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Journal of Orthopaedic Surgery (Hong... 2021This study aims to systematically review the literature comparing surgical treatments options and respective failure rates for basicervical hip fractures.
PURPOSE
This study aims to systematically review the literature comparing surgical treatments options and respective failure rates for basicervical hip fractures.
METHODS
A comprehensive search of databases, including MEDLINE, Embase, Web of Science, and Cochrane Central for studies published in English on or before June 21, 2019 was performed. Selected search terms included "basicervical," "basi cervical," "AO/OTA type 31-B," "femoral neck fracture" AND "bone nails," "bone screws," "fracture fixation," "internal fixation," "arthroplasty," "cephalomedullary," "sliding hip screw," "ORIF," and "treatment outcome." We included studies that assessed outcomes of basicervical fracture fixation using open reduction internal fixation or arthroplasty. Two authors extracted the following data from each paper: study design, country, cohort year, definition of basicervical, intervention type, sample size, patient demographics, follow-up length, percent of fractures that required revision, and the percent of implants that failed.
RESULTS
Sixteen articles encompassing 910 patients were included. The main outcome was the percent of implants that required revision. The total revision rates were 8% (8 studies, 157 patients, range 0%-55%) for cephalomedullary nails, 7% (10 studies, 584 patients, range 0%-18%) for sliding hip screws, 23% (3 studies, 40 patients, range 16%-50%) for cannulated screws, 0% (1 study, 6 patients) for total hip arthroplasty, and 8% (2 studies, 13 patients, range 0%-11%) for hemiarthroplasty.
CONCLUSION
Management of basicervical fractures with SHS and CMN produces similar failure and re-operation rates. Limited evidence is available on the use of cannulated screws and arthroplasty, but available studies suggest that cannulated screws have an unacceptable revision rate (23%) while arthroplasty may be acceptable. Future studies examining the comparative efficacy of various fixation methods would benefit from strict definition of fracture type as well as consistent reporting of functional outcomes, re-operation rates, and mortality.
Topics: Aged; Aged, 80 and over; Bone Nails; Bone Screws; Female; Femoral Neck Fractures; Fracture Fixation, Internal; Hip Fractures; Humans; Male; Open Fracture Reduction; Postoperative Complications; Prognosis; Reoperation; Treatment Outcome
PubMed: 33779387
DOI: 10.1177/23094990211003344 -
European Spine Journal : Official... Feb 2010
Topics: Atlanto-Occipital Joint; Bone Screws; Cervical Atlas; Female; Gait Disorders, Neurologic; Humans; Internal Fixators; Joint Instability; Middle Aged; Occipital Bone; Postoperative Complications; Prosthesis Implantation; Spinal Cord Compression; Spinal Fusion; Treatment Outcome; Wounds and Injuries
PubMed: 20130929
DOI: 10.1007/s00586-010-1303-3 -
Journal of Orthopaedic Surgery and... May 2023To develop a bidirectional slide guide to assist screw placement in the axial lamina and to preliminarily discuss the accuracy and feasibility of auxiliary screw...
PURPOSE
To develop a bidirectional slide guide to assist screw placement in the axial lamina and to preliminarily discuss the accuracy and feasibility of auxiliary screw placement.
METHODS
CT data from 40 randomly selected patients were imported into the software for modelling, and cross-pinning was used to simulate pinning. According to the different crossing methods of the upper and lower laminar screws, they are divided into two groups. In the software, the position of the needlepoint of each screw is accurately measured, and the needle point is kept unchanged to simulate the movable range of the screw tail under the condition that the body does not penetrate the cortical bone. The data were compared by grouping and gender. Finally, the guide was designed by combining the screw exit point and fine adjustment angle data of all patients with the centripetal principle of the slide rail.
RESULTS
The needle exit data L1/L2/L3/L4 were 6.44 ± 0.52 mm, 7.05 ± 0.48 mm, 3.55 ± 0.75 mm and 5.09 ± 0.74 mm, respectively, and the fine adjustment angle of the slide rail was 10.51° ± 0.87°. There was no significant difference between the two groups or between men and women (p > 0.05).
