RESUMEN
PURPOSE: Malalignment of distal tibia fractures can lead to malunion/nonunion or alter the limb mechanical axis which may cause arthritis. Proposed methods to decrease malalignment include fibular fixation or multiplanar interlocking screws, however these remain controversial. This study aimed to identify factors associated with malalignment in distal tibial fractures with associated fibular shaft fractures. METHODS: A retrospective review was performed of distal tibia fractures with associated fibular shaft fractures treated with intramedullary nailing at two level one trauma centers between 2015 and 2019. Cases involving malalignment (> 5° of deviation from anatomic axis on either coronal/sagittal axis) on final follow-up (minimum three months postoperatively) were compared to those without malalignment with regard to demographics, fracture characteristics, intraoperative characteristics, and complications. RESULTS: The rate of malalignment was 13%. On multivariate analysis, multiplanar distal interlocking screw fixation (odds ratio [OR], 0.18; 95% confidence interval [CI] 0.03-0.92) was associated with a decreased rate of final malalignment, while nail diameter > 10 mm was associated with a higher rate (OR, 4.05; 95% CI 1.25-13.11). Fibular fixation was not associated with malalignment. CONCLUSION: Multiplanar distal interlocking screws may protect against malalignment. Fibula fixation does not appear associated with a decreased rate of malalignment in distal tibia fractures treated with intramedullary nails. LEVEL OF EVIDENCE: III.
Asunto(s)
Desviación Ósea , Peroné , Fijación Intramedular de Fracturas , Fracturas de la Tibia , Humanos , Fijación Intramedular de Fracturas/efectos adversos , Fijación Intramedular de Fracturas/instrumentación , Fijación Intramedular de Fracturas/métodos , Fracturas de la Tibia/cirugía , Fracturas de la Tibia/complicaciones , Masculino , Femenino , Peroné/lesiones , Peroné/cirugía , Estudios Retrospectivos , Desviación Ósea/etiología , Desviación Ósea/cirugía , Persona de Mediana Edad , Adulto , Factores de Riesgo , Clavos Ortopédicos/efectos adversos , Complicaciones Posoperatorias/etiología , Tornillos Óseos/efectos adversos , Anciano , Fracturas de PeronéRESUMEN
PURPOSE: The radial nerve may be painfully irritated or damaged by open reduction and internal fixation (ORIF) of humeral fractures. Secondary radial nerve lesions after ORIF of humeral shaft fractures are described in up to 16%. Not only peripheral nerves but also orthopaedic instruments and osteosynthesis material are well visible by ultrasound. The aim of this study was to evaluate the accuracy of ultrasound in assessing the relation between the bone overlapping screw tips and the radial nerve close to the humeral bone. METHODS: Ultrasound-guided drilling was used to place screws as close as possible to the radial nerve in 8 humeral bones of four cadavers. The relation between the radial nerve and the screw tips was assessed by high-resolution ultrasound, and the overlap of all screw tips over the bone was measured by ultrasound and fluoroscopy. Thereafter, the findings were validated by anatomical dissection. RESULTS: We could correctly identify all screw tips and their relation to the radial nerve by ultrasound. In 7 of 8 cases, the screw tip had direct contact with the radial nerve. The overlaying length of the screw tip was accurately measured by using ultrasound in all cases. In contrast fluoroscopy underestimated this length in 50% of cases. CONCLUSION: With this study, we show that ultrasound can reliable visualize the screw tips and its relation to the radial nerve. Ultrasound is a promising diagnostic tool to evaluate patients with radial nerve irritations or lesions after ORIF of humeral fractures. Furthermore, ultrasound could be an adequate tool to guide drilling.
Asunto(s)
Tornillos Óseos , Cadáver , Fijación Interna de Fracturas , Fracturas del Húmero , Nervio Radial , Humanos , Fijación Interna de Fracturas/instrumentación , Fijación Interna de Fracturas/métodos , Fijación Interna de Fracturas/efectos adversos , Nervio Radial/lesiones , Nervio Radial/diagnóstico por imagen , Fracturas del Húmero/cirugía , Fracturas del Húmero/diagnóstico por imagen , Tornillos Óseos/efectos adversos , Fluoroscopía/métodos , Ultrasonografía Intervencional/métodos , Ultrasonografía/métodosRESUMEN
To investigate the wear and corrosion of titanium alloy spinal implants in vivo, we evaluated removed implants and their surrounding scar tissues from 27 patients between May 2019 and April 2021. We performed scanning electron microscopy, energy-dispersive X-ray spectroscopy, and histological analysis. The results revealed metal-like particles in the soft tissues of seven patients, without any considerable increase in inflammatory cell infiltration. Patients with fractures showed lower percentages of wear and corrosion compared with other patients (42% and 17% vs. 59% and 26%). Polyaxial screws exhibited higher wear and corrosion percentages (53% and 23%) compared with uniaxial screws (39% and 3%), although in patients with fracture, the reverse was observed (20% and 0% vs. 39% and 3%). We found that titanium alloy spinal implants experience some degree of wear and corrosion in vivo. The titanium alloy particles formed by wear exhibited good histocompatibility, not causing inflammation, foreign body reactions, or osteolysis. Therefore, spinal implants should be removed cautiously when treating titanium alloy spinal metallosis. The wear and corrosion of the implants increase with the increase in implantation time, although the screw structure does not significantly affect these changes.
