RESUMEN
Hangman's fracture occurs in the elderly following low kinetic energy fall from their height, or in the young during traffic accident. Classically described as bipedicular C2 fracture, Hangman's fracture results from oblique hyperextension-flexion vector forces which can lead to anterior dislocation of C1C2 complex over C3 vertebral body in case of associated damage to C2C3 disc and ligaments. Even though most cases of Hangman's fracture are not displaced (grade 1) and can be managed with orthopaedic treatment using cervical brace, highly displaced cases of Hangman's fractures (some grade 2, all grade 3) require surgical stabilization. Given the limited capabilities of reduction and the odds for mechanical failure of anterior C2C3 discectomy and fusion, we provide a reproducible method using a specific rod persuader on C1 screws aiming to realign and stabilize displaced cases of Hangman fracture using the C1C3 "Harms-Goel" procedure.
Asunto(s)
Vértebras Cervicales , Fracturas de la Columna Vertebral , Fusión Vertebral , Humanos , Fracturas de la Columna Vertebral/cirugía , Vértebras Cervicales/cirugía , Vértebras Cervicales/lesiones , Fusión Vertebral/métodos , Fijación Interna de Fracturas/métodos , Masculino , Anciano , Tornillos Óseos , Femenino , Resultado del TratamientoRESUMEN
The current primary treatment approach for malignant pelvic tumors involves hemipelvic prosthesis reconstruction following tumor resection. In cases of Enneking type II + III pelvic tumors, the prosthesis necessitates fixation to the remaining iliac bone. Prevailing methods for prosthesis fixation include the saddle prosthesis, ice cream prosthesis, modular hemipelvic prosthesis, and personalized prosthetics using three-dimensional printing. To prevent failure of hemipelvic arthroplasty protheses, a novel fixation method was designed and finite element analysis was conducted. In clinical cases, the third and fourth sacral screws broke, a phenomenon also observed in the results of finite element analysis. Based on the original surgical model, designs were created for auxiliary dorsal iliac, auxiliary iliac bottom, auxiliary sacral screw, and auxiliary pubic ramus fixation. A nonlinear quasi-static finite element analysis was then performed under the maximum load of the gait cycle, and the results indicated that assisted sacral dorsal fixation significantly reduces stress on the sacral screws and relative micromotion exceeding 28 µm. The fixation of the pubic ramus further increased the initial stability of the prosthesis and its interface osseointegration ability. Therefore, for hemipelvic prostheses, incorporating pubic ramus support and iliac back fixation is advisable, as it provides new options for the application of hemipelvic tumor prostheses.
Asunto(s)
Análisis de Elementos Finitos , Neoplasias Pélvicas , Humanos , Neoplasias Pélvicas/cirugía , Ilion/cirugía , Femenino , Tornillos Óseos , Huesos Pélvicos/cirugía , Masculino , Diseño de Prótesis , Impresión Tridimensional , Prótesis e Implantes , Sacro/cirugíaRESUMEN
During the last decades, effective pain reduction and early mobilization were identified as the central priorities in therapy of insufficiency fractures of the pelvis. For operative treatment minimally-invasive stabilization techniques are favored. While there is consensus on the significance of sufficient dorsal stabilization the role of additional fixation of the anterior fracture component stays under discussion. Within the present study we developed an internal ring fixator system (RingFix) with the question whether an in-itself-closed construct can improve stability of the entire ring structure. RingFix was evaluated on an osteoporotic bone model with a standardized FFP IIIc fracture within an established biomechanical setup regarding its primary stabilization potential. Further, it was compared to transiliac-transsacral screw fixation with and without stabilization of the anterior fracture component. The transiliac-transsacral fixation with separate screw fixation of the anterior fracture showed significantly higher stability than the RingFix and the transiliac-transsacral screw fixation without anterior stabilization. Our results show that stabilization of the anterior fracture component relevantly improves the stability of the entire ring construct. As a bridging stabilizer, RingFix shows biomechanical advantages over an isolated dorsal fracture fixation, but inferior results than direct stabilization of the single fracture components.
Asunto(s)
Fijación Interna de Fracturas , Huesos Pélvicos , Humanos , Huesos Pélvicos/lesiones , Huesos Pélvicos/cirugía , Fenómenos Biomecánicos , Fijación Interna de Fracturas/métodos , Fijación Interna de Fracturas/instrumentación , Tornillos Óseos , Fijadores Internos , Fracturas Óseas/cirugía , Osteoporosis/cirugíaRESUMEN
The use of a filling block can improve the initial stability of the fixation plate in the open wedge high tibial osteotomy (OWHTO), and promote bone healing. However, the biomechanical effects of filling block structures and materials on OWHTO remain unclear. OWHTO anatomical filling block model was designed and built. The finite element analysis method was adopted to study the influence of six filling block structure designs and four different materials on the stress of the fixed plate, tibia, screw, and filling block, and the micro-displacement at the wedge gap of the OWHTO fixation system. After the filling block was introduced in the OWHTO, the maximum von Mises stress of the fixation plate was reduced by more than 30%, the maximum von Mises stress of the tibia decreased by more than 15%, and the lateral hinge decreased by 81%. When the filling block was designed to be filled in the posterior position of the wedge gap, the maximum von Mises stress of the fixation system was 97.8 MPa, which was smaller than other filling methods. The minimum micro-displacement of osteotomy space was -2.9 µm, which was larger than that of other filling methods. Compared with titanium alloy and tantalum metal materials, porous hydroxyapatite material could obtain larger micro-displacement in the osteotomy cavity, which is conducive to stimulating bone healing. The results demonstrate that OWHTO with a filling block can better balance the stress distribution of the fixation system, and a better fixation effect can be obtained by using a filling block filled in the posterior position. Porous HA used as the material of the filling block can obtain a better bone healing effect.
