Staged internal plate fixation of severe lower extremity fractures that use a temporary external fixator for the initial treatment as an intraoperative retention tool: a technical note

Abstract BackgroundGood clinical outcomes for locking plates as an external fixator to treat tibial fractures have been reported. However, external locking plate fixation is still generally rarely performed. This study aimed to compare the stability of external locking plate fixator with that of conventional external fixator for extraarticular proximal tibial fractures, using finite element analysis. MethodsThree models were constructed: (1) external locking plating of proximal tibial fracture with lateral proximal tibial locking plate and 5-mm screws (ELP), (2) conventional external fixation of proximal tibial fracture with an 11-mm rod and 5-mm Schanz screws (EF-11), and (3) conventional external fixation of proximal tibial fracture with a 7-mm rod and 5-mm Schanz screws (EF-7). The stress distribution, displacement at the fracture gap, and stiffness of the three finite element models at 30-, 40-, 50-, and 60-mm plate–rod offset from the lateral surface of the lateral condyle of the tibia were determined. ResultsThe conventional external fixator showed higher stiffness than did the external locking plate fixator. In all models, the stiffness decreased as the distance of the plate–rod from the bone surface increased. The maximum stiffness was 121.06 N/mm in the EF-11 model with 30-mm tibia–rod offset. In the EF-7 model group, the maximum stiffness was 40.00 N/mm in the model with 30-mm tibia–rod offset. In the ELP model group, the maximum stiffness was 35.79 N/mm in the model with 30-mm tibia–plate offsetConclusionsExternal locking plate fixation is more flexible than conventional external fixation, which can influence secondary bone healing. External locking plate fixation requires the placement of the plate as close as possible to the skin, which allow low-profile design, because the increased distance of the plate from bone can be too flexible for bone healing.

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Military experience in the management of pelvic fractures from OIF/OEF

BMJ Military Health ◽

10.1136/bmjmilitary-2020-001469 ◽

2020 ◽

pp. bmjmilitary-2020-001469

Author(s):

William Parker ◽

R W Despain ◽

J Bailey ◽

E Elster ◽

C J Rodriguez ◽

...

Keyword(s):

Lower Extremity ◽

Pelvic Fracture ◽

External Fixator ◽

Injury Severity ◽

Fracture Pattern ◽

Injury Pattern ◽

Pelvic Fractures ◽

Vertical Shear ◽

Treatment Modalities ◽

Pelvic Binder

IntroductionPelvic fractures are a common occurrence in combat trauma. However, the fracture pattern and management within the most recent conflicts, i.e. Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF), have yet to be described, especially in the context of dismounted complex blast injury. Our goal was to identify the incidence, patterns of injury and management of pelvic fractures.MethodsWe conducted a retrospective review on all combat-injured patients who arrived at our military treatment hospital between November 2010 and November 2012. Basic demographics, Young-Burgess fracture pattern classification and treatment strategies were examined.ResultsOf 562 patients identified within the study time period, 14% (81 of 562) were found to have a pelvic fracture. The vast majority (85%) were secondary to an improvised explosive device. The average Injury Severity Score for patients with pelvic fracture was 31±12 and 70% were classified as open. Of the 228 patients with any traumatic lower extremity amputation, 23% had pelvic fractures, while 30% of patients with bilateral above-knee amputations also sustained a pelvic fracture. The most common Young-Burgess injury pattern was anteroposterior compression (APC) (57%), followed by lateral compression (LC) (36%) and vertical shear (VS) (7%). Only 2% (nine of 562) of all patients were recorded as having pelvic binders placed in the prehospital setting. 49% of patients with pelvic fracture required procedural therapy, the most common of which was placement of a pelvic external fixator (34 of 40; 85%), followed by preperitoneal packing (16 of 40; 40%) and angioembolisation (three of 40; 0.75%). 17 (42.5%) patients required combinations of these three treatment modalities, the majority of which were a combination of external fixator and preperitoneal packing. The likelihood to need procedural therapy was impacted by injury pattern, as 72% of patients with an APC injury, 100% of patients with a VS injury and 25% of patients with an LC injury required procedural therapy.ConclusionsPelvic fractures were common concomitant injuries following blast-induced traumatic lower extremity amputations. APC was the most common pelvic fracture pattern identified. While procedural therapy was frequent, the majority of patients underwent conservative therapy. However, placement of an external fixator was the most frequently used modality. Considering angioembolisation was used in less than 1% of cases, in the forward deployed military environment, management should focus on pelvic external fixation±preperitoneal packing. Finally, prehospital pelvic binder application may be an area for further process improvement.

