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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 -
British Medical Journal (Clinical... Dec 1985
Topics: Bone Nails; Braces; Fracture Fixation; Fracture Fixation, Intramedullary; Humans
PubMed: 3935200
DOI: 10.1136/bmj.291.6509.1596 -
Journal of Orthopaedic Surgery and... Mar 2021Leg length (LL) and offset (OS) are important factors in total hip arthroplasty (THA). Because most LL and OS callipers used in THA depend on fixed points on the pelvis...
BACKGROUND
Leg length (LL) and offset (OS) are important factors in total hip arthroplasty (THA). Because most LL and OS callipers used in THA depend on fixed points on the pelvis and the femur, limb position could affect measurement error. This study was conducted on a THA simulator to clarify the effects of lower limb position and iliac pin position on LL and OS errors and to determine the permissible range of limb position for accurate LL and OS measurement.
METHODS
An LL and OS measurement instrument was used. Two pin positions were tested: the iliac tubercle and the top of the iliac crest intersecting with the extension of the femoral axis. First, the limb was moved in one direction (flexion-extension, abduction-adduction, or internal-external rotation), and LL and OS were measured for each pin position. Next, the limb was moved in combinations of the three directions. Then, the permissible range of combined limb position, which resulted in LL and OS measurement error within ±2 mm, was determined for each pin position.
RESULTS
Only 4° of abduction/adduction caused 5-7 mm error in LL and 2-4 mm error in OS, irrespective of pin position. The effects of flexion-extension and internal-external rotation on LL error were smaller for the top of the iliac crest than for the iliac tubercle, though OS error was similar for both pin positions. For LL, the permissible range of the combined limb position was wider for the top of the iliac crest than for the iliac tubercle.
CONCLUSION
To minimize LL and OS measurement errors in THA, adduction-abduction must be maintained. The iliac pin position in the top of the iliac crest is preferred because it provides less LL measurement error and a wider permissible range of combined limb position for accurate LL measurement.
Topics: Arthroplasty, Replacement, Hip; Bone Nails; Humans; Leg Bones; Leg Length Inequality; Lower Extremity; Models, Anatomic; Pelvis
PubMed: 33726774
DOI: 10.1186/s13018-021-02347-z -
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 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 -
Journal of Orthopaedic Surgery (Hong... Apr 2014
Topics: Bone Nails; Bone Plates; Female; Femoral Fractures; Femur; Fracture Fixation, Internal; Hip Fractures; Humans; Male
PubMed: 24897756
DOI: 10.1177/230949901402200133 -
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 -
Chinese Journal of Traumatology =... Sep 2023Surgical management of femoral shaft fractures with intramedullary nails has become the standard of care, with multiple options for entry point described, including... (Review)
Review
Surgical management of femoral shaft fractures with intramedullary nails has become the standard of care, with multiple options for entry point described, including piriformis entry, trochanter entry and retrograde femoral nails. Our present review describes the surgical anatomy of the proximal and distal femur and its relation to different entry points for intramedullary femoral nails. In addition, we reviewed relative indications for each technique, difficulties associated and possible complications.
Topics: Humans; Femoral Fractures; Bone Nails; Femur; Fracture Fixation, Intramedullary; Lower Extremity
PubMed: 37031048
DOI: 10.1016/j.cjtee.2023.03.006 -
International Journal of Surgery... Oct 2015Intramedullary nails (IM nails) now include dedicated fibular nails for lateral malleolus fractures. This study reviewed nail versus plate for fixation of unstable ankle... (Comparative Study)
Comparative Study Review
INTRODUCTION
Intramedullary nails (IM nails) now include dedicated fibular nails for lateral malleolus fractures. This study reviewed nail versus plate for fixation of unstable ankle fractures.
DESIGN
Systematic review and meta-analysis of published reports.
RESULTS
Four studies met the inclusion criteria, including 375 patients. Two included studies were randomised-control studies and two were non-randomised case series. The implants investigated included: Knowles Pins, Fibular Nails, Rush Rods and Inyo Nails. The overall risk of bias was high. Pooled data showed a statistically significant lower risk of wound infection (RR 0.10; 95% CI 0.02 to 0.44), symptomatic hardware (RR 0.14; 95% CI 0.05 to 0.35) and removal of hardware (RR 0.57; 95% CI 0.39 to 0.81) with intramedullary nail fixation.
CONCLUSIONS
There is a paucity of literature upon which to draw reliable conclusions. There was a high risk of bias towards favourable outcomes for the nail group. It would appear that intramedullary nail fixation of distal fibular fractures can outperform conventional fixation with plate and screws. There is a need for adequately powered, scientific trials.
Topics: Ankle Fractures; Bone Nails; Bone Plates; Fracture Fixation, Internal; Humans
PubMed: 26255000
DOI: 10.1016/j.ijsu.2015.07.697 -
Journal of Orthopaedic Surgery (Hong... 2022The concept of antibiotic-coated implants, mainly coated intramedullary nails, has become increasingly used for the treatment of fracture related infections. After a... (Review)
Review
The concept of antibiotic-coated implants, mainly coated intramedullary nails, has become increasingly used for the treatment of fracture related infections. After a long period of hand-made implants, commercially fabricated implants combine several benefits. Antibiotic-coated nails constitute a solid treatment option for unstable diaphyseal infections with fractures or non-unions. They release high concentrations of antibiotics locally, while retaining reduction and providing axial stability. This review aims to provide an overview about the background, the development, the indications, the treatment strategies and the outcomes of antibiotic-coated intramedullary nails.
Topics: Humans; Anti-Bacterial Agents; Bone Nails; Fractures, Bone; Fracture Fixation, Intramedullary; Treatment Outcome
PubMed: 36545939
DOI: 10.1177/10225536221118521