Asunto(s)
Placas Óseas , Análisis de Elementos Finitos , Osteotomía , Impresión Tridimensional , Tibia , Osteotomía/métodos , Tibia/cirugía , Humanos , Fenómenos Biomecánicos , Estrés Mecánico , Tornillos ÓseosRESUMEN
OBJECTIVE: To propose a screw algorithm and investigate the anatomical feasibilities and clinical outcomes of five distinct fixation methods for C2-3 fused vertebra with high-ridding vertebral arteries (VA) (HRVA) when the C2 pedicle screw placement is unfeasible. METHODS: Thirty surgical patients with congenital C2-3 fusion, HRVA, and atlantoaxial dislocation (AAD) were included. We designed a algorithm for alternative screw implantation into C2-3 fused vertebrae, including C2 pedicle screw with in-out-in (passing VA groove) technique (in-out-in screw), subfacetal screw, translaminar screw, lateral mass screw, C3 pedicle screw. VA diameter and position, C2 and C3 pedicles, superior facets, fused lamina, and fused lateral mass dimensions were evaluated for screw implantation indication. Implant failure, reduction loss, implant placement accuracy were investigated by computed tomography. RESULTS: A total of 5 VAs were identified as distant VAs; a total of 2 VAs were categorized as occlusive VAs. Sufficient dimension of lateral mass and lamina provided the broadest indications for screw implantation, while the distant or occlusive VA provided the most limited indications for in-out-in screw. The indications of five alternative methods ranged from narrowest to widest as follows: in-out-in screw, C3 pedicle screw, subfacetal screw, translaminar screw, lateral mass screw. The translaminar screws and the lateral mass screws increased the probability of implant failure. All patients who received in-out-in screws, C3 pedicle screws, and subfacetal screws achieved fusion. The accuracy ranged from lowest to highest as follows: C3 pedicle screw, lateral mass screw, in-out-in screw, subfacetal screw, translaminar screw. No translaminar screws deviated. CONCLUSIONS: The algorithm proved to be a valuable tool for screw selection in cases of C2-3 fused vertebrae with HRVAs. The subfacetal screw, boasting broad indications, a high fusion rate, and exceptional accuracy, stood as the primary preferred alternative.
Asunto(s)
Algoritmos , Tornillos Pediculares , Fusión Vertebral , Arteria Vertebral , Humanos , Masculino , Fusión Vertebral/métodos , Femenino , Adulto , Arteria Vertebral/cirugía , Persona de Mediana Edad , Resultado del Tratamiento , Adulto Joven , Adolescente , Vértebras Cervicales/cirugía , Articulación Atlantoaxoidea/cirugía , Tornillos Óseos , AncianoRESUMEN
PURPOSE: This study aimed to compare the clinical outcomes and differences in biomechanical characteristics between the femoral neck system (FNS) and cannulated cancellous screws (CCSs) in the treatment of femoral neck fractures. METHODS: This study retrospectively analysed a cohort of 38 registered cases of femoral neck fractures treated surgically with either the FNS (n = 17) or CCSs (n = 21) between January 2020 and December 2023. Indicators such as fluoroscopy frequency, length of hospital stay, and fracture healing time were compared between the two groups. Functional status was evaluated via the Harris hip score (HHS) and visual analogue scale (VAS), whereas prognosis was assessed based on changes in the neck shaft angle and femoral neck shortening. Additionally, six sets of femoral neck fracture models were developed based on Pauwels angles of 30°, 40°, 50°, 60°, 70°, and 80°. Two experimental groups, FNS and CCS, were established, and a joint reaction force of 1800 N was applied to the proximal femur. The displacement, stress, and stiffness of the components of interest in the different models were tested and compared. RESULTS: The distributions of all the baseline characteristics were similar between the two groups (p > 0.05). The FNS group presented significantly shorter fluoroscopy frequency, length of hospital stay, and fracture healing time (p < 0.05). Harris and VAS scores were higher in the FNS group than in the CCS group (p < 0.05). Postoperative changes in the neck shaft angle and femoral neck shortening were significantly lower in the FNS group than in the CCS group (p < 0.05). The results of the finite element analysis indicated that the maximum stress on the femoral head and varus angle were generally lower in the FNS group than in the CCS group and that the maximum displacement of the femoral head and FNS was generally lower in the FNS group than in the CCS group. However, the superiority of FNS over CCS decreased with increasing Pauwels angle. Additionally, the effectiveness of FNS in limiting displacement of the femoral neck upper wall was not as favourable as that of CCS. CONCLUSIONS: The treatment of femoral neck fractures with FNS is superior and contributes to improved hip joint function. Biomechanical research has confirmed its structural stability and advantages in resisting femoral head varus. However, challenges to its fixation efficacy persist, particularly at higher Pauwels angles.
