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Clinics (Sao Paulo, Brazil) Mar 2019The halo ring can be applied in children, through skeletal traction or a halo vest device, to treat many cervical spine pathologies, including traumatic injuries and... (Observational Study)
Observational Study
OBJECTIVES
The halo ring can be applied in children, through skeletal traction or a halo vest device, to treat many cervical spine pathologies, including traumatic injuries and pathologies related to deformities. However, the procedure is associated with various complications, such as infection, pin loosening, and respiratory and neurological problems. Although widely studied in adults, the best pin insertion site in children and the correlations of pin insertion sites with outcomes and complications have not been completely elucidated. This study aimed to determine alternative pin placement sites based on a morphological analysis of the infant skull by computerized tomography (CT).
METHODS
An analytical-descriptive study was performed using 50 CT scans from children. The Wilcoxon and Friedman tests were used.
RESULTS
A linear and directly proportional relation was found between cranial thickness and patient age. The average thicknesses of the anterior points across all ages analyzed ranged from 4.16 mm to 4.98 mm. The thicknesses of the posterior points varied from 3.94 mm to 4.27 mm. Within each age range, points 1 cm above the standard insertion sites had thicknesses similar to those of the standard sites, and points 2 cm above the standard insertion sites had thicknesses greater than those of the standard sites.
CONCLUSIONS
The cranial thickness at all points increases linearly with age. Points 1 and 2 cm above the standard insertion sites are viable alternatives for the placement of halo pins. Preoperative CT can aid in choosing the best positioning sites for pins in the skull.
Topics: Adolescent; Age Factors; Bone Nails; Cervical Vertebrae; Child; Child, Preschool; Female; Humans; Imaging, Three-Dimensional; Male; Orthotic Devices; Preoperative Care; Skull; Tomography, X-Ray Computed
PubMed: 30892417
DOI: 10.6061/clinics/2019/e781 -
Clinical Orthopaedics and Related... Jun 2019
Topics: Animals; Bone Nails; Books; Equipment Design; Fracture Fixation, Intramedullary; Fractures, Bone; Germany; History, 20th Century; Humans; Military Medicine; World War II
PubMed: 31094839
DOI: 10.1097/CORR.0000000000000792 -
International Journal of Surgery... Jul 2017The optimum treatment with intramedullary nails (IMN) or sliding hip screws (SHS) for type 31-A2 trochanteric fractures remains controversial. Therefore, we performed a... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
The optimum treatment with intramedullary nails (IMN) or sliding hip screws (SHS) for type 31-A2 trochanteric fractures remains controversial. Therefore, we performed a meta-analysis of randomized controlled trials (RCTs) to compare IMN with SHS in AO/OTA 31-A2 trochanteric fractures.
MATERIAL AND METHODS
Databases including PubMed, Cochrane, and Embase were searched to identify RCTs published before December 2016, which compared IMN with SHS for intraoperative and postoperative outcomes in AO/OTA 31-A2 trochanteric fractures.
RESULTS
A total of 909 patients from six RCTs were subjected to the meta-analysis. The results showed that the IMN group was associated with less operative blood loss, leg shortening, wound infections, length of hospital stay, and days to mobilization with walking aids and also yielded a higher Parker score as compared to the SHS group. No significant difference was seen in the other parameters including operative details, fracture fixation complications, postoperative complications, and 1 year mortality.
CONCLUSION
IMN fixation was found to be the superior treatment of choice for 31-A2 trochanteric fractures as compared with SHS fixation in our meta-analysis. The adverse effects appeared comparable between the two groups. However, due to the variations in the included studies, more large-sample, measures-unified, and high-quality RCTs are needed to validate these conclusions.
Topics: Adult; Bone Nails; Bone Screws; Fracture Fixation, Intramedullary; Hip Fractures; Humans; Length of Stay; Postoperative Period; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 28549994
DOI: 10.1016/j.ijsu.2017.05.042 -
BMC Musculoskeletal Disorders Dec 2017Treatment of displaced and angulated radial neck fractures in children is controversial and challenging. Numerous studies have been conducted regarding treatment...
