, a method of bone fixation is proposed with transparent biopolymers anchored in place via light-activated biocomposites based on expanding CaproGlu bioadhesives. The transparent biopolymers serve as a UV light guide for the activation of CaproGlu biocomposites, which results in evolution of molecular nitrogen (from diazirine photolysis), simultaneously expanding the covalently cross-linked matrix. Osseointegration additives of hydroxyapatite or Bioglass 45S5 yield a biocomposite matrix with increased stiffness and pullout strength. The structure-property relationships of UV joules dose, pin diameter, and biocomposite additives are assessed with respect to the apparent viscosity, shear modulus, spatiotemporal pin curing, and lap-shear adhesion. Finally, a model system is proposed based on investigation with bone tissue for the exploration and optimization of UV-active transparent biopolymer fixation.
Topics: Bone Nails; Diazomethane; Durapatite; Fractures, Bone; Humans
PubMed: 34387486
DOI: 10.1021/acsbiomaterials.1c00473