Asunto(s)
Tornillos Óseos , Fracturas del Cuello Femoral , Fijación Interna de Fracturas , Humanos , Fracturas del Cuello Femoral/cirugía , Fracturas del Cuello Femoral/fisiopatología , Femenino , Masculino , Estudios Retrospectivos , Persona de Mediana Edad , Anciano , Fenómenos Biomecánicos , Fijación Interna de Fracturas/instrumentación , Fijación Interna de Fracturas/métodos , Resultado del Tratamiento , Curación de Fractura , Cuello Femoral/cirugía , Cuello Femoral/diagnóstico por imagen , Tiempo de Internación , Anciano de 80 o más AñosRESUMEN
BACKGROUND: Displaced femoral neck fractures are associated with a high revision rate. The new femoral neck system(FNS) offers advantages in fixation stability, potentially reducing the need for revision. The purpose of this study was to compare the revision rate of patients with different reduction quality treated with the FNS and cannulated screws (CS). METHODS: This retrospective study included patients with Garden III or IV femoral neck fractures who underwent osteosynthesis in a level 1 trauma center between July 2019 and June 2023. A total of 141 cases met the inclusion criteria and received treatment with either the FNS (N = 65) or CS (N = 76). The quality of fracture reduction, surgical complications (such as femoral neck shortening, avascular necrosis of femoral head, nonunion of fracture, implant failure and withdrawal), revision surgery and the reasons for revision were analyzed. RESULTS: The mean age of the 141 cases was 52.0 years (range 18-65); with sixty-five cases being male (46.1%). Eighty-four fractures (59.6%) were classified as Garden type III. Reduction quality was good in 71 cases (50.4%) and fair in 70 cases. The mean follow-up period was 25.9 months (range 12-46). A total of 26 cases(18.4%) underwent revision surgery. The revision rate in cases with good reduction was 11.3% (8/71 cases), with seven cases (four hardware removal and three arthroplasty) in the CS group and one case (arthroplasty for fracture nonunion and implant failure) in the FNS group, a significant difference was found between the two groups(P = 0.041). Among the 18 cases (25.7%, 18/70) with fair reduction who underwent revision surgery, nine cases (six hardware removal and three arthroplasty) in the CS group, and nine cases (arthroplasty for implant failure and cut-out) in the FNS group, and there was no significant difference between the two groups (P = 0.672). The total revision rate between the FNS group (15.4%, 10/65) and the CS group (21.1%, 16/76) was not significantly different (P = 0.387). CONCLUSIONS: The total revision rate between the FNS and CS group showed no difference. However, in cases with good reduction, the revision rate was lower in the FNS group compared to the CS group.
Asunto(s)
Tornillos Óseos , Fracturas del Cuello Femoral , Fijación Interna de Fracturas , Reoperación , Humanos , Fracturas del Cuello Femoral/cirugía , Estudios Retrospectivos , Masculino , Femenino , Reoperación/estadística & datos numéricos , Adulto , Persona de Mediana Edad , Fijación Interna de Fracturas/métodos , Fijación Interna de Fracturas/instrumentación , Anciano , Adulto Joven , Adolescente , Estudios de Seguimiento , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiologíaRESUMEN
STATEMENT OF PROBLEM: The demand for immediate implant placement (IIP) in the esthetic zone is rapidly increasing. Despite the treatment's benefits, the sagittal root position often dictates implant angulation, commonly necessitating the use of cement-retained restorations. This study investigates the impact of angulated screw channel on IIP in the esthetic zone. PURPOSE: The purpose of this cone-beam computed tomography (CBCT) study was to determine the probability of IIP in the esthetic zone, using four different implant angulations. MATERIALS AND METHODS: A retrospective review of CBCT images was conducted and accessed on 9 June 2021. The midsagittal images of maxillary anterior teeth were input into an implant planning software (Implant Studio®). Bone Level X Straumann® implant (BLX 3.5, 3.75, 4.0, 4.5, 5.0 mm) and Bone Level Tapered implant (BLT 2.9, 3.3 mm) were selected for 3D implant planning of IIP in the esthetic zone. The frequency distribution and probability of IIP were recorded and compared among all maxillary anterior teeth. RESULTS: CBCT images from 720 teeth (120 patient) were evaluated, revealing an overall probability of IIP in the esthetic zone is 76.11% (548/720). Different implant restoration type was evaluated in this study, with the following results; straight screw-retained prosthesis at 3.47% (19/548), cement-retained prosthesis at 14.59% (80/548) and angle screw-retained prosthesis at 85.40% (468/548). CONCLUSION: IIP with traditional straight screw-retained prosthesis demonstrated the lowest probability. Nevertheless, the use of angulated screw channels enhances the probability of achieving straight screw-retained prostheses. CLINICAL IMPLICATIONS: The angulated screw channel is essential for increasing the probability of screw-retained prosthesis in IIP in the esthetic zone. However, limitation in screw angle correction still necessitate the use of cement-retained prostheses for numbers of patients undergoing IIP.