BACKGROUND
Treatment of displaced and angulated radial neck fractures in children is controversial and challenging. Numerous studies have been conducted regarding treatment algorithms and surgical techniques that use fluoroscopy. However, ultrasonography (US)-guided reduction of pediatric radial neck fractures has not been reported yet. We aimed to determine the safety and efficacy of US-guided reduction and fixation of radial neck fractures in children.
METHODS
Among 28 cases of radial neck fracture from 2014 to 2016, 12 were classified as type III or IV according to the Judet classification. All 12 patients underwent US-guided reduction and percutaneous fixation with Kirschner wire and follow-up for more than 6 months. US was used primarily to monitor the angulation and reduction of the radial neck. Fluoroscopy was applied to confirm the fixation with Kirschner wire. Dose area product (DAP; mGy/cm) was measured to assess per-procedure radiation dose. Radiological and clinical results were evaluated at 6 months after the surgery by using the Metaizeau criteria.
RESULTS
Of the patients, 4 were boys and 8 were girls, with a mean age of 7.7 years (range, 5-11 years). Judet type III fractures accounted for 83% of all injuries. The mean preoperative radial angulation was 62.5° (range: 46°-76°). The mean postoperative radial angulation was 5.6° (range: 2°-9°). The mean fluoroscopy time was 31 s (range: 10-73 s), and the mean DAP was 10.7 mGy/cm (range: 7.2-18.7 mGy/cm). The mean follow-up period was 18.3 months (range, 8-24 months). According to the Metaizeau criteria, 10 cases were excellent and 2 cases were good at the last follow-up.
CONCLUSIONS
US-guided reduction and percutaneous fixation is safe and reliable option to treat displaced radial neck fractures in children.
Topics: Bone Nails; Child; Child, Preschool; Female; Fracture Fixation, Internal; Humans; Male; Monitoring, Intraoperative; Radius Fractures; Retrospective Studies; Ultrasonography, Interventional
PubMed: 29216921
DOI: 10.1186/s12891-017-1891-8 -
International Journal of Surgery... May 2016Intertrochanteric hip fracture is associated with increased morbidity. Currently, a dramatic change in practice was demonstrated, with the intramedullary fixation rate... (Comparative Study)
Comparative Study Meta-Analysis Review
INTRODUCTION
Intertrochanteric hip fracture is associated with increased morbidity. Currently, a dramatic change in practice was demonstrated, with the intramedullary fixation rate increasing, despite a lack of evidence in the literature supporting the change. As a minimally invasive technique, percutaneous compression plating (PCCP) has been advocated to reduce blood loss, relieve pain, and lead to faster rehabilitation for treatment of intertrochanteric hip fractures. The purpose of this meta-analysis was to estimate the outcomes and complications of the PCCP versus intramedullary nail (IMN) fixation for intertrochanteric fractures.
METHODS
A comprehensive search of related literature was conducted to identify all articles in Medline, Embase, Scopus, Research Gate, and the Cochrane Central Register of Controlled Trials published on or between January 1998 and January 2016. All studies that compared PCCP with IMN in treating adult patients with intertrochanteric fractures were included. Main outcomes about the two fixation method were collected and analysised using the Review Manager 5.1 provided by The Cochrane Collaboration.
RESULTS
Six trials involving 908 fractures met the inclusion criteria. Compared with IMN, PCCP had similar operation time, intraoperative blood loss, mortality, system complications, function score, function recovery, and reoperation rate (P > 0.05). But hospital stay, transfusion need, and incidence of implant-related complications significantly favored the PCCP (P < 0.05).