Asunto(s)
Aleaciones , Titanio , Titanio/química , Titanio/efectos adversos , Corrosión , Aleaciones/química , Persona de Mediana Edad , Masculino , Humanos , Femenino , Anciano , Adulto , Microscopía Electrónica de Rastreo , Tornillos Óseos/efectos adversos , Prótesis e Implantes/efectos adversos , Ensayo de MaterialesRESUMEN
OBJECTIVES: The stability of the abutment screw is pivotal for successful implant-supported restorations, yet screw loosening remains a common complication, leading to compromised function and potential implant failure. This study aims to evaluate the effect of different implant-abutment types and heights on screw loosening in cases with increased crown height space (CHS). MATERIALS AND METHODS: In this in vitro study, a total of 64 abutments in eight distinct groups based on their type and height were evaluated. These groups included stock, cast, and milled abutments with heights of 4 mm (groups S4, C4, and M4), 7 mm (groups S7, C7, and M7), and 10 mm (groups C10 and M10). Removal torque loss (RTL) was assessed both before and after subjecting the abutments to dynamic cyclic loading. Additionally, the differences between initial RTL and RTL following cyclic loading were analyzed for each group (p < .05). RESULTS: The C10 group demonstrated the highest RTL, whereas the S4 group exhibited the lowest initial RTL percentage (p < .05). Furthermore, the study established significant variations in RTL percentages and the discrepancies between initial and postcyclic loading RTL across different abutment groups (p < .05). Additionally, both abutment types and heights were found to significantly influence the RTL percentage (p < .05). CONCLUSION: The type and height of the implant abutment affected screw loosening, and in an increased CHS of 12 mm, using a stock abutment with a postheight of 4 mm can be effective in minimizing screw loosening.
Asunto(s)
Coronas , Pilares Dentales , Diseño de Implante Dental-Pilar , Fracaso de la Restauración Dental , Torque , Humanos , Diseño de Implante Dental-Pilar/efectos adversos , Pilares Dentales/efectos adversos , Coronas/efectos adversos , Tornillos Óseos/efectos adversos , Prótesis Dental de Soporte Implantado/efectos adversos , Análisis del Estrés Dental , Técnicas In VitroRESUMEN
The incidence of proximal femur fractures is increasing due to aging of the population. Intramedullary nails are the mainstay of treatment for intertrochanteric hip fractures mainly due to their better biomechanical properties compared to dynamic hip screw devices, shorter operative time, and less blood loss during surgery. However intramedullary nail fixation is not devoid of complications. The purpose of this study is to look at complications related to intramedullary nailing for intertrochanteric hip fractures in a major trauma center. A retrospective study was conducted including all patients having suffered an intertrochanteric femur fracture and treated with intramedullary nails from October 1, 2020, to October 1, 2022, in the Orthopaedic Surgery Clinic. The intramedullary hip systems used were the Stryker Gamma3 Nail and the VITUS PF Nail. All complications following the postoperative period were recorded in detail. Overall, 240 patients with a mean age of 82.3 years treated with hip intramedullary devices were identified. Superior cutout of the lag screw in two patients (females 90 and 87 years old) was identified 8 and 10 weeks following initial surgery. Avascular necrosis (AVN) of the femoral head was identified in one patient (male 81 years old) which occurred 12 weeks postoperatively. All three cases were revised by replacing the nail with cemented hemiarthroplasty. Periprosthetic fractures occurred in an 88-year-old male and a 73-year-old female following an injury distal to the stem and were managed by replacing the nail with a long stem device (Long Gamma3). One case of metalwork fracture was also recorded. There are many advantages in managing intertrochanteric hip fractures with intramedullary hip devices such as shorter theater time, less blood loss, and improved biomechanical properties. However, complications such as cutout of the lag screw, AVN, and periprosthetic fracture are serious and require complex revision surgery.
