Fixation stability and implant-associated complications in periacetabular osteotomy: a comparison of screw and K-wire fixation

Abstract Aims The aim of this study was to compare the fixation stability and complications in patients undergoing periacetabular osteotomy (PAO) with either K-wire or screw fixation. Patients and methods We performed a retrospective study to analyze a consecutive series of patients who underwent PAO with either screw or K-wire fixation. Patients who were treated for acetabular retroversion or had previous surgery on the ipsilateral hip joint were excluded. 172 patients (191 hips: 99 K-wire/92 screw fixation) were included. The mean age at the time of PAO was 29.3 years (16–48) in the K-wire group and 27.3 (15–45) in the screw group and 83.9% were female. Clinical parameters including duration of surgery, minor complications (soft tissue irritation and implant migration) and major complications (implant failure and non-union) were evaluated. Radiological parameters including LCE, TA and FHEI were measured preoperatively, postoperatively and at 3-months follow-up. Results Duration of surgery was significantly reduced in the K-wire group with 88.2 min (53–202) compared to the screw group with 119.7 min (50–261) (p < 0.001). Soft tissue irritation occurred significantly more often in the K-wire group (72/99) than in the screw group (36/92) (p < 0.001). No group showed significantly more implant migration than the other. No major complications were observed in either group. Postoperative LCE, TA and FHEI were improved significantly in both groups for all parameters (p = < 0.0001). There was no significant difference for initial or final correction for the respective parameters between the two groups. Furthermore, no significant difference in loss of correction was observed between the two groups for the respective parameters. Conclusion K-wire fixation is a viable and safe option for fragment fixation in PAO with similar stability and complication rates as screw fixation. An advantage of the method is the significantly reduced operative time. A disadvantage is the significantly higher rate of implant-associated soft tissue irritation, necessitating implant removal. Level of evidence III, retrospective trial.

Download Full-text

Comparison of Bioabsorbable Magnesium versus Titanium Screw Fixation for Modified Distal Chevron Osteotomy in Hallux Valgus

BioMed Research International ◽

10.1155/2018/5242806 ◽

2018 ◽

Vol 2018 ◽

pp. 1-9 ◽

Cited By ~ 8

Author(s):

Baver Acar ◽

Ozkan Kose ◽

Adil Turan ◽

Melih Unal ◽

Yusuf Alper Kati ◽

...

Keyword(s):

Hallux Valgus ◽

Screw Fixation ◽

Clinical Results ◽

Significant Loss ◽

Compression Screw ◽

Titanium Screw ◽

Chevron Osteotomy ◽

Valgus Angle ◽

Significant Difference ◽

Screw Group

Objective. The purpose of this retrospective study was to compare the clinical and radiological results of magnesium versus titanium screw fixation for modified distal chevron osteotomy in hallux valgus (HV). Materials and Methods. A total of 31 patients who underwent modified distal chevron osteotomy for HV deformity between 2014 and 2017 were reviewed retrospectively. Headless magnesium (Mg) compression screw fixation was applied in 16 patients (17 feet) and headless titanium (Ti) compression screw in 15 patients (17 feet). Patients were followed up for at least 12 months with a mean of 19.0 ± 6.8 months in the Mg screw group and 16.2 ± 6.19 in the Ti screw group, respectively (p: 0.234). Clinical results were evaluated using the American Orthopedic Foot and Ankle Society Hallux metatarsophalangeal-interphalangeal (AOFAS-MTP-IP) scale and a visual analogue scale (VAS). The hallux valgus angle (HVA) and intermetatarsal angle (IMA) were measured before and after surgery. Time to osteotomy union and any complications were recorded and compared between the groups. Results. An improvement in the AOFAS-MTP-IP scale and VAS points were recorded in both groups with no statistically significant difference between the groups (p: 0.764 and 0.535, resp.). At the final follow-up examination, HVA and IMA were similar (p: 0.226 and 0.712, resp.). There was no significant loss of correction between the early and final radiographs in respect of HVA and IMA in both groups (p: 0.321 and p: 0.067). Full union of the osteotomy was obtained in all patients. Prolonged (1.5 months) swelling and mild hyperemia around the surgical incision were observed in 1 patient in the Mg group but there was a good response to physical and medical therapy, and the complaints were completely resolved. There were no other significant complications in either group. Conclusion. The results of this study showed that bioabsorbable Mg compression screw fixation has similar therapeutic efficacy to Ti screw fixation in respect of functional and radiological outcomes. Bioabsorbable Mg screw is an alternative fixation material that can be safely used for modified distal chevron osteotomy in HV surgery.

Download Full-text

Is transverse screw fixation really necessary in PAO?—A comparative in vivo study

Journal of Hip Preservation Surgery ◽

10.1093/jhps/hnab034 ◽

2021 ◽

Author(s):

Vincent J Leopold ◽

Juana Conrad ◽

Christian Hipfl ◽

Maximilian Müllner ◽

Thilo Khakzad ◽

...