CONCLUSIONS
The PCCP was associated with less transfusion need, reduced hospital stay, and fewer incidence of implant-related complications compared with IMN. Although a change in practice was occurred, the patients treated with IMN seemed to face the potential for more complications. Owing to the limitations of this systematic review, more high-quality randomized controlled trials (RCTs) are still needed to confirm this conclusion.
Topics: Adult; Aged; Blood Transfusion; Bone Nails; Bone Plates; Female; Fracture Fixation, Internal; Hip Fractures; Humans; Length of Stay; Male; Operative Time; Postoperative Complications; Reoperation; Treatment Outcome
PubMed: 27063859
DOI: 10.1016/j.ijsu.2016.03.065 -
Journal of Orthopaedics and... Sep 2016Aggressive bone neoplasms, such as giant cell tumors, often affect the proximal tibia warranting bony resection via curettage leaving behind massive defects that require... (Comparative Study)
Comparative Study
BACKGROUND
Aggressive bone neoplasms, such as giant cell tumors, often affect the proximal tibia warranting bony resection via curettage leaving behind massive defects that require extensive reconstruction. Reconstruction is usually accomplished with poly(methyl methacrylate) (PMMA) packing supplemented with an internal fixation construct. The purpose of this study is to compare Steinmann pin augmentation to locking plate constructs to determine which offers the stiffer reconstruction option.
MATERIALS AND METHODS
Large defects were created below the lateral condyle of fresh frozen tibias. The defects extended for an average of 35 mm beneath the lateral plateau in the frontal plane, and from the anterior to posterior cortex in the sagittal plane. Distally the defect extended for an average of 35 mm to the metadiaphyseal junction. In the Pin group, the tibias were reconstructed with three 4-mm diameter Steinmann pins placed in the medullary canal and PMMA packing. In the Plate group, the tibias were reconstructed with a 6-hole 3.5-mm LCP Proximal locking plate fixed to the proximal-lateral tibia utilizing seven 3.5-mm screws and PMMA packing. The tibias were tested for stiffness on a MTS machine by applying up to 400 N to the tibial plateau in force control at 5 N/s. Fatigue properties were tested by applying a haversine loading waveform between 200 N and 1,200 N at 3 Hz simulating walking upstairs/downstairs.
RESULTS
Locking plate constructs (801.8 ± 78 N/mm) had greater (p = 0.041) stiffness than tibial constructs fixed with Steinmann pins (646.5 ± 206.3 N/mm).
CONCLUSIONS
Permanent deformation was similar between the Pin and Plate group; however, two tibia from the Pin group exhibited displacements >5 mm which we considered failure.
LEVEL OF EVIDENCE
n/a.
Topics: Bone Nails; Bone Plates; Cadaver; Female; Fracture Fixation, Internal; Fractures, Bone; Humans; In Vitro Techniques; Male; Middle Aged; Polymethyl Methacrylate; Tibia; Treatment Outcome
PubMed: 26883439
DOI: 10.1007/s10195-016-0394-y -
BMC Musculoskeletal Disorders May 2022The incidence and characteristics of iatrogenic comminution (IC) are unknown, and the influence of IC on fracture union is unclear. This study was aimed to investigate...
The characteristics and influence of iatrogenic fracture comminution following antegrade interlocking nailing for simple femoral shaft fractures, a retrospective cohort study.
AIM
The incidence and characteristics of iatrogenic comminution (IC) are unknown, and the influence of IC on fracture union is unclear. This study was aimed to investigate the (1) incidence and characteristics of IC and (2) the outcomes of IC following antegrade interlocking nailing of simple femoral shaft fractures.
METHODS
We retrospectively collected data on patients who experienced simple femoral shaft fractures and underwent antegrade interlocking nailing between February 2009 and December 2016. The incidence and characteristics of IC were examined. According to the presence of IC, patients were divided into two groups: an IC group and a non-IC (NIC) group. Demographic information and nonunion rates were compared between the two groups. Potential risk factors for IC (age, gender, body mass index (BMI), nail fit ratio, reduction technique, and greater trochanter nail entry) were analyzed using univariate and multivariate logistic regression. The aforementioned variables, along with IC occurrence, were also assessed as potential risk factors for nonunion at 12 and 24 months after operation using multivariate logistic regression.