Asunto(s)
Clavos Ortopédicos , Fijación Intramedular de Fracturas , Fracturas de Cadera , Complicaciones Posoperatorias , Humanos , Estudios Retrospectivos , Fijación Intramedular de Fracturas/efectos adversos , Fijación Intramedular de Fracturas/instrumentación , Femenino , Fracturas de Cadera/cirugía , Masculino , Anciano de 80 o más Años , Clavos Ortopédicos/efectos adversos , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/epidemiología , Anciano , Tornillos Óseos/efectos adversos , Necrosis de la Cabeza Femoral/cirugía , Necrosis de la Cabeza Femoral/etiologíaRESUMEN
OBJECTIVE: Medical records for dogs treated with tibial plateau leveling osteotomy (TPLO) using Arthrex 3.5 mm self-tapping screws (STS) were evaluated to determine the incidence rate of transcortical tibial fractures (TCTF) and development of complications. STUDY DESIGN: Retrospective case report. STUDY POPULATION: A total of 78 dogs. METHODS: Dogs that underwent a TPLO performed from March 2022 to August 2023 were reviewed. Postoperative TPLO radiographs were examined for evidence of a TCTF with Arthrex 3.5 mm STS. Records were reviewed for complications up to 14 weeks after surgery. RESULTS: Evidence of a TCTF was found in 42% of cases (33 of 78) and 14% (36 of 250) of STS screws distal to the osteotomy. TCTFs were only identified distal to the osteotomy. Three dogs had radiographic evidence of more than one TCTF. Of the dogs with radiographic TCTF, 6% of patients (2 of 33) developed a major complication that required surgical stabilization of a tibial fracture associated with screw angulation relative to the plate. CONCLUSION: Use of Arthrex 3.5 mm STS for TPLO is associated with risk of TCTF. TCTF can compromise the structural properties of the tibia and cause complete tibial fracture requiring major revision surgery. CLINICAL SIGNIFICANCE: Development of TCTF after use of STS for TPLO has been recognized, in contrast to use of non-self-tapping screws, and was considered a benign complication. Our findings suggest TCTF associated with Arthrex 3.5 mm STS use in TPLO can contribute to major complications after surgery, including complete tibial fracture, particularly if screws are not placed perpendicular to the plate.
Asunto(s)
Tornillos Óseos , Osteotomía , Fracturas de la Tibia , Animales , Perros/lesiones , Osteotomía/veterinaria , Osteotomía/efectos adversos , Osteotomía/métodos , Fracturas de la Tibia/veterinaria , Fracturas de la Tibia/cirugía , Tornillos Óseos/veterinaria , Tornillos Óseos/efectos adversos , Estudios Retrospectivos , Femenino , Masculino , Enfermedades de los Perros/cirugía , Tibia/cirugía , Complicaciones Posoperatorias/veterinariaRESUMEN
Interfaces between AISI 304 stainless steel screws and cranial bone were investigated after long-term implantation lasting for 42 years. Samples containing the interface regions were analyzed using state-of-the-art analytical techniques including secondary ion mass, Fourier-transform infrared, Raman, and X-ray photoelectron spectroscopies. Local samples for scanning transmission electron microscopy were cut from the interface regions using the focused ion beam technique. A chemical composition across the interface was recorded in length scales covering micrometric and nanometric resolutions and relevant differences were found between peri-implant and the distant cranial bone, indicating generally younger bone tissue in the peri-implant area. Furthermore, the energy dispersive spectroscopy revealed an 80 nm thick steel surface layer enriched by oxygen suggesting that the AISI 304 material undergoes a corrosion attack. The attack is associated with transport of metallic ions, namely, ferrous and ferric iron, into the bone layer adjacent to the implant. The results comply with an anticipated interplay between released iron ions and osteoclast proliferation. The interplay gives rise to an autocatalytic process in which the iron ions stimulate the osteoclast activity while a formation of fresh bone resorption sites boosts the corrosion process through interactions between acidic osteoclast extracellular compartments and the implant surface. The autocatalytic process thus may account for an accelerated turnover of the peri-implant bone.
Asunto(s)
Tornillos Óseos , Cráneo , Acero Inoxidable , Tornillos Óseos/efectos adversos , Acero Inoxidable/química , Humanos , Corrosión , Cráneo/patología , Espectroscopía Infrarroja por Transformada de Fourier , Interfase Hueso-Implante , Propiedades de Superficie , Espectroscopía de Fotoelectrones , Espectrometría Raman , Hierro/químicaRESUMEN
Background: Bennett fractures are traditionally fixed with percutaneous K-wires from dorsal to volar, or with a volar to dorsal screw via a volar open approach. While volar to dorsal screw fixation is biomechanically advantageous, an open approach requires extensive soft tissue dissection, thus increasing morbidity. This study aims to investigate the practicality and safety of Bennett fracture fixation using a percutaneous, volar to dorsal screw, particularly with regard to the median nerve and its motor branch during wire and screw insertion. Methods: Fifteen fresh frozen forearm and hand specimens were obtained from the University of Auckland human cadaver laboratory. A guidewire is placed under image intensifier from volar to dorsal with the thumb held in traction, abduction and pronation. The wire is passed through the skin volarly under image intensifier, then the median nerve is dissected from the carpal tunnel and the motor branch of the median nerve (MBMN) is dissected from its origin to where it supplies the thenar musculature. The distance between the K-wire to the MBMN is measured. Results: In 14 of 15 specimens, the wire was superficial and radial to the carpal tunnel. The mean distance to the origin of the MBMN is 6.2 mm (95% CI 4.1-8.3) with the closest specimen 1 mm away. The mean closest distance the wire gets to any part of the MBMN is 3.7 mm (95% CI 1.6-5.8); in two specimens, the wire was through the MBMN. Conclusions: Wire placement, although done under image intensifier, is subject to significant variation in exiting location. While research has shown the thenar portal in arthroscopic thumb surgery is safe, our guidewire needs to exit further ulnar to capture the Bennett fracture fragment, placing the MBMN at risk. This cadaveric study has demonstrated the proposed technique is unsafe for use.