Asunto(s)
Tornillos Óseos , Tomografía Computarizada de Haz Cónico , Carga Inmediata del Implante Dental , Humanos , Tomografía Computarizada de Haz Cónico/métodos , Estudios Retrospectivos , Femenino , Masculino , Carga Inmediata del Implante Dental/métodos , Persona de Mediana Edad , Adulto , Maxilar/cirugía , Maxilar/diagnóstico por imagen , Estética Dental , Implantes Dentales , AncianoRESUMEN
OBJECTIVES: To identify whether intramaxillary miniscrew anchorage could achieve a better maxillary arch distalization effect in clear aligner treatment compared to Class II elastics. MATERIALS AND METHODS: Thirty adult patients with Class II dentition who were treated with whole maxillary arch distalization using clear aligners were collected. Either intramaxillary miniscrew anchorage (miniscrew group, n = 17) or intermaxillary Class II elastics (Class II elastic group, n = 13) were used to support maxillary arch distalization. Three-dimensional predicted and achieved displacements, and angular changes of maxillary posterior teeth and anterior teeth, were measured and compared. RESULTS: The achieved distalization efficiency was 36.2%-43.9% in the posterior teeth and the retraction efficiency was 36.9%-49.4% in the anterior teeth. No statistically significant differences were found in maxillary arch distalization efficiency between the groups. The miniscrew group achieved less incisor extrusion and posterior tooth distal tipping than the Class II elastic group. Both groups achieved comparable arch expansion, posterior tooth buccal inclination, and anterior tooth lingual inclination. CONCLUSIONS: Intramaxillary miniscrew anchorage and intermaxillary Class II elastics achieved comparable efficiency in maxillary arch distalization. However, the miniscrew anchorage showed better vertical control in anterior teeth and mesiodistal tipping control in posterior teeth.
Asunto(s)
Tornillos Óseos , Maloclusión Clase II de Angle , Maxilar , Métodos de Anclaje en Ortodoncia , Técnicas de Movimiento Dental , Humanos , Métodos de Anclaje en Ortodoncia/instrumentación , Métodos de Anclaje en Ortodoncia/métodos , Femenino , Masculino , Técnicas de Movimiento Dental/instrumentación , Técnicas de Movimiento Dental/métodos , Adulto , Maloclusión Clase II de Angle/terapia , Adulto Joven , Diseño de Aparato OrtodóncicoRESUMEN
A bone-borne full-arch vertical control strategy using miniscrews was deployed with aligners to treat a case of skeletal hyperdivergent Class II malocclusion with bimaxillary protrusion. Miniscrews were inserted in the posterior buccal and palatal regions and the anterior buccal region of the maxilla to distribute vertical intrusive force through the upper arch by anchoring vertical elastics from the miniscrews to the aligners. Synergetic lower anterior intrusion was completed using bilateral posterior miniscrews to counteract the extrusive force generated. Substantial full upper arch and lower anterior vertical intrusion was achieved. In conjunction with en masse anterior-posterior retraction, synergetic posterior and anterior vertical intrusion facilitated counterclockwise rotation of the mandible, creating significant esthetic improvement. Anterior vertical elastics also provided flaring of the anterior teeth, reducing the side effect of lingual tipping from en masse retraction, while successfully controlling overbite and incisor torque during space closure. The bone-borne full-arch vertical intrusion strategy can work well with aligners to address hyperdivergent skeletal Class II malocclusion with bimaxillary protrusion.
Asunto(s)
Tornillos Óseos , Maloclusión Clase II de Angle , Métodos de Anclaje en Ortodoncia , Técnicas de Movimiento Dental , Humanos , Maloclusión Clase II de Angle/terapia , Técnicas de Movimiento Dental/instrumentación , Técnicas de Movimiento Dental/métodos , Métodos de Anclaje en Ortodoncia/instrumentación , Métodos de Anclaje en Ortodoncia/métodos , Diseño de Aparato Ortodóncico , Femenino , Cefalometría , Maxilar , Sobremordida/terapiaRESUMEN
OBJECTIVES: To examine dentoalveolar changes following intrusion of maxillary incisors with one or two anterior miniscrews in subjects with gummy smile and deep bite. MATERIALS AND METHODS: Forty-three subjects were selected and divided into two groups: group I (22 subjects: 15 women, 7 men; mean age 30 ± 10 years) received one miniscrew between the upper central incisors, and group II (21 subjects: 16 women, 5 men; mean age 30 ± 10 years) received two miniscrews between the canines and lateral incisors. Dentoalveolar parameters, including amount of intrusion, root resorption, incisor inclination, alveolar bone thickness, and buccal alveolar crest height (cementoenamel junction to labial alveolar crest), were evaluated using cone-beam computed tomography scans obtained before and after intrusion. The intergroup comparison was analyzed using a paired t-test and unpaired t-test to determine significant changes within and between groups. RESULTS: The amount of intrusion was significantly greater in group II than in group I (P < .05). No statistically significant differences were found between groups I and II for changes in incisor inclination, labial bone thickness, and buccal alveolar crest height (P > .05). CONCLUSIONS: Maxillary central and lateral incisor intrusion was significantly greater in subjects treated with two miniscrews. Root resorption of the maxillary central incisors was notably greater in subjects with one miniscrew, while maxillary lateral incisor resorption was greater in subjects treated with two miniscrews.
