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Clinics in Orthopedic Surgery Jun 2020Distal clavicle fractures are less common than mid-shaft fractures in adults and there is no consensus on the best classification system or the ideal treatment approach... (Review)
Review
Distal clavicle fractures are less common than mid-shaft fractures in adults and there is no consensus on the best classification system or the ideal treatment approach considering that high nonunion rates have been reported. Although there are numerous treatment options for distal clavicle fractures, a gold standard treatment has not yet been established. Each surgical technique has its pros and cons. In this review article, we provide an overview of classification systems and treatment methods for distal clavicle fractures.
Topics: Clavicle; Fracture Fixation, Internal; Fractures, Bone; Humans; Internal Fixators
PubMed: 32489533
DOI: 10.4055/cios20010 -
BMC Musculoskeletal Disorders Dec 2022The commonly used technique for treating unstable pelvic fractures with sacroiliac screws and anterior internal fixator (INFIX) is prone to complications, such as injury...
BACKGROUND
The commonly used technique for treating unstable pelvic fractures with sacroiliac screws and anterior internal fixator (INFIX) is prone to complications, such as injury to the pelvic vasculature and nerves, life-threatening bleeding, lateral femoral cutaneous neuritis, and wound infection. This study investigated the clinical effects of using a modified percutaneous iliosacral screw and INFIX technique for treating unstable pelvic fractures.
METHODS
A retrospective analysis of minimally invasive internal fixation using modified incision of an anterior-ring INFIX application combined with modified percutaneous iliosacral screw placement was performed for 22 cases of unstable pelvic fractures from January 2017 to December 2018. Based on the Tile classification, there were 4 type B1, 7 type B2, 5 type B3 and 6 type C1 injuries. Preoperatively, the length and orientation of the internal fixation were computer-simulated and measured. On postoperative day 3, pelvic radiographs and three-dimensional computed tomograms were used to assess fracture reduction and fixation. All patients were regularly followed up at 4 weeks, 12 weeks, 6 months, 12 months, 24 months and annually thereafter. Fracture healing, complications, visual analogue scale (VAS) scores, the quality of fracture repositioning and Majeed score were assessed during follow-up.
RESULTS
All patients were followed up for a mean of 25.23 ± 1.48 months. All fractures healed without loss of reduction and no patient showed evidence of delayed union or nonunion. Two years postoperatively, the mean VAS score was 0.32 ± 0.09 and the mean Majeed score was 94.32 ± 1.86.
CONCLUSION
The modified percutaneous iliosacral screw technique increases the anterior tilt of the sacroiliac screw by shifting the entry point posteriorly to increase the safety of the screw placement. Downward modification of the INFIX incision reduces the risk of lateral femoral cutaneous nerve injury. This technique is safe, effective and well tolerated by patients.
Topics: Humans; Retrospective Studies; Pelvic Bones; Fractures, Bone; Bone Screws; Fracture Fixation, Internal; Internal Fixators
PubMed: 36471331
DOI: 10.1186/s12891-022-06036-8 -
Orthopaedics & Traumatology, Surgery &... Feb 2021Medical and surgical treatment of osteogenesis imperfecta has undergone two revolutions that improved quality of life and functional capacity: reduced bone absorption... (Review)
Review
Medical and surgical treatment of osteogenesis imperfecta has undergone two revolutions that improved quality of life and functional capacity: reduced bone absorption with the use of bisphosphonates, and improvement in internal fixation with the development of Dubow-Bailey then Fassier-Duval™ telescopic rodding. Telescopic intramedullary rodding in osteogenesis imperfecta and in other pathologies (congenital non-union and other congenital bone disorders) progressed with the replacement of the Dubow-Bailey rod by the telescopic Fassier-Duval™ rod. The aim of the present study was to provide an update on a technique that requires the utmost rigor and is not free of complications. Pitfalls and tips-and-tricks are presented in the light of our own experience.