Asunto(s)
Tornillos Óseos , Cadáver , Fijación Interna de Fracturas , Humanos , Fijación Interna de Fracturas/métodos , Fijación Interna de Fracturas/instrumentación , Fijación Interna de Fracturas/efectos adversos , Tornillos Óseos/efectos adversos , Hilos Ortopédicos/efectos adversos , Fractura-Luxación/cirugía , Fractura-Luxación/diagnóstico por imagen , Nervio Mediano/lesiones , Nervio Mediano/cirugía , Fracturas Óseas/cirugíaRESUMEN
PURPOSE: Cannulated screw fixation for femoral neck fractures is often limited by concerns of avascular necrosis (AVN) occurring, historically seen in 5-40% of fixed intracapsular fractures. This study aims to assess the outcomes, particularly the AVN rate, associated with current surgical techniques within our unit. METHODS: We conducted a single-center cross-sectional study, manually searching operative records between July 14, 2014, and December 1, 2018, identifying patients with intracapsular fractured neck of femur fixed with cannulated screws, with a minimum of two years follow-up. Patient records and radiographs were reviewed for clinical and radiographic diagnoses of AVN, non-union, post-operative metalwork infection, and screw penetration of the head. Additionally, fracture pattern and displacement, screw configuration, reduction techniques, and adequacy of reduction were recorded, with radiographs independently analyzed by four orthopedic surgeons. RESULTS: Fifty-six patients were included; average age of 67 years (range 30-100). Forty-two patients (75%) sustained displaced fractures and 14 patients (25%) had undisplaced fractures. Two (4%) patients developed AVN, with no cases of non-union, post-operative metalwork infection or screw penetration of the head. Eight patients (14%) sustained a high-energy injury, though none of these patients developed AVN. All fractures required closed reduction; no open reductions performed. Twenty-seven (64%) of reductions were adequate. CONCLUSION: Our observed AVN rate is notably lower than the widely reported figures, even among a significant proportion of displaced fractures that were fixed. This study underscores that with adequate fixation, cannulated screws represent an excellent option for treating intracapsular neck of femur fractures, even in cases of displaced fracture patterns with imperfect reduction.
Asunto(s)
Tornillos Óseos , Fracturas del Cuello Femoral , Necrosis de la Cabeza Femoral , Fijación Interna de Fracturas , Humanos , Fracturas del Cuello Femoral/cirugía , Tornillos Óseos/efectos adversos , Fijación Interna de Fracturas/efectos adversos , Fijación Interna de Fracturas/métodos , Fijación Interna de Fracturas/instrumentación , Masculino , Persona de Mediana Edad , Femenino , Anciano , Necrosis de la Cabeza Femoral/cirugía , Necrosis de la Cabeza Femoral/etiología , Estudios Transversales , Adulto , Anciano de 80 o más Años , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/epidemiología , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
Background: The study employs finite element analysis to investigate stress distribution in the radius of toy poodles after screw removal. The examination focuses on the biomechanical implications of varied screw hole configurations using 1.5 and 2.0-mm locking compression plates (LCPs) with notched head T-Plates. Aim: To provide a noninvasive approach to analyzing the immediate consequences of screw removal from the radius bone in toy poodles. Specifically, it explores the impact of varied plate designs and screw arrangements on stress distribution within the forelimb bones. Methods: The study constructs a three-dimensional bone model of the toy poodle's forelimb based on computed tomography (CT) images. Simulations were designed to replicate jumping and landing from a 40 cm height, comparing stress distribution in the radius post-screw removal. Results: The analysis reveals significant variations in stress distribution patterns between the two LCPs. The radius implanted with the 2.0-mm LCP displays a uniform stress distribution, contrasting with the 1.5-mm plates. Localized stress concentration is observed around the screw holes, while trabecular bone regions near the screw holes exhibit lower stress levels. Conclusion: The study highlights the plate designs and screw configurations that affect bone stress in toy poodle forelimbs post-screw removal. The findings provide valuable insights for veterinarians, aiding informed decisions in veterinary orthopedic practices.