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Use of an external fixator pin to aid closed reduction of a displaced intracapsular hip fracture—A case report with a technical note

Injury Extra ◽

10.1016/j.injury.2012.03.008 ◽

2012 ◽

Vol 43 (6) ◽

pp. 35-36

Author(s):

Shashi Kumar Nanjayan ◽

Dan Deakin ◽

Marius Espag ◽

James Hutchinson

Keyword(s):

Case Report ◽

Hip Fracture ◽

External Fixator ◽

Closed Reduction ◽

Technical Note ◽

Intracapsular Hip Fracture

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Efficacy of anterior cervical decompression and fusion procedures for monomelic amyotrophy treatment: a prospective randomized controlled trial

Journal of Neurosurgery Spine ◽

10.3171/2013.4.spine12575 ◽

2013 ◽

Vol 19 (4) ◽

pp. 412-419 ◽

Cited By ~ 19

Author(s):

Feizhou Lu ◽

Hongli Wang ◽

Jianyuan Jiang ◽

Wenjun Chen ◽

Xin Ma ◽

...

Keyword(s):

Bone Grafting ◽

Iliac Crest ◽

Plate Fixation ◽

Cervical Collar ◽

Therapeutic Effects ◽

Iliac Crest Bone Grafting ◽

Anterior Cervical Decompression ◽

Significant Difference ◽

Internal Plate Fixation

Object Monomelic amyotrophy (MMA) is a benign, self-limiting lower motor neuron disease. Optimal surgical strategies—discectomy decompression and fusion (DDF) or corpectomy decompression and fusion (CDF)—for patients with aggravated symptoms (within 6 months of presentation) are controversial, particularly in those who are ineligible for conventional treatment. These 2 methods of anterior cervical decompression and fusion for MMA in patients unwilling or unable to wear a conventional cervical collar long term were evaluated. Methods Anterior cervical decompression and fusion were performed in 48 male patients with MMA between September 2007 and September 2010. Patients were randomly treated with anterior cervical discectomy decompression with autologous iliac crest bone grafting and internal plate fixation (DDF group: 24 patients) or anterior cervical corpectomy, posterior longitudinal ligament resection, autologous iliac crest bone grafting, and internal plate fixation (CDF group: 24 patients). Subjective symptom assessments and electromyography (EMG) examinations were conducted both preoperatively and postoperatively. Results Subjective assessments and EMG studies (mean follow-up duration 25.9 months) indicated improvement in 64.6% and 60% of patients, respectively. No significant correlations between the effectiveness of surgery and age at symptom onset, preoperative symptom duration, or postoperative follow-up time were found. Conclusions The lack of a significant difference in effectiveness between DDF and CDF favors DDF as more clinically applicable because of its lower procedural risks. As a second-line alternative to cervical collar treatment, surgical anterior cervical decompression and fusion via DDF or CDF may prevent further deterioration and produce good short-term therapeutic effects in patients with MMA; however, cervical collar treatment is recommended for eligible patients because of its lower associated risks.

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Endoscopic Aqueductal Stenting via the Fourth Ventricle under Navigating System Guidance: Technical Note

Operative Neurosurgery ◽

10.1227/01.neu.0000144493.33345.9f ◽

2005 ◽

Vol 56 (suppl_1) ◽

pp. ONS-E206-ONS-E206 ◽

Cited By ~ 5

Author(s):

Hideo Hamada ◽

Nakamasa Hayashi ◽

Masanori Kurimoto ◽

Shunro Endo

Keyword(s):

Ventriculoperitoneal Shunt ◽

Initial Treatment ◽

Fourth Ventricle ◽

Technical Note ◽

New Method ◽

Cerebellar Hemisphere ◽

Shunt Placement ◽

Isolated Fourth Ventricle ◽

Ventricular Hemorrhage ◽

Reasonable Choice

Abstract OBJECTIVE: We report three patients with symptomatic isolated fourth ventricle after ventriculoperitoneal shunt placement for hydrocephalus associated with ventricular hemorrhage. All three patients were treated successfully with our new method of endoscopic aqueductal stenting under navigating system guidance. METHODS: A therapeutic rigid endoscope was inserted through the thin cerebellar hemisphere, and endoscopic aqueductal stenting was performed via the enlarged fourth ventricle under navigating system guidance. RESULTS: All three patients underwent successful procedures with good outcomes. CONCLUSION: Our method of aqueductal stenting is a reasonable choice for initial treatment of patients with isolated fourth ventricle, and it entails less invasive neurosurgery.