Topics: Bone Diseases; Child; Fracture Fixation, Intramedullary; Humans; Internal Fixators; Osteogenesis Imperfecta; Quality of Life
PubMed: 33316440
DOI: 10.1016/j.otsr.2020.102759 -
Orthopaedic Surgery Aug 2016Since the late 1980s, spinal interbody cages (ICs) have been used to aid bone fusion in a variety of spinal disorders. Utilized to restore intervertebral height, enable... (Review)
Review
Since the late 1980s, spinal interbody cages (ICs) have been used to aid bone fusion in a variety of spinal disorders. Utilized to restore intervertebral height, enable bone graft containment for arthrodesis, and restore anterior column biomechanical stability, ICs have since evolved to become a highly successful means of achieving fusion, being associated with less postoperative pain, shorter hospital stay, fewer complications and higher rates of fusion when than bone graft only spinal fusion. IC design and materials have changed considerably over the past two decades. The threaded titanium-alloy cylindrical screw cages, typically filled with autologous bone graft, of the mid-1990s achieved greater fusion rates than bone grafts and non-threaded cages. Threaded screw cages, however, were soon found to be less stable in extension and flexion; additionally, they had a high incidence of cage subsidence. As of the early 2000s, non-threaded box-shaped titanium or polyether ether ketone IC designs have become increasingly more common. This modern design continues to achieve greater cage stability in flexion, axial rotation and bending. However, cage stability and subsidence, bone fusion rates and surgical complications still require optimization. Thus, this review provides an update of recent research findings relevant to ICs over the past 3 years, highlighting trends in optimization of cage design, materials, alternatives to bone grafts, and coatings that may enhance fusion.
Topics: Equipment Design; Humans; Internal Fixators; Spinal Fusion
PubMed: 27627709
DOI: 10.1111/os.12264 -
Journal of Orthopaedics and... Mar 2020Limb lengthening continues to be a real challenge to both the patient and the orthopaedic surgeon. Although it is not a difficult operative problem, there is a long and... (Review)
Review
Limb lengthening continues to be a real challenge to both the patient and the orthopaedic surgeon. Although it is not a difficult operative problem, there is a long and exhausting postoperative commitment which can jeopardize early good results. I aim to review the history, evolution, biology, complications and current concepts of limb lengthening. Ilizarov's innovative procedure using distraction histeogenesis is the mainstay of all newly developing methods of treatment. The method of fixation is evolving rapidly from unilateral external fixator to ring fixator, computer assisted and finally lengthening intramedullary nails. The newly manufactured nails avoid many of the drawbacks of external fixation but they have their own complications. In general, the indications for limb lengthening are controversial. The indications have been extended from lower limb length inequality to upper extremity lengthening, including humeral, forearm and phalangeal lengthening. A wide range in frequency of complications is recorded in the English literature, which may reach up to 100% of cases treated. With developing experience, cosmetic lengthening has become possible using external or internal lengthening devices with an acceptable rate of problems.Level of evidence: V.
Topics: Bone Lengthening; Bone Nails; External Fixators; Humans; Internal Fixators; Leg Length Inequality; Postoperative Complications; Radiography; Treatment Outcome
PubMed: 32140790
DOI: 10.1186/s10195-019-0541-3 -
The Cochrane Database of Systematic... Oct 2017Recognition of some of the limitations of titanium plates and screws used for the fixation of bones has led to the development of plates manufactured from bioresorbable... (Review)
Review
BACKGROUND
Recognition of some of the limitations of titanium plates and screws used for the fixation of bones has led to the development of plates manufactured from bioresorbable materials. Whilst resorbable plates appear to offer clinical advantages over metal plates in orthognathic surgery, concerns remain about the stability of fixation and the length of time required for their degradation and the possibility of foreign body reactions. This review compares the use of titanium versus bioresorbable plates in orthognathic surgery and is an update of the Cochrane Review first published in 2007.
OBJECTIVES
To compare the effects of bioresorbable fixation systems with titanium systems used during orthognathic surgery.
SEARCH METHODS
Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 20 January 2017); the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 11) in the Cochrane Library (searched 20 January 2017); MEDLINE Ovid (1946 to 20 January 2017); and Embase Ovid (1980 to 20 January 2017). We searched the US National Institutes of Health Ongoing Trials Register ClinicalTrials.gov (clinicaltrials.gov; searched 20 January 2017), and the World Health Organization International Clinical Trials Registry Platform (searched 20 January 2017) for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases.
SELECTION CRITERIA
Randomised controlled trials comparing bioresorbable versus titanium fixation systems used for orthognathic surgery in adults.
DATA COLLECTION AND ANALYSIS
Two review authors independently screened the results of the electronic searches, extracted data and assessed the risk of bias of the included studies. We resolved disagreement by discussion. Clinical heterogeneity between the included trials precluded pooling of data, and only a descriptive summary is presented.
MAIN RESULTS
This review included two trials, involving 103 participants, one comparing titanium with resorbable plates and screws and the other titanium with resorbable screws. Both studies were at high risk of bias and provided very limited data for the primary outcomes of this review. All participants in one trial suffered mild to moderate postoperative discomfort with no statistically significant difference between the two plating groups at different follow-up times. Mean scores of patient satisfaction were 7.43 to 8.63 (range 0 to 10) with no statistically significant difference between the two groups throughout follow-up. Adverse effects reported in one study were two plate exposures in each group occurring between the third and ninth months. Plate exposures occurred mainly in the posterior maxillary region, except for one titanium plate exposure in the mandibular premolar region. Known causes of infection were associated with loosened screws and wound dehiscence with no statistically significant difference in the infection rate between titanium (3/196), and resorbable (3/165) plates.