Asunto(s)
Tornillos Óseos , Tomografía Computarizada de Haz Cónico , Incisivo , Maxilar , Métodos de Anclaje en Ortodoncia , Sonrisa , Técnicas de Movimiento Dental , Humanos , Femenino , Técnicas de Movimiento Dental/métodos , Técnicas de Movimiento Dental/instrumentación , Masculino , Incisivo/diagnóstico por imagen , Adulto , Maxilar/diagnóstico por imagen , Tomografía Computarizada de Haz Cónico/métodos , Métodos de Anclaje en Ortodoncia/instrumentación , Métodos de Anclaje en Ortodoncia/métodos , Proceso Alveolar/diagnóstico por imagen , Proceso Alveolar/patología , Adulto Joven , Sobremordida/terapia , Resorción Radicular/diagnóstico por imagen , Resorción Radicular/etiologíaRESUMEN
OBJECTIVES: To evaluate anchorage loss after en masse retraction in bimaxillary dentoalveolar protrusion patients using friction vs frictionless mechanics. MATERIALS AND METHODS: Thirty patients with bimaxillary dentoalveolar protrusion needing extraction of upper first premolars and en masse retraction with maximum anchorage were included in this two-arm, parallel, single-center, single-blinded randomized clinical trial with a 1:1 allocation ratio using fully sealed opaque envelopes. Friction group retraction utilized elastomeric power chain between miniscrews and hooks crimped mesial to upper canines on 17 × 25 stainless steel archwire. Frictionless group used customized T-loop springs loading upper first molars indirectly anchored to miniscrews. Activation was every 4 weeks until full retraction. The primary outcome assessed was anchorage loss evaluated at cusp tip and root apex of the first molar. First molar rotation, incisor tip and torque, and root resorption of anterior teeth were evaluated on digital models and cone beam computed tomography taken before and after space closure. RESULTS: Anchorage loss at crown of first molar was significantly more in frictionless group by 2.1 mm (95% CI = -0.4 to 3.5), (P = .014), while there was no significant difference in anchorage loss at root apex between groups. Significant mesial in molar rotation of 6.672° (95% CI = 12.2-21.2), (P = 0.02) was greater in the frictionless group. Both groups showed comparable tip, torque, and root resorption values. No severe harms were reported. There was mild gingival overgrowth and inflammation in the frictionless group due to T-loop irritation. CONCLUSIONS: Extra anchorage considerations are needed during en masse retraction when frictionless mechanics is implemented as higher anchorage loss and molar rotation were detected. No difference in tip, torque, and root resorption was observed.
Asunto(s)
Fricción , Métodos de Anclaje en Ortodoncia , Técnicas de Movimiento Dental , Humanos , Métodos de Anclaje en Ortodoncia/instrumentación , Métodos de Anclaje en Ortodoncia/métodos , Femenino , Masculino , Adolescente , Técnicas de Movimiento Dental/métodos , Técnicas de Movimiento Dental/instrumentación , Método Simple Ciego , Alambres para Ortodoncia , Diente Molar , Tomografía Computarizada de Haz Cónico/métodos , Maxilar , Adulto Joven , Resorción Radicular/etiología , Resorción Radicular/diagnóstico por imagen , Torque , Diseño de Aparato Ortodóncico , Tornillos Óseos , Cierre del Espacio Ortodóncico/instrumentación , Cierre del Espacio Ortodóncico/métodosRESUMEN
BACKGROUND: Distal tibial fractures remains a significant challenge in orthopedic trauma surgery. As the fracture level approaches the joint, alternative fixation options instead of intramedullary nailing (IMN) come to the fore. The present study aimed to assess the biomechanical stability of IMN at different distal tibial fracture levels and the number of locking screws required. METHODS: Using a total of 21 sawbone models, 3 different tibial fracture levels (3, 4.5, and 6 cm proximally to the talocrural joint) were created and the fractures were fixed using 2, 3, or 4 distal locking screws. A single compression force at a speed of 30 mm/min with a maximum force of 800 Newton and a cyclic compression force of 60 cycles at a speed of 60 mm/min was applied to all tibia models. The applied weight and displacements from the fracture lines were recorded and evaluated. RESULTS: There was no statistically significant difference in fixation with 2 distal locking screws in groups 1, 2, and 3 (single test P =.9689) (cyclic test P =.8050). Therefore, if 2 distal screws are used, the fracture level does not affect the strength of fixation. In fractures located 6 cm proximal to the talocrural joint, all 4 holes of the nail can be used to insert screws, which provides a stronger fixation. When 2 screws are used, a statistically weaker fixation is obtained than with 3 or 4 screws. However, there is no significant difference between using 3 or 4 screws. CONCLUSION: Our findings support the use of IMN with 2 distal locking screws as a viable option for the management of distal tibial fractures. We found that it provides sufficient fixation regardless of the fracture level, suggesting that there is no need to choose an alternative fixation technique due to concerns of inadequate fixation as the fracture line moves distally. In cases where more stable fixation is desired, an additional locking screw can be used, but the potential increase in procedure and fluoroscopy time should be considered.