CONCLUSION
In this experiment, using the data obtained from the simulation of screw insertion, a two-way slide guide was designed to assist the insertion of axial laminar screws. The guide locks the screw outlet point to position and guides the screw inlet point, which improves the accuracy and safety of screw placement.
Topics: Male; Humans; Female; Bone Screws; Software; Cortical Bone; Fracture Fixation, Intramedullary; Spinal Fusion; Pedicle Screws
PubMed: 37143107
DOI: 10.1186/s13018-023-03784-8 -
Journal of Orthopaedic Surgery and... Oct 2018Surgery for adult spinal deformity requires optimal patient-specific spino-pelvic-lower extremity alignment. Distal fixation in thoracolumbar spinal deformity surgery is...
BACKGROUND
Surgery for adult spinal deformity requires optimal patient-specific spino-pelvic-lower extremity alignment. Distal fixation in thoracolumbar spinal deformity surgery is crucial when arthrodesis to the sacrum is indicated. Although we had performed sacro-pelvic fixation with bilateral S1 and bilateral single iliac screws previously, iliac screw loosening and/or S1 screw loosening occurred frequently. So, the authors attempted to fuse spino-pelvic lesions with the dual iliac screws and S1 pedicle screws.
METHODS
Twenty-seven consecutive adult spinal deformity patients underwent thoracolumbar-pelvic correction surgery with bilateral double iliac screws between May 2014 and September 2015. Sagittal vertical axis, lumbar lordosis, pelvic tilt, sacral slope, T1 pelvic angle, and global tilt were assessed radiographically and by computed tomography both preoperatively and 24 months postoperatively. Iliac screw loosening, S1 pedicle screw loosening, and screw penetration of the ilium were evaluated 2 years postoperatively.
RESULTS
Only two patients (7.4%) at 1 year and three patients (11.1%) at 2 years presented with iliac screw loosening postoperatively. Loosening of the S1 screw occurred in three cases (11.1%) 2 years postoperatively. Displacement of the iliac screw occurred in eight cases (25%). Internal and external perforation of the ilium by the iliac screw occurred in six (22.2%) and three (11.1%) cases respectively. One reoperation was performed due to back-out of the iliac screw and rod breakage.
CONCLUSION
Bilateral dual iliac screws and an S1 pedicle screw system achieve longer stability for spinal and pelvic fusion in adult spinal deformity patients, with few severe complications.
Topics: Aged; Bone Screws; Female; Humans; Ilium; Lumbar Vertebrae; Male; Middle Aged; Pedicle Screws; Postoperative Complications; Prosthesis Failure; Radiography; Spinal Curvatures; Spinal Fusion; Tomography, X-Ray Computed
PubMed: 30340613
DOI: 10.1186/s13018-018-0969-9 -
Journal of Orthopaedic Research :... Apr 2018Traditional fracture fixation teaching suggests that fully threaded screws do not provide interfragmentary compression unless placed through a glide hole. Based on this...
UNLABELLED
Traditional fracture fixation teaching suggests that fully threaded screws do not provide interfragmentary compression unless placed through a glide hole. Based on this assumption, pelvic surgeons typically use fully threaded screws in the treatment of comminuted transforaminal sacral fractures to limit iatrogenic neuroforaminal stenosis. Clinical experience with fully threaded screws suggests that interfragmentary compression actually does occur. We hypothesized that the use of a fully threaded screw does not produce any interfragmentary compression and that there is no difference in insertional torque between partially threaded and fully threaded screws. To test this hypothesis, fully and partially threaded 7.0 millimeter (mm) cannulated screws were placed across two synthetic bone blocks fabricated to simulate normal and osteoporotic bone. We compared two groups of normal and osteoporotic blocks for compression achieved and maximal insertional torque generated with fully threaded and partially threaded screw insertion. A micro computed tomography (CT) scan of the composite blocks was obtained to investigate for structural changes created during screw insertion. For both groups, compression was achieved with fully threaded screws and the maximal insertional torque was higher using fully threaded screws. Micro CT analysis demonstrated local bone damage with structural disruption in the near segment of the fully threaded screw path in comparison to the partially threaded.