AUTHORS' CONCLUSIONS
We do not have sufficient evidence to determine if titanium plates or resorbable plates are superior for fixation of bones after orthognathic surgery. This review provides insufficient evidence to show any difference in postoperative pain and discomfort, level of patient satisfaction, plate exposure or infection for plate and screw fixation using either titanium or resorbable materials.
Topics: Absorbable Implants; Bone Plates; Bone Screws; Device Removal; Humans; Internal Fixators; Mandible; Maxilla; Osteotomy; Randomized Controlled Trials as Topic; Titanium
PubMed: 28977689
DOI: 10.1002/14651858.CD006204.pub3 -
Advances in Clinical and Experimental... May 2019Severe osteoarthritis (OA) of the ankle joint constitutes an important social problem.
BACKGROUND
Severe osteoarthritis (OA) of the ankle joint constitutes an important social problem.
OBJECTIVES
We used (1) the GRIMBY scale, (2) the LOWER LIMB Activity scale, (3) the UCLA (University of California Los Angeles) activity scale, (4) the VAS (visual analogue scale) ACTIVITY scale, and (5) the FAAM (foot and ankle ability measure) SPORT scale to verify whether the type of ankle joint arthrodesis stabilization affected sports and physical activity levels.
MATERIAL AND METHODS
We carried out a prospective clinical study of 47 patients who had undergone ankle arthrodesis with Ilizarov external fixator stabilization (Group 1, n = 21) or internal stabilization with screws (Group 2, n = 26) at Orthopaedic Clinic at the Wroclaw Medical University, Poland, from 2007 to 2015. Sports and physical activity levels were measured by (1) the GRIMBY scale, (2) the LOWER LIMB Activity scale, (3) the UCLA activity scale, (4) the VAS ACTIVITY scale, and (5) the FAAM SPORT scale.
RESULTS
A comparison between the average results of Group 1 and Group 2 on the LOWER LIMB Activity scale and the GRIMBY scale before and after surgery revealed no significant differences. In Group 1, the mean scores on the VAS ACTIVITY scale and the UCLA activity scale after treatment were higher than in Group 2. In Group 1, the mean outcome in the SPORT FAAM scale after treatment was 40; in Group 2 it was 30.06.
CONCLUSIONS
Ilizarov fixation of ankle arthrodesis is associated with better scores on the FAAM SPORT, UCLA activity and VAS ACTIVITY scales after treatment than internal fixation. The scores on the GRIMBY scale and the UCLA activity scale were significantly higher after treatment than before treatment in both groups. In this study, ankle fusion with Ilizarov fixation and internal fixation was found to be effective in the treatment of ankle arthritis. The levels of sport and physical activity were satisfactory in both groups, but the outcomes after fixation with the Ilizarov apparatus were better than after internal stabilization.
Topics: Ankle Joint; Arthritis; Arthrodesis; Bone Screws; Exercise; External Fixators; Fracture Fixation, Internal; Humans; Ilizarov Technique; Internal Fixators; Poland; Prospective Studies; Sports; Treatment Outcome
PubMed: 30079998
DOI: 10.17219/acem/80258 -
BMC Musculoskeletal Disorders Dec 2018Tibia infected nonunion and chronic osteomyelitis are challenging clinical presentations. Bone transportation with external or hybrid fixators (combined external and... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Tibia infected nonunion and chronic osteomyelitis are challenging clinical presentations. Bone transportation with external or hybrid fixators (combined external and internal fixators) is versatile to solve these problems. However, the infection-free rates of these fixator systems are unknown. Additionally, the prognosis factors for results of bone transportation are obscure. Therefore, this systematic review and meta-analysis was conducted to answer these questions.
METHODS
A systematic review was conducted following the PRISMA-IPD guidelines. Relevant publications from January 1995 to September 2018 were compiled from Medline, Embase, and Cochrane. The infection-free rates of external and hybrid fixators were achieved by synthesizing aggregate data and individual participant data (IPD). IPD was analyzed by two-stage method with logistical regression to identify prognosis factors of sequelae.
RESULTS
Twenty-two studies with 518 patients were identified, including 11 studies with 167 patients' IPD, and 11 studies with 351 patients' aggregate data. The infection-free rate of hybrid fixator group was 86% (95%CI: 79-94%), lower than that of external fixator which was 97% (95%CI: 95-98%,). The number of previous surgeries was found predict factor of bone union sequelae (p = 0.04) and function sequelae(p < 0.01); The external fixation time was found predict factor of function sequelae (p = 0.015).