RESULTS
Of the 211 total patients, IC occurred in 20.9% (n = 44) of patients. Most ICs were found at the level of the isthmus, and involved the medial cortex. Compared with the NIC group, higher nonunion rates were observed in the IC group at 12 months (31.8% vs. 12.5%, p = 0.002) and 24 months (18% vs. 6.5%, p = 0.017) after surgery. Age older than 35 years old was related with the occurrence of IC in univariate analysis. Multivariate analysis found no risk factor associated with IC. Open reduction technique, IC occurrence and higher BMI were identified as the risk factors of nonunion at 12 months and 24 months after surgery in multivariate analysis.
CONCLUSION
IC is a non-rare complication in antegrade interlocking nailing of simple femoral shaft fractures and was associated with higher nonunion rate. Age older than 35 years old showed a trend toward increasing risk of iatrogenic fracture comminution. In multivariate analysis, open reduction technique, IC occurrence and higher BMI significantly correlated with fracture nonunion.
LEVEL OF EVIDENCE
Level IV.
Topics: Adult; Bone Nails; Femoral Fractures; Fracture Fixation, Intramedullary; Fracture Healing; Fractures, Comminuted; Humans; Iatrogenic Disease; Retrospective Studies; Treatment Outcome
PubMed: 35568932
DOI: 10.1186/s12891-022-05418-2 -
PloS One 2023Tibiotalocalcaneal (TTC) arthrodesis is a procedure to treat severe ankle and subtalar arthropathy by providing pain free and stable fusion using IM nails. These nails...
Tibiotalocalcaneal (TTC) arthrodesis is a procedure to treat severe ankle and subtalar arthropathy by providing pain free and stable fusion using IM nails. These nails can be manufactured with multiple materials and some feature the ability to dynamize the arthrodesis construct. However, the impact of IM nail material and nail dynamization on load-sharing and in the setting of bone resorption have not been quantified. This work utilized a patient-specific finite element analysis model of TTC arthrodesis to investigate IM nails with differing material moduli and the impact of nail dynamization on load-sharing and intersegmental compression in the setting of bone resorption. Each nail was virtually inserted into a patient-specific model of a hindfoot, which was segmented into the three bones of the TTC complex and assigned material properties based on the densitometry of the bone. Compression, amount of load-sharing, and stress distributions after simulated bone resorption were quantified and compared between the varying IM nails. Simulations revealed that bone segments were only subjected to 17% and 22% of dynamic gait forces in the titanium and carbon fiber nail constructs, whereas the pseudoelastic NiTi nail constructs allowed for 67% of the same. The titanium and carbon fiber nails lost all initial compression in less than 0.13mm of bone resorption, whereas the NiTi nail maintained compression through all simulated values of bone resorption. These data highlight the poor load-sharing of static nail TTC arthrodesis constructs and the ability of a pseudoelastic IM nail construct to maintain intersegmental compression when challenged with bone resorption.
Topics: Humans; Titanium; Bone Nails; Finite Element Analysis; Carbon Fiber; Ankle Joint; Arthrodesis; Bone Resorption
PubMed: 37972050
DOI: 10.1371/journal.pone.0288049 -
Archives of Orthopaedic and Trauma... Dec 2022Magnetic internal lengthening nails (MILNs) have been used for femoral lengthening to avoid complications associated with external fixation. The titanium version of the...
INTRODUCTION
Magnetic internal lengthening nails (MILNs) have been used for femoral lengthening to avoid complications associated with external fixation. The titanium version of the MILN (PRECICE) has been in use since 2011 but had limitations (50-75 lb) in post-operative weight bearing. A new stainless-steel version of the MILN (STRYDE) allows 150-250 lb of post-operative weight bearing. The aim is to compare the outcomes of using these two different MILNs for both unilateral and bilateral femoral lengthening.