CLINICAL SIGNIFICANCE
this study demonstrates that compression is generated using fully threaded screws without using a predrilled glide hole. The insertional torque required to generate compression with fully threaded screws is increased but is clinically applicable. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:1099-1105, 2018.
Topics: Bone Screws; Cancellous Bone; Fracture Fixation, Internal; Humans; Osteoporosis
PubMed: 28885726
DOI: 10.1002/jor.23724 -
Annals of the Royal College of Surgeons... Jan 2022Akin osteotomies are commonly fixed with a screw or staple. Hardware-related symptoms are not uncommon. We compared the outcomes and costs of the two implants. (Comparative Study)
Comparative Study
INTRODUCTION
Akin osteotomies are commonly fixed with a screw or staple. Hardware-related symptoms are not uncommon. We compared the outcomes and costs of the two implants.
METHODS
We evaluated 74 Akin osteotomies performed in conjunction with first metatarsal osteotomy for hallux valgus. The osteotomy was fixed with a headless compression screw in 39 cases and a staple in 35 cases. We looked at the implant-related complications, removal of metalwork, revision, non-union and cost. Pre- and postoperative hallux valgus interphalangeal (HI) angles and length of the proximal phalanx were measured.
RESULTS
There was 100% union, no failure of fixation, no revision surgery and no delayed union in either group. The radiological prominence of screws was significant (=0.02), but there was no significant difference in soft-tissue irritation (=0.36) or removal of implants (=0.49). Two cortical breaches (5.8%) occurred in staple fixation and 4 (10.2%) in screw fixation (not statistically significant (NS), =0.50). The mean improvement in HI angle was 4.3° with screw fixation and 4.1° with staple fixation (NS, =0.69). The mean shortening of the proximal phalanx was 2.5mm with screw fixation and 2.3mm with staple fixation (NS, =0.64). The total cost was £1,925 for staple fixation and £4,290 for screw fixation.
CONCLUSIONS
Staple and screw fixation are reproducible modalities with satisfactory outcomes, but screw fixation is expensive. We conclude staple fixation is a cost-effective alternative.
Topics: Bone Screws; Female; Hallux Valgus; Humans; Male; Metatarsal Bones; Middle Aged; Osteotomy; Retrospective Studies; Sutures
PubMed: 34323127
DOI: 10.1308/rcsann.2021.0029 -
Orthopaedics & Traumatology, Surgery &... Dec 2022
Topics: Humans; Biomechanical Phenomena; Bone Plates; Bone Screws; Finite Element Analysis; Bone Cements; Stress, Mechanical
PubMed: 36270441
DOI: 10.1016/j.otsr.2022.103448 -
BMC Musculoskeletal Disorders Nov 2022To compare the breakage risk of lengthened sacroiliac screws and ordinary sacroiliac screws to treat unilateral vertical sacral fractures and provide a reference for...
OBJECTIVE
To compare the breakage risk of lengthened sacroiliac screws and ordinary sacroiliac screws to treat unilateral vertical sacral fractures and provide a reference for clinical application.
METHODS
A finite element model of Tile C pelvic ring injury (unilateral type Denis II fracture of the sacrum) was produced. The sacral fractures were fixed with a lengthened sacroiliac screw and ordinary sacroiliac screw in 6 types of models. The maximal von Mises stresses and stress distributions of the two kinds of screws when standing on both feet were measured and compared.
RESULTS
The maximal von Mises stress of the lengthened screw was less than that of the ordinary screw. Compared with ordinary screw, the stress distribution in the lengthened screw was more homogeneous.