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Management of nonunion of lower-extremity long bones using mono-lateral external fixator – Report of 37 cases

Injury ◽

10.1016/j.injury.2013.11.019 ◽

2014 ◽

Vol 45 (3) ◽

pp. 560-567 ◽

Cited By ~ 29

Author(s):

Raj Kumar Harshwal ◽

Sohan Singh Sankhala ◽

Divesh Jalan

Keyword(s):

Lower Extremity ◽

External Fixator ◽

Long Bones

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Distal femoral osteotomy using a novel deformity reduction device

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.3415/vcot-15-11-0186 ◽

2016 ◽

Vol 29 (05) ◽

pp. 426-432 ◽

Cited By ~ 4

Author(s):

Fulvio Cappellari ◽

Matteo Olimpo ◽

Lisa Piras ◽

Robert Radasch ◽

Antonio Ferretti ◽

...

Keyword(s):

Surgical Procedure ◽

Tibial Plateau ◽

Preoperative Planning ◽

Plate Fixation ◽

Corrective Osteotomy ◽

Femoral Osteotomy ◽

Limb Alignment ◽

Distal Femoral Osteotomy ◽

Femoral Deformity ◽

Internal Plate Fixation

SummaryDistal femoral osteotomy is a surgical procedure used to correct patellar luxation, secondary to a femoral deformity. A distal femoral osteotomy using the tibial plateau levelling osteotomy-jig to temporarily provide stability of the distal femoral osteotomy, maintaining limb alignment in the frontal and axial planes prior to internal plate fixation of the osteotomy, has been described. This report describes a novel jig named Deformity Reduction Device (DRD). This device was developed with the specific aim of increasing precision and predictability during corrective osteotomy execution in order to be consistent with the preoperative planning. The distal femoral osteotomy DRD-assisted procedure is described in detail, discussing the theoretical and practical principles of the application.

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Internal plate fixation of fractures: short history and recent developments

Journal of Orthopaedic Science ◽

10.1007/s00776-005-0984-7 ◽

2006 ◽

Vol 11 (2) ◽

pp. 118-126 ◽

Cited By ~ 179

Author(s):

Hans K. Uhthoff ◽

Philippe Poitras ◽

David S. Backman

Keyword(s):

Plate Fixation ◽

Short History ◽

Recent Developments ◽

Internal Plate Fixation

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Cervical Single-Level Pincer Stenosis Causing Myelopathy: A Technical Note and Medium-term Results of a One-Session Microsurgical 360-Degree Treatment

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0041-1723811 ◽

2021 ◽

Author(s):

Luca Papavero ◽

Markus Pietrek ◽

Carlos Joan Marques ◽

Gregor Schmeiser

Keyword(s):

Plate Fixation ◽

Japanese Orthopaedic Association ◽

Technical Note ◽

X Rays ◽

Medium Term ◽

Improvement Rate ◽

Single Level ◽

Postoperative Mri ◽

The Mean ◽

Degenerative Cervical Myelopathy

Abstract Background and Study Aims Single-level circumferential or pincer stenosis (PS) affects few patients with degenerative cervical myelopathy (DCM). The surgical technique and medium-term results of a one-session microsurgical 360-degree (m360°) procedure are presented. Patients Between 2013 and 2018, the data of 23 patients were prospectively collected out of 371 patients with DCM. The m360° procedure comprised a microsurgical anterior cervical decompression and fusion (ACDF), with additional plate fixation, followed by flipping the patient and performing a microsurgical posterior bilateral decompression via a unilateral approach in crossover technique. Results The mean age of the patients was 72 years (range: 50–84); 17 patients were males. The mean follow-up time was 12 months (range: 6–31). The patients filled in the patient-derived modified Japanese Orthopaedic Association (P-mJOA) questionnaire on average 53 months after surgery. One patient received a two-level ACDF. Lesions were mostly (92%) located at the C3/C4 (8/24), C4/C5 (7/24), and C5/C6 (7/24) levels. Functional X-rays showed segmental instability in 10 of 23 patients (44%). All preoperative T2-weighted magnetic resonance imaging (MRI) showed an intramedullary hyperintensity. The median preoperative mJOA score was 13 (range 3), and it improved to 16 (range 3) postoperatively. The mean improvement rate in the mJOA score was 73%. When available, postoperative MRI confirmed good circumferential decompression with persistent intramedullary hyperintensity. There were two complications: a long-lasting radicular paresthesia at C6 and a transient C5 palsy. No revision surgery was required. Conclusion The one-session m360° procedure was found to be a safe surgical procedure for the treatment of PS, and the medium-term clinical outcome was satisfactory.

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