CONCLUSIONS
Hybrid fixators may be associated with a greater risk of infection-recurrence in the treatment of tibia infected nonunion and chronic osteomyelitis. The number of previous surgeries and external fixation time can be used as predictors of outcomes. Proper fixators and meticulously designed surgery are important to avoid unexpected operations and shorten external fixation time.
Topics: Anti-Bacterial Agents; Bacterial Infections; Chronic Disease; External Fixators; Fracture Fixation, Internal; Fractures, Ununited; Humans; Ilizarov Technique; Internal Fixators; Osteomyelitis; Postoperative Complications; Reoperation; Risk Factors; Secondary Prevention; Tibial Fractures; Time Factors
PubMed: 30545342
DOI: 10.1186/s12891-018-2363-5 -
Journal of Orthopaedic Trauma Feb 2011The development of far cortical locking (FCL) was motivated by a conundrum: locked plating constructs provide inherently rigid stabilization, yet they should facilitate... (Review)
Review
The development of far cortical locking (FCL) was motivated by a conundrum: locked plating constructs provide inherently rigid stabilization, yet they should facilitate biologic fixation and secondary bone healing that relies on flexible fixation to stimulate callus formation. Recent studies have confirmed that the high stiffness of standard locked plating constructs can suppress interfragmentary motion to a level that is insufficient to reliably promote secondary fracture healing by callus formation. Furthermore, rigid locking screws cause an uneven stress distribution that may lead to stress fracture at the end screw and stress shielding under the plate. This review summarizes four key features of FCL constructs that have been shown to enhance fixation and healing of fractures: flexible fixation, load distribution, progressive stiffening, and parallel interfragmentary motion. Specifically, flexible fixation provided by FCL reduces the stiffness of a locked plating construct by 80% to 88% to actively promote callus proliferation similar to an external fixator. Load is evenly distributed between FCL screws to mitigate stress risers at the end screw. Progressive stiffening occurs by near cortex support of FCL screws and provides additional support under elevated loading. Finally, parallel interfragmentary motion by the S-shaped flexion of FCL screws promotes symmetric callus formation. In combination, these features of FCL constructs have been shown to induce more callus and to yield significantly stronger and more consistent healing compared with standard locked plating constructs. As such, FCL constructs function as true internal fixators by replicating the biomechanical behavior and biologic healing response of external fixators.
Topics: Biomechanical Phenomena; Bone Plates; Bone Screws; Equipment Design; Fracture Fixation, Internal; Humans
PubMed: 21248556
DOI: 10.1097/BOT.0b013e318207885b -
Journal of Orthopaedic Research :... Feb 2019Orthopedic device-related infection (ODRI), including both fracture-related infection (FRI) and periprosthetic joint infection (PJI), remain among the most challenging... (Review)
Review
Orthopedic device-related infection (ODRI), including both fracture-related infection (FRI) and periprosthetic joint infection (PJI), remain among the most challenging complications in orthopedic and musculoskeletal trauma surgery. ODRI has been convincingly shown to delay healing, worsen functional outcome and incur significant socio-economic costs. To address this clinical problem, ever more sophisticated technologies targeting the prevention and/or treatment of ODRI are being developed and tested in vitro and in vivo. Among the most commonly described innovations are antimicrobial-coated orthopedic devices, antimicrobial-loaded bone cements and void fillers, and dual osteo-inductive/antimicrobial biomaterials. Unfortunately, translation of these technologies to the clinic has been limited, at least partially due to the challenging and still evolving regulatory environment for antimicrobial drug-device combination products, and a lack of clarity in the burden of proof required in preclinical studies. Preclinical in vivo testing (i.e. animal studies) represents a critical phase of the multidisciplinary effort to design, produce and reliably test both safety and efficacy of any new antimicrobial device. Nonetheless, current in vivo testing protocols, procedures, models, and assessments are highly disparate, irregularly conducted and reported, and without standardization and validation. The purpose of the present opinion piece is to discuss best practices in preclinical in vivo testing of antimicrobial interventions targeting ODRI. By sharing these experience-driven views, we aim to aid others in conducting such studies both for fundamental biomedical research, but also for regulatory and clinical evaluation. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:271-287, 2019.
Topics: Animal Experimentation; Animals; Anti-Infective Agents; Fracture Fixation, Internal; Internal Fixators; Models, Animal; Prosthesis-Related Infections; Research Design
PubMed: 30667561
DOI: 10.1002/jor.24230