Asunto(s)
Tornillos Óseos , Fijación Intramedular de Fracturas , Fracturas de la Tibia , Fijación Intramedular de Fracturas/métodos , Fijación Intramedular de Fracturas/instrumentación , Fracturas de la Tibia/cirugía , Humanos , Fenómenos Biomecánicos , Clavos Ortopédicos , Modelos AnatómicosRESUMEN
In this article, we attempted to identify risk factors affecting the loss of vertebral height and kyphosis correction on type A thoracolumbar fractures. Patients with type A thoracolumbar fractures who underwent short segments with intermediate screws at the fracture level management between 2017 and 2022 were included in this study. Clinical factors including patients' demographic characteristics (age, sex), history (smoking, hypertension and/or diabetes), value of height/kyphosis correction, the thoracolumbar injury classification and severity score (TLICS), the load sharing classification (LSC) scores and bone mineral density were collected. Correlation coefficient, simple linear regression analysis and multivariate regression analysis were performed to identify the clinical factors associated with the loss of vertebral height/kyphosis correction. Finally, 166 patients were included in this study. The mean height and kyphosis correction were 21.8%â ±â 7.5% and 9.9°â ±â 3.8°, respectively, the values of the loss were 6.5%â ±â 4.0% and 3.9°â ±â 1.9°, respectively. Simple linear regression analysis and multivariate regression analysis showed that age, value of height correction, LSC scores and bone mineral density were significantly associated with the loss of vertebral height and kyphosis correction (Pâ <â .01) We could draw the conclusion that patients with older age, lower bone mineral density, higher LSC scores and diabetes are at higher risk of vertebral height and kyphosis correction loss increase. For these patients, appropriate clinical measures such as long segment fixation, control of blood glucose, and increase of bone density must be taken to reduce the loss of correction.
Asunto(s)
Cifosis , Vértebras Lumbares , Fracturas de la Columna Vertebral , Vértebras Torácicas , Humanos , Masculino , Femenino , Estudios Retrospectivos , Vértebras Torácicas/lesiones , Vértebras Torácicas/cirugía , Persona de Mediana Edad , Fracturas de la Columna Vertebral/cirugía , Fracturas de la Columna Vertebral/etiología , Vértebras Lumbares/lesiones , Vértebras Lumbares/cirugía , Cifosis/cirugía , Cifosis/etiología , Adulto , Tornillos Óseos , Factores de Riesgo , Fijación Interna de Fracturas/métodos , Fijación Interna de Fracturas/efectos adversos , Fijación Interna de Fracturas/instrumentación , Anciano , Densidad ÓseaRESUMEN
BACKGROUND: Ogden type V tibial tubercle avulsion fracture is an unusual type of physial injury. Thus, little is known about its mechanism of injury and treatment. The type of osteosynthesis is variable and depends on the experience of the surgeon. We commonly used cancellous screws fixation combined with tension band wiring for displaced fracture of the anterior tibial tuberosity. CASE PRESENTATION: The present manuscript describes a case of a Han nationality 13-year-old boy who presented with severe pain of the left knee, which began after landing following a high jump. He had no significant past medical history apart from a high body mass index of 30.3. Radiographs revealed that he had an unusual Ogden type V tibial tubercle avulsion fracture. He was treated by open reduction and combined fixation with cannulated screws and tension-band wiring. After 3 months, the fracture healed without any complications or knee symptoms with full range of motion. He underwent reoperation for symptomatic hardware, which was removed at 5 months after initial surgery, and returned to his prior level of sporting activity at 1 year follow-up. CONCLUSION: Our case suggests that excellent functional outcome could be achievable by open reduction with the combination of internal fixation and tension-band wiring for Ogden type V tibial tubercle avulsion fracture. This type of osteosynthesis could not only achieve anatomical reduction and stable fixation for such fractures, but also avoid further damage to the proximal tibial epiphysis, which prevents serious complications, such difference in leg length.