Asunto(s)
Placas Óseas , Tornillos Óseos , Análisis de Elementos Finitos , Animales , Tornillos Óseos/veterinaria , Tornillos Óseos/efectos adversos , Placas Óseas/veterinaria , Fenómenos Biomecánicos , Estrés Mecánico , Radio (Anatomía)/cirugía , Miembro Anterior , Tomografía Computarizada por Rayos X/veterinariaRESUMEN
OBJECTIVE: Femoral neck fractures (FNFs) are among the most common fractures in elderly individuals. Surgery is the main treatment for FNFs, and osteonecrosis of the femoral head (ONFH) is one of the unacceptable complications. This study aimed to assess both the clinical and radiological outcomes in patients with FNFs treated with three parallel cannulated screws and to identify relationship between screws position and ONFH. PATIENTS AND METHODS: A total of 100 patients who were treated with closed reduction and fixed with 3 parallel cannulated screws met the inclusion criteria between January 2014 and December 2020 at authors' institution. The follow-up duration, age, sex, affected side, and injury-to-surgery interval were collected; the neck-shaft angle of both hips, screw-apex distance (SAD) and the tip-apex distance (TAD)were measured; and the Garden classification, quality of reduction and presence of ONFH were evaluated. RESULTS: The sample consisted of 37 males and 63 females, with 60 left and 40 right hips affected. The mean age of patients was 54.93 ± 12.24 years, and the mean follow-up was 56.3 ± 13.38 months. The overall incidence of ONFH was 13%. No significant difference was observed in the incidence of ONFH by affected side, age, fracture displacement, injury-to-surgery interval, neck-shaft angle deviation, or reduction quality. The SAD was significantly shorter in ONFH patients than in normal patients for all three screws (p = 0.02, 0.02, and 0.01, respectively). CONCLUSIONS: The short SAD of all screws is associated with femoral head necrosis of FNFs treated with 3 cannulated screws. The short SAD indicated that screws malpositioning in the weight-bearing area of the femoral head, potentially harming the blood supply and compromising the anchorage of the primary compressive trabeculae in this region.
Asunto(s)
Fracturas del Cuello Femoral , Fenofibrato , Osteonecrosis , Adulto , Anciano , Femenino , Masculino , Humanos , Persona de Mediana Edad , Cabeza Femoral/diagnóstico por imagen , Cabeza Femoral/cirugía , Fracturas del Cuello Femoral/diagnóstico por imagen , Fracturas del Cuello Femoral/cirugía , Necrosis , Tornillos Óseos/efectos adversosRESUMEN
BACKGROUND: Single limb support phase of the gait-cycle in patients who are treated for a pertrochanteric fracture is characterized by transversal loads acting on the lag screw, tending to block its dynamization. If the simultaneous axial force overcomes transversal loads of the sliding screw, the dynamization can still occur. METHODS: Biomechanical investigation was performed for three types of dynamic implants: Gamma Nail, and two types of Selfdynamizable Internal Fixators (SIF) - SIF-7 (containing two 7 mm non-cannulated sliding screws), and SIF-10 (containing one 10 mm cannulated sliding screw). Contact surface between the stem and the sliding screws is larger in SIF implants than in Gamma Nail, as the stem of Gamma Nail is hollow. A special testing device was designed for this study to provide simultaneous application of a controlled sliding screws bending moment and a controlled transversal load on sliding screws (Qt) without using of weights. Using each of the implants, axial forces required to initiate sliding screws dynamization (Qa) were applied and measured using a tensile testing machine, for several values of sliding screws bending moment. Standard least-squares method was used to present the results through the linear regression model. RESULTS: Positive correlation between Qt and Qa was confirmed (p < 0.05). While performing higher bending moments in all the tested implants, Qa was higher than it could be provided by the body weight. It was the highest in Gamma Nail, and the lowest in SIF-10. CONCLUSIONS: A larger contact surface between a sliding screw and stem results in lower forces required to initiate dynamization of a sliding screw. Patients treated for a pertrochanteric fracture by a sliding screw internal fixation who have longer femoral neck or higher body weight could have different programme of early postoperative rehabilitation than lighter patients or patients with shorter femoral neck.
Asunto(s)
Tornillos Óseos , Fracturas del Fémur , Humanos , Tornillos Óseos/efectos adversos , Fenómenos Biomecánicos , Fijadores Internos , Fijación Interna de Fracturas , Fracturas del Fémur/etiología , Peso CorporalRESUMEN
INTRODUCTION: The aim of this study is to assess the risk of peroneal artery injury of hardware placement at the fixation of syndesmotic injuries. MATERIALS AND METHODS: The lower extremity computed tomography angiography was used to design the study. The syndesmosis screw placement range was simulated every 0.5 cm, from 0.5 to 5 cm proximal to the ankle joint. The screw axes were drawn as 20°, 30° or individual angle according to the femoral epicondylar axis. The proximity between the screw axis and the peroneal artery was measured in millimeters. Potential peroneal artery injury was noted if the distance between the peroneal artery to the axis of the simulated screw was within the outer shaft radius of the simulated screw. The Pearson chi-square test was used and a p-value < 0.05 was considered significant. RESULTS: The potential for injury to the peroneal artery increased as the syndesmosis screw level rose proximally from the ankle joint level or as the diameter of the syndesmosis screw increasds. In terms of syndesmosis screw trajection, the lowest risk of injury was observed with the syndesmosis screw angle of 20°. Simulations with a screw diameter of 3.5 mm exhibited the least potential for peroneal artery injury. CONCLUSION: Thanks to this radiological anatomy simulation study, we believe that we have increased the awareness of the peroneal artery potential in syndesmosis screw application. Each syndesmosis screw placement option may have different potential for injury to the peroneal artery. To decrease the peroneal artery injury potential, we recommend the followings. If individual syndesmosis screw angle trajection can be measured, place the screw 1.5 cm proximal to the ankle joint using a 3.5 mm screw shaft. If not, fix it with 30° trajection regardless of the screw diameter at the same level. If the most important issue is the peroneal artery circulation, use the screw level up to 1 cm proximal to the ankle joint regardless of the screw angle trajection and screw diameter.