CONCLUSIONS
The breakage risk of screws fixed in double segments is lower than that of screws fixed in single segments, the breakage risk of lengthened screws is lower than that of ordinary screws, and the breakage risk of screws fixed in S2 segments is lower than that of screws fixed in S1 segments.
Topics: Humans; Sacrum; Finite Element Analysis; Bone Screws; Fracture Fixation, Internal; Fractures, Bone; Spinal Fractures
PubMed: 36329449
DOI: 10.1186/s12891-022-05898-2 -
Journal of Orthopaedic Research :... Jan 2018Screw fixation in osteoporotic patients is becoming an increasing problem in orthopaedic surgery as deterioration of cortical and cancellous bone hamper biomechanical...
Screw fixation in osteoporotic patients is becoming an increasing problem in orthopaedic surgery as deterioration of cortical and cancellous bone hamper biomechanical stability and screw fixation. This might result in delayed weight-bearing or failure of instrumentation. We hypothesized that local peri-operative shock wave treatment can optimize osseointegration and subsequent screw fixation. In eight female Wistar rats, two cancellous and two cortical bone screws were implanted in both femora and tibiae. Immediately after implantation, 3.000 unfocused extracorporeal shock waves (energy flux density 0.3 mJ/mm ) were applied to one side. The other side served as non-treated internal control. Evaluation of osseointegration was performed after 4 weeks with the use of microCT scanning, histology with fluorochrome labeling, and pull-out tests of the screws. Four weeks after extracorporeal shock wave treatment, treated legs exhibited increased bone formation and screw fixation around cortical screws as compared to the control legs. This was corroborated by an increased pull-out of the shock wave treated cortical screws. The cancellous bone screws appeared not to be sensitive for shock wave treatment. Formation of neocortices after shock wave therapy was observed in three of eight animals. Furthermore, de novo bone formation in the bone marrow was observed in some animals. The current study showed bone formation and improved screw fixation as a result of shock wave therapy. New bone was also formed at locations remote from the screws, hence, not contributing to screw fixation. Further, research is warranted to make shock wave therapy tailor-made for fracture fixation. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:76-84, 2018.
Topics: Animals; Biomechanical Phenomena; Bone Screws; Extracorporeal Shockwave Therapy; Female; Fracture Fixation, Internal; Rats; Rats, Wistar; X-Ray Microtomography
PubMed: 28543599
DOI: 10.1002/jor.23615 -
Revista Da Associacao Medica Brasileira... Feb 2019To present the surgical results of patients who underwent axis screw instrumentation, discussing surgical nuances and complications of the techniques used.
OBJECTIVE
To present the surgical results of patients who underwent axis screw instrumentation, discussing surgical nuances and complications of the techniques used.
METHODS
Retrospective case-series evaluation of patients who underwent spinal surgery with axis instrumentation using screws.
RESULTS
Sixty-five patients were included in this study. The most common cause of mechanical instability was spinal cord trauma involving the axis (36 patients - 55.4%), followed by congenital craniocervical malformation (12 patients - 18.5%). Thirty-seven (57%) patients required concomitant C1 fusion. Bilateral axis fixation was performed in almost all cases. Twenty-three patients (35.4%) underwent bilateral laminar screws fixation; pars screws were used in twenty-two patients (33.8%), and pedicular screws were used isolated in only three patients (4.6%). In fourteen patients (21.5%), we performed a hybrid construction. There was no neurological worsening nor vertebral artery injury in this series.
CONCLUSION
Axis screw instrumentation proved to be a safe and efficient method for cervical stabilization. Laminar and pars screws were the most commonly used.
Topics: Adolescent; Adult; Aged; Axis, Cervical Vertebra; Bone Screws; Child; Child, Preschool; Female; Humans; Male; Middle Aged; Postoperative Complications; Retrospective Studies; Spinal Fusion; Treatment Outcome; Young Adult
PubMed: 30892444
DOI: 10.1590/1806-9282.65.2.198