Asunto(s)
Tornillos Óseos , Fijación Interna de Fracturas , Fracturas por Avulsión , Fracturas de la Tibia , Humanos , Masculino , Adolescente , Fijación Interna de Fracturas/métodos , Fracturas de la Tibia/cirugía , Fracturas de la Tibia/diagnóstico por imagen , Fracturas por Avulsión/cirugía , Fracturas por Avulsión/diagnóstico por imagen , Resultado del Tratamiento , Radiografía , Hilos Ortopédicos , Rango del Movimiento Articular , Reoperación , Reducción Abierta/métodosRESUMEN
CASE: We present a case of robot-assisted placement of 3 trans-sacral transiliac screws through a single corridor for an unstable U-type sacral fracture in a 95-year-old woman. She had persistent pain and inability to mobilize with physical therapy. At 3-month follow-up, the patient had evidence of interval healing and stable hardware and was able to return to her prior functional baseline. CONCLUSION: We demonstrate successful utilization of robotics to place 3 trans-sacral transiliac screws in a single corridor for fixation of an unstable pelvic ring injury. This technique was used to overcome challenges with visualization and implant placement.
Asunto(s)
Tornillos Óseos , Fijación Interna de Fracturas , Procedimientos Quirúrgicos Robotizados , Sacro , Fracturas de la Columna Vertebral , Humanos , Femenino , Sacro/cirugía , Sacro/lesiones , Sacro/diagnóstico por imagen , Procedimientos Quirúrgicos Robotizados/métodos , Fijación Interna de Fracturas/instrumentación , Fijación Interna de Fracturas/métodos , Anciano de 80 o más Años , Fracturas de la Columna Vertebral/cirugía , Fracturas de la Columna Vertebral/diagnóstico por imagenRESUMEN
Plate fixation is a common treatment option for radial head fractures (RHFs). Due to the benefits of less invasiveness and fewer complications of internal fixation, the application of small-diameter headless compression screws (HCSs) to treat RHFs has become a new trend. This study aimed to compare the mechanical stability of four distinct internal fixation protocols for transversely unstable RHFs via finite element analysis. Using computed tomography data from 10 patients, we developed 40 patient-specific FE models of transversely unstable RHFs fixed by parallel, crossed, and tripod HCSs and mini-T plate (MTP). Under simulated physiological loading of the elbow joint, the construct stiffness, displacement, and von Mises stresses were evaluated and verified by a biomechanical experiment. Under shear loading, the MTP group exhibited lower construct stiffness, larger displacement, and higher Von Mises stress than the HCSs group. The stiffness of tripod HCSs was greater than parallel and crossed screw fixation techniques. There was a strong relationship between apparent bone density and construct stiffness (R = 0.98 to 0.99). In the treatment of transversely unstable RHFs, HCSs have superior biomechanical stability than MTP. The tripod technique was also more stable than parallel and crossed fixation.
Asunto(s)
Tornillos Óseos , Análisis de Elementos Finitos , Fijación Interna de Fracturas , Fracturas del Radio , Humanos , Fijación Interna de Fracturas/métodos , Fijación Interna de Fracturas/instrumentación , Masculino , Femenino , Fracturas del Radio/cirugía , Fracturas del Radio/fisiopatología , Persona de Mediana Edad , Adulto , Fenómenos Biomecánicos , Placas Óseas , Tomografía Computarizada por Rayos X , Articulación del Codo/fisiopatología , Articulación del Codo/cirugía , Estrés Mecánico , Anciano , Fracturas Radiales de Cabeza y CuelloRESUMEN
BACKGROUND: In acetabular fracture surgery, understanding the biomechanical behaviour of fractures and implants is beneficial for clinical decision-making about implant selection and postoperative (early) weightbearing protocols. This study outlines a novel approach for creating finite element models (FEA) from actual clinical cases. Our objectives were to (1) create a detailed semi-automatic three-dimensional FEA of a patient with a transverse posterior wall acetabular fracture and (2) biomechanically compare patient-specific implants with manually bent off-the-shelf implants. METHODS: A computational study was performed in which we developed three finite element models. The models were derived from clinical imaging data of a 20-year-old male with a transverse posterior wall acetabular fracture treated with a patient-specific implant. This implant was designed to fit the patient's anatomy and fracture configuration, allowing for optimal placement and predetermined screw trajectories. The three FEA models included an intact hemipelvis for baseline comparison, one with a fracture fixated with a patient-specific implant, and another with a conventional implant. Two loading conditions were investigated: standing up and peak walking forces. Von Mises stress and displacement patterns in bone, implants and screws were analysed to assess the biomechanical behaviour of fracture fixation with either a patient-specific versus a conventional implant. RESULTS: The finite element models demonstrated that for a transverse posterior wall type fracture, a patient-specific implant resulted in lower peak stresses in the bone (30 MPa and 56 MPa) in standing-up and peak walking scenario, respectively, compared to the conventional implant model (46 MPa and 90 MPa). The results suggested that patient-specific implant could safely withstand standing-up and walking after surgery, with maximum von Mises stresses in the implant of 156 MPa and 371 MPa, respectively. The results from the conventional implant indicate a likelihood of implant failure, with von Mises stresses in the implant (499 MPa and 1000 MPa) exceeding the yield stress of stainless steel. CONCLUSION: This study presents a workflow for conducting finite element analysis of real clinical cases in acetabular fracture surgery. This concept of personalized biomechanical fracture and implant assessment can eventually be applied in clinical settings to guide implant selection, compare conventional implants with innovative patient-specific ones, optimizing implant designs (including shape, size, materials, screw positions), and determine whether immediate full weight-bearing can be safely permitted.