Asunto(s)
Tornillos Óseos , Angiografía por Tomografía Computarizada , Humanos , Tornillos Óseos/efectos adversos , Angiografía por Tomografía Computarizada/métodos , Lesiones del Sistema Vascular/etiología , Lesiones del Sistema Vascular/prevención & control , Lesiones del Sistema Vascular/diagnóstico por imagen , Fijación Interna de Fracturas/métodos , Fijación Interna de Fracturas/instrumentación , Fijación Interna de Fracturas/efectos adversos , Traumatismos del Tobillo/cirugía , Traumatismos del Tobillo/diagnóstico por imagen , Arterias/lesiones , Arterias/diagnóstico por imagen , Arterias/anatomía & histologíaRESUMEN
BACKGROUND Non-calculus foreign bodies in the bladder are rare and are usually introduced via the urethra. Reports of the migration of metallic foreign bodies from previous surgery are uncommon and mainly associated with surgical screws used for the internal fixation of pubic bone fracture and total hip replacement. This report is of a 56-year-old woman presenting with a surgical screw foreign body in the bladder 19 years after open surgical reduction and internal plate and screw fixation of traumatic fracture of the pubic bone. CASE REPORT A 56-year-old woman visited a urologist because of gross hematuria. She mentioned a mild pelvic pain and multiple lower urinary tract infections over the past 2 years, with no other symptoms. From the previous history, she had undergone an open reduction and internal fixation of the pelvic ring, with surgical plates and screws following pubic bone's fracture, due to an accident 19 years earlier. Cystoscopy identified the presence of a screw head protruding into the bladder wall. The screw was extracted via open surgery, and the patient was discharged 2 days later. CONCLUSIONS While intravesical foreign bodies are rarely seen in Emergency Departments, clinicians should maintain a level of suspicion in certain cases. The purpose of this case report is to present the unlikely and delayed complication of internal pubic bone fixation resulting in the migration of a fixation screw to the bladder. It also highlights the importance of imaging in diagnosis and localization of the foreign body in the bladder.
Asunto(s)
Cuerpos Extraños , Fracturas Óseas , Fracturas de la Columna Vertebral , Femenino , Humanos , Persona de Mediana Edad , Vejiga Urinaria/cirugía , Fracturas Óseas/diagnóstico por imagen , Fracturas Óseas/cirugía , Cuerpos Extraños/complicaciones , Cuerpos Extraños/diagnóstico por imagen , Cuerpos Extraños/cirugía , Tornillos Óseos/efectos adversosRESUMEN
PURPOSE: This study was performed to compare the radiographic results of robot-assisted and traditional methods of treating lower extremity deformities (LEDs). METHODS: From January 2019 to February 2022, 55 patients with LEDs were treated by temporary hemiepiphysiodesis with eight-plates. They were divided into a robot group and a freehand group. The fluoroscopy time and operation time were recorded. The accuracy of screw placement was measured after the operation using the following parameters: coronal entering point (CEP), sagittal entering point (SEP), and angle between the screw and epiphyseal plate (ASEP). The limb length discrepancy (LLD) and femorotibial angle (FTA) were measured before the operation, after the operation, and at the last follow-up. Patients were followed up for 12 to 24 months, and the radiographic results of the 2 groups were compared. RESULTS: Among the 55 patients with LEDs, 36 had LLD and 19 had angular deformities. Seventy-six screws were placed in the robot group and 85 in the freehand group. There was no difference in the CEP between the 2 groups ( P >0.05). The robot group had a better SEP (2.96±1.60 vs. 6.47±2.80 mm) and ASEP (3.46°±1.58° vs. 6.92°±3.92°) than the freehand group ( P <0.001). At the last follow-up, there was no difference in the LLD or FTA improvement between the two groups ( P >0.05). The incidence of complications was significantly lower in the robot group than in the freehand group (0/27 vs. 5/28, P <0.05). CONCLUSION: Robot-assisted temporary hemiepiphysiodesis with eight-plates is a safe and effective method for treating LEDs in children. Robotic placement of screws is superior to freehand placement with respect to the entering position and direction. Although the correction effect for LLD and angular deformity is similar, screw dislocation is less common when using robot assistance. LEVELS OF EVIDENCE: Level-III. Retrospective comparative study.