METHODS
A single-center, retrospective cohort study was conducted in which patients' records were reviewed from the period from January 2017 to March 2020. A total of 66 femoral lengthening procedures were included in the study and were divided into two groups: STRYDE group (30 femora) and PRECICE group (36 femora). Outcomes assessed were the 6-months post-operative Limb Deformity-Scoliosis Research Society (LD-SRS) Score, adjacent joint range of motion (ROM), average distraction rate, bone healing index (BHI), and complications.
RESULTS
No statistically significant difference was found between the two groups in regard to the (LD-SRS) score, hip ROM, or knee ROM. Statistically significant differences were found between the two groups in regard to BHI (average of 0.84 months/cm and 0.67 months/cm for STRYDE and PRECICE, respectively) and distraction rate (average of 0.6 mm/day and 0.9 mm/day for STRYDE and PRECICE, respectively). No mechanical nail complications were reported in the STRYDE group compared to three events of nail failure in the PRECICE group. One femur in the PRECICE group needed BMAC injection for delayed healing compared to four femurs in the STRYDE group.
CONCLUSION
The STRYDE MILN yields comparable functional results to those of PRECICE MILN and shows fewer mechanical nail complications. However, STRYDE MILN requires a slower distraction rate and yields slower healing (larger BHI).
LEVEL OF EVIDENCE
Level III, Therapeutic study.
Topics: Humans; Bone Lengthening; Leg Length Inequality; Bone Nails; Retrospective Studies; Nails; Titanium; Treatment Outcome; Femur; Magnetic Phenomena; Steel
PubMed: 33983528
DOI: 10.1007/s00402-021-03943-8 -
Veterinary Surgery : VS Oct 2017To investigate the feasibility of placing bi-cortical cortex (B-cort) or mono-cortical locking screws (M-lock) in a plate-rod construct applied to the feline tibia in...
OBJECTIVE
To investigate the feasibility of placing bi-cortical cortex (B-cort) or mono-cortical locking screws (M-lock) in a plate-rod construct applied to the feline tibia in combination with different intramedullary (IM) pins.
METHODS
Twenty-four feline tibiae of cats were divided into 4 groups, corresponding to IM pin sizes filling approximately 30% (1.0 mm), 40% (1.4 mm), 45% (1.6 mm), and 50% (1.8 mm) of the medullary canal. Computed tomography (CT) was performed to trace potential screw trajectories in each group. A 12-hole, 2.4 mm locking compression plate was then applied on the medial aspect of the tibia. M-lock and B-cort screws were inserted subsequently in each plate hole. Success rates of screw insertion based on CT analysis and cadaveric simulation were compared with screw type, IM pin diameter, and anatomic location as variables.
RESULTS
Screw insertion rates were underestimated on CT compared to cadaveric specimens. During cadaveric simulation, B-cort screws could be inserted in all specimens in the 3 most proximal plate holes and in at least 1 of the 3 distal plate holes. The smallest pin size (30%) allowed placement of a greater number of B-cort screws (P < .05) compared to other pins. Fewer B-cort screws could be inserted in the distal diaphyseal region (P < .05) compared to other regions. A total of 99.3% of M-lock screws could be inserted regardless of IMP size.
CLINICAL SIGNIFICANCE
Plate rod constructs can include bicortical screws in the proximal and distal metaphysis, and monocortical screws in the diaphysis, combined with an IM pin filling up to 50% of the medullary canal.
Topics: Animals; Biomechanical Phenomena; Bone Nails; Bone Plates; Bone Screws; Cats; Diaphyses; Fracture Fixation, Internal; Humans; Tibia; Tomography, X-Ray Computed
PubMed: 28640396
DOI: 10.1111/vsu.12678