Asunto(s)
Acetábulo , Análisis de Elementos Finitos , Fracturas Óseas , Humanos , Acetábulo/lesiones , Acetábulo/cirugía , Acetábulo/diagnóstico por imagen , Masculino , Fenómenos Biomecánicos , Fracturas Óseas/cirugía , Fracturas Óseas/diagnóstico por imagen , Adulto Joven , Fijación Interna de Fracturas/métodos , Fijación Interna de Fracturas/instrumentación , Soporte de Peso , Tornillos ÓseosRESUMEN
OBJECTIVE: To retrospectively analyze and assess the long-term effectiveness of robotic navigation and traditional closed reduction internal fixation in the treatment of Delbet type II femoral neck fracture in children. METHODS: A total of fifty-five patients diagnosed with pediatric Delbet type II femoral neck fracture, who were admitted to Foshan Hospital of Traditional Chinese Medicine between January 2018 and June 2022, were included in this study. Among them, 22 cases of nailing under robotic navigation were set as the observation group, and 33 cases of nailing under fluoroscopy of the C-arm machine were set as the control group. All patients had their femoral neck fractures closed and repositioned first. After confirming the satisfactory fracture repositioning under the fluoroscopic view of the C-arm machine, internal fixation was performed by inserting hollow compression screws in the corresponding surgical way.A comparative analysis was conducted between the two groups to assess the disparity in the amount of X-ray exposure during surgery, the number of guide pins inserted, and the duration of the surgical procedure. The quality of comparative fracture reduction was assessed according to the Haidukewych criteria on the first postoperative hip X-ray, and the parallelism and distribution of the comparative screws were measured. The incidence of hip function and postoperative complications according to the Ratliff criteria were evaluated between each of the subgroups at the final follow-up. RESULTS: Comparison of general information, operation duration, and quality of fracture reduction between the two groups failed to reveal statistically significant results (P > 0.05). The observation group had a lower number of X-ray exposures and guide pin placements compared to the control group, and this difference was statistically significant (P < 0.05).At the last follow-up, the observation group exhibited superior screw parallelism and distribution, as well as hip joint function, compared to the control group, and this difference was statistically significant (P < 0.05). The incidence of complications in the observation group was lower than that in the control group; however, the difference was not statistically significant (P > 0.05). CONCLUSION: Closed reduction and internal fixation under orthopedic robot navigation can achieve better long-term efficacy in treating Delbet type II femoral neck fracture in children.
Asunto(s)
Reducción Cerrada , Fracturas del Cuello Femoral , Fijación Interna de Fracturas , Procedimientos Quirúrgicos Robotizados , Humanos , Fracturas del Cuello Femoral/cirugía , Masculino , Femenino , Estudios Retrospectivos , Procedimientos Quirúrgicos Robotizados/métodos , Fijación Interna de Fracturas/métodos , Niño , Resultado del Tratamiento , Reducción Cerrada/métodos , Factores de Tiempo , Preescolar , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/epidemiología , Estudios de Seguimiento , Tornillos ÓseosRESUMEN
OBJECTIVE: In pediatric patients, femoral neck fracture is a relatively rare injury with a high complication rate despite proper diagnosis and treatment. Fixation of femoral neck fractures is usually performed with screws placed along the neck axis. In this study, we aim to compare two different implants and methods in terms of biomechanics. MATERIALS AND METHODS: Twenty-eight right-left fresh femur bones of 6-month-old male Ovis aries lambs grown on the same farm were used. Bones were randomly divided into 4 groups (n=7). In group 1, the Delbet type III femoral neck fracture model was fixed with two 4.5 mm cannulated screws, one screw crossing the physis. In group 2, two 4.5 mm cannulated screws, which did not cross the physis, were used. In group 3, Delbet type III femoral neck fracture model was fixed with a 3.5 mm proximal femoral anatomical plate and five screws, one screw crossing the physis. Finally, in group 4, Delbet type III femoral neck fracture model was fixed with one 3.5 mm proximal femoral anatomical plate and five screws that did not exceed the physis. RESULTS: Biomechanical tests were performed using a Zwick/Roell AllroundLine 100 kN device. While axial failure burden (F = 6.819, p<.05, d = .46) and axial stiffness (F = 3.576, p<.05, d = .30) have been found to be significantly different between the independent treatment groups, axial failure displacement (F = .622, p>.05) and axial failure energy (F = .727, p>.05) have been found not to be significant between the independent groups. The effect sizes of the axial failure load and axial stiffness variables were 0.46 and 0.30, respectively, suggesting a moderate clinical effect. The highest axial failure load was recorded in group 3, while the smallest load was recorded in group 2. Similarly, the axial stiffness level in group 3 was statistically higher than the axial stiffness measurement recorded in group 2, p<.05. CONCLUSIONS: Consequently, we found that the biomechanical fixation success was the highest with a 3.5 mm proximal femoral anatomical plate, a 3.5 mm locking screw crossing the physis, and five 3.5 mm screws.