Asunto(s)
Tornillos Pediculares , Robótica , Niño , Humanos , Estudios Retrospectivos , Tornillos Óseos/efectos adversos , Fluoroscopía/métodos , Extremidad InferiorRESUMEN
OBJECTIVES: To compare the complications associated with cannulated hip screws (CHS) and dynamic hip screws (DHS) techniques. METHODS: In this multicenter retrospective chart study, we reviewed the records and data of all patients operated upon by DHS or CHS for treatment of Garden type I and type II intracapsular non-displaced femoral neck fracture from January 2017 to December 2022. Patients with incomplete files or follow-ups of less than one year were excluded from the study. RESULTS: The study enrolled 85 patients, 35 males, and 50 females, with a mean age of 72±5.4 for males and 70.6±7.6 for females. A total of 44 patients were operated upon with DHS, and 41 patients with CHS. The mortality rate of DHS was 15.9% and was 17.1% in the CHS group (p>0.05). Non-union was recorded in 4.5% of the DHS group and 4.9% of CHS patients (p>0.05). Avascular necrosis (AVN) was significantly higher in DHS (9.1%) than in CHS (4.9%, p<0.05). A revision was required in 15.9% of DHS patients and 14.6% of CHS patients (p>0.05). CONCLUSION: This study found that DHS was superior to CHS in AVN rate. However, there was no significant difference between both methods regarding mortality, revision, and non-union.
Asunto(s)
Fracturas del Cuello Femoral , Fijación Interna de Fracturas , Masculino , Femenino , Humanos , Anciano , Estudios Retrospectivos , Fijación Interna de Fracturas/efectos adversos , Fijación Interna de Fracturas/métodos , Tornillos Óseos/efectos adversos , Fracturas del Cuello Femoral/cirugía , Fracturas del Cuello Femoral/etiología , Necrosis , Resultado del TratamientoRESUMEN
Numerous interference screws of different compositions exist including titanium screws, bioabsorbable screws, and polyetheretherketone (PEEK) screws. PEEK-based implants are frequently used in orthopaedic surgery due to their biocompatibility, similar elastic modulus to cortical bone, and purported negligible risk of osteolysis compared with bioabsorbable screws. In this case report, we present the case of a 48-year-old healthy female who experienced a massive osteolytic reaction in the talus and fibula after 11 weeks following implantation of PEEK-based interference screws during lateral ankle ligament reconstruction. The patient subsequently underwent removal of the PEEK screws and specimens were sent for microbiological and histopathological analysis. The specimens report demonstrated fibrotic tenosynovial soft tissue with patchy chronic inflammation, oedematous reactive changes, and histiocytic reaction, with no evidence of any significant acute inflammation. The patient recovered well and was asymptomatic at 6 months postoperatively. To our knowledge, this is the first case report of a massive osteolytic reaction to PEEK-based interference screws.
Asunto(s)
Benzofenonas , Tornillos Óseos , Peroné , Cetonas , Osteólisis , Polietilenglicoles , Polímeros , Astrágalo , Humanos , Femenino , Persona de Mediana Edad , Osteólisis/etiología , Tornillos Óseos/efectos adversos , Cetonas/efectos adversos , Polietilenglicoles/efectos adversos , Polímeros/efectos adversos , Peroné/cirugía , Astrágalo/cirugía , Materiales Biocompatibles/efectos adversosRESUMEN
PURPOSE: The detrimental effect of greater tuberosity malposition on functional scores is well known. Superior or posterior malpositions exceeding five mm lead to excessive loading on the deltoid strength. However, the significance of situations where greater tuberosity becomes medialized due to the compressive effect of the locking plate fixation, especially in fractures with metaphyseal dead space, has not been emphasized. It is hypothesized that this condition may cause shortening of the rotator cuff moment arm and consequently impact functional scores. METHODS: Between 2012 and 2018, 52 patients, aged 65,28 (ranging 40-85) proximal humerus fractures treated with locking plate fixation were included in the study. Cephalodiaphyseal angle, greater tuberosity displacement , patients reported outcome and Constant-Murley scores were evaluated. RESULTS: The mean Constant Murley score was determined to be 78.76 (ranging from 38 to 100). According to the patients reported outcome 39 excellent , five good , two fair, six poor results were observed. Avascular necrosis with screw migration was detected in five cases, while one patient experienced implant insufficiency along with varus deformity. Greater tuberosity was found to be positioned between 6 mm posterior-superior and -13 mm medial. Significant medial malposition was observed in three patients, with -9, -12, and -13 mm of medialization, respectively. Cephalodiaphysial angle was determined as 139.30 degrees (ranging from 120 to 150 degrees) and showed weak correlation with the functional score. Greater tuberosity medialization also showed weak correlation with the Constant-Murley score. The values exhibiting deviation were associated with low patient-reported outcome results and functional scores. In the examination of greater tuberosity displacement values, it was observed that Neer type 3 and 4 fractures differed significantly from Neer type 2 fractures regarding to Kruskal-Wallis test. CONCLUSIONS: Medial impaction of greater tuberosity may be the reason of decreased functional scores, similar to superior or posterior malposition. The medialization of greater tuberosity should be considered as a potential factor leading to the shortening of the rotator cuff's abductor moment.
Asunto(s)
Fracturas del Hombro , Hombro , Humanos , Manguito de los Rotadores/cirugía , Tornillos Óseos/efectos adversos , Resultado del Tratamiento , Fijación Interna de Fracturas/efectos adversos , Fijación Interna de Fracturas/métodos , Placas Óseas/efectos adversos , Estudios RetrospectivosRESUMEN
PURPOSE: To evaluate the clinical and radiographic outcomes of anterior cruciate (ACL) reconstruction at minimum 10-year follow-up. METHODS: Ninety-three patients who underwent primary unilateral ACL reconstruction with hamstring tendon autograft, transtibial technique and femoral cortico-cancellous screw suspension device (Athrax, Leader Medica s.r.l) between 2010 and 2012 were retrospectively reviewed. Mean follow-up was 136 months. Evaluation was performed using the International Knee Documentation Committee score (IKDC), Knee injury and Osteoarthritis Outcome Score (KOOS), Lysholm Knee Score and Tegner Activity Level Scale. Incidence of OA was determined by comparing standard anteroposterior and lateral weightbearing radiographs of the ACL-reconstructed and contralateral knee. Osteoarthritis severity was graded according to the Kellgren-Lawrence (KL) score. RESULTS: Median Tegner activity level was 6 (5-7). Lysholm and IKDC scores were 100 (95-100) and 90 (86-95), respectively, KOOS was 98 (95-100). Of ACL-reconstructed knees, 41 (50%) had radiographic OA, of which 6 (7.3%) had severe OA (KL III). Of the contralateral healthy knees, 28 (34.1%) had radiographic evidence of OA. Of these 22 (26.8%) and 6 (7.3%) patients had, respectively, KL-I and KL-II. 11 patients (11.8%) underwent subsequent knee surgery: 5 (5.4%) revisions, 3 (3.2%) meniscal surgeries, 2 (2.2%) other surgeries, 1 (1.1%) contralateral ACL reconstruction. CONCLUSIONS: The study demonstrates that ACL reconstruction with HT autograft and cortico-cancellous screw suspension device determines satisfying clinical results after 10 years of follow-up. From our cohort, a low rate of graft failure has been reported, even though almost 50% of patients present a knee OA greater or equal to grade II KL.
Asunto(s)
Lesiones del Ligamento Cruzado Anterior , Reconstrucción del Ligamento Cruzado Anterior , Tendones Isquiotibiales , Osteoartritis de la Rodilla , Humanos , Tendones Isquiotibiales/trasplante , Lesiones del Ligamento Cruzado Anterior/cirugía , Lesiones del Ligamento Cruzado Anterior/complicaciones , Estudios Retrospectivos , Autoinjertos , Osteoartritis de la Rodilla/cirugía , Reconstrucción del Ligamento Cruzado Anterior/métodos , Tornillos Óseos/efectos adversos , Estudios de SeguimientoRESUMEN
OBJECTIVE: Bioabsorbable magnesium-based alloy screws release gas upon resorption. The resulting findings in the adjacent soft tissues and joints may mimic infection. The aim of the study was to evaluate the ultrasound (US) findings in soft tissues and joints during screw resorption. METHODS: Prospectively acquired US studies from pediatric patients treated with magnesium screws were evaluated for screw head visibility, posterior acoustic shadowing, twinkling artifact, foreign body granuloma, gas (soft tissue, intra-articular), alterations of the skin and subcutaneous fat, perifascial fluid, localized fluid collections, hypervascularization, and joint effusion. RESULTS: Sixty-six US studies of 28 pediatric patients (nfemale = 9, nmale = 19) were included. The mean age of the patients at the time of surgery was 10.84 years; the mean time between surgery and ultrasound was 128.3 days (range = 6-468 days). The screw head and posterior acoustic shadowing were visible in 100% of the studies, twinkling artifact in 6.1%, foreign body granuloma in 92.4%, gas locules in soft tissue in 100% and intra-articular in 18.2%, hyperechogenicity of the subcutaneous fat in 90.9%, cobblestoning of the subcutaneous fat in 24.2%, loss of normal differentiation between the epidermis/dermis and the subcutaneous fat in 57.6%, localized fluid collection in 9.9%, perifascial fluid in 12.1%, hypervascularization in 27.3%, and joint effusion in 18.2%. CONCLUSION: US findings in pediatric patients treated with magnesium screws strongly resemble infection, but are normal findings in the setting of screw resorption. CLINICAL RELEVANCE STATEMENT: Bioabsorbable magnesium-based alloy screws release gas during resorption. The resulting US findings in the adjacent soft tissues and joints in pediatric patients may mimic infection, but are normal findings. KEY POINTS: ⢠Bioabsorbable magnesium-based alloy screws release gas upon resorption. ⢠The resulting ultrasound findings in children's soft tissues and joints closely resemble those of soft tissue infection or osteosynthesis-associated infection. ⢠Be familiar with these ultrasound findings in order to avoid inadvertently misdiagnosing a soft tissue infection or osteosynthesis-associated infection.