Keyword(s):

Screw Fixation ◽

Periacetabular Osteotomy ◽

Fixation Technique ◽

Acetabular Fragment ◽

Center Edge ◽

Significant Difference ◽

Group 2 ◽

Group 1

Abstract The optimal fixation technique in periacetabular osteotomy (PAO) remains controversial. This study aims to assess the in vivo stability of fixation in PAO with and without the use of a transverse screw. We performed a retrospective study to analyse consecutive patients who underwent PAO between January 2015 and June 2017. Eighty four patients (93 hips) of which 79% were female were included. In 54 cases, no transverse screw was used (group 1) compared with 39 with transverse screw (group 2). Mean age was 26.5 (15–44) in group 1 and 28.4 (16–45) in group 2. Radiological parameters relevant for DDH including lateral center edge angle of Wiberg (LCEA), Tönnis angle (TA) and femoral head extrusion index (FHEI) were measured preoperatively, post-operatively and at 3-months follow-up. All patients were mobilized with the same mobilization regimen. Post-operative LCEA, TA and FHEI were improved significantly in both groups for all parameters (P ≤ 0.0001). Mean initial correction for LCEA (P = 0.753), TA (P = 0.083) and FHEI (P = 0.616) showed no significant difference between the groups. Final correction at follow-up of the respective parameters was also not significantly different between both groups for LCEA (P = 0.447), TA (P = 0.100) and FHEI (P = 0.270). There was no significant difference between initial and final correction for the respective parameters. Accordingly, only minimal loss of correction was measured, showing no difference between the two groups for LCEA (P = 0.227), TA (P = 0.153) and FHEI (P = 0.324). Transverse screw fixation is not associated with increased fragment stability in PAO. This can be taken into account by surgeons when deciding on the fixation technique of the acetabular fragment in PAO.

Download Full-text

Cost Comparison of Kirschner Wire Versus Intramedullary Screw Fixation of Metacarpal and Phalangeal Fractures

Hand ◽

10.1177/15589447211030690 ◽

2021 ◽

pp. 155894472110306

Author(s):

Christopher F. Brewer ◽

Quillian Young-Sing ◽

Adam Sierakowski

Keyword(s):

Health Care ◽

Screw Fixation ◽

Kirschner Wire ◽

Complication Rates ◽

Hand Fractures ◽

Significant Difference ◽

Wire Fixation ◽

Phalangeal Fractures ◽

Intramedullary Screw

Background Intramedullary screw fixation is a relatively new technique for fixation of metacarpal and phalangeal fractures. The objective of this study was to compare health care–associated costs and outcomes for intramedullary screw versus Kirschner wire (K-wire) fixation of hand fractures. Methods A retrospective review of patients undergoing intramedullary screw fixation of hand fractures at a single center during 2016-2019 inclusive was conducted. Health care–associated costs were compared with age-matched and fracture pattern–matched controls who underwent K-wire fixation. Results Fifty patients met the study inclusion criteria, incorporating 62 fractures (29 K-wire, 33 intramedullary screw fixation). The median age was 34.6 years (18.0-90.1 years). There was no significant difference in primary operative costs (£1130.4 ± £162.7 for K-wire vs £1087.0 ± £104.2 for intramedullary screw), outpatient follow-up costs (£958.7 ± £149.4 for K-wire vs £782.4 ± £143.8 for intramedullary screw), or total health care–associated costs (£2089.1 ± £209.0 for K-wire vs £1869.4 ± £195.3 for intramedullary screw). However, follow-up costs were significantly lower for the uncomplicated intramedullary screw cohort (£847.1 ± £109.1 for K-wire vs £657.5 ± £130.8 for intramedullary screw, P = .05). Subgroup analysis also revealed that overall costs were significantly higher for buried K-wire techniques. Complication rates, time to return to active work, and Disabilities of the Arm, Shoulder, and Hand scores were similar. Conclusions This study identified significantly lower outpatient follow-up costs for uncomplicated intramedullary screw fixation of hand fractures compared with K-wires, along with a trend toward lower overall health care–associated costs. In addition, buried K-wire techniques were also found to carry a significantly higher financial burden. Higher powered prospective studies are required to determine indirect costs.

Download Full-text

Suture Button vs Conventional Screw Fixation for Isolated Lisfranc Ligament Injuries

Foot & Ankle International ◽

10.1177/1071100720976074 ◽

2020 ◽

pp. 107110072097607

Author(s):

Jaeho Cho ◽

Jahyung Kim ◽

Tae-Hong Min ◽

Dong-Il Chun ◽

Sung Hun Won ◽

...

Keyword(s):

Clinical Outcome ◽

Screw Fixation ◽

Single Case ◽

Foot Pressure ◽

Level Of Evidence ◽

Suture Button ◽

Significant Difference ◽

Lisfranc Ligament ◽

Screw Group

Background: Suture buttons have been used for isolated Lisfranc ligament (ILL) fixation. However, no study has reported on its clinical and radiologic outcomes. Method: In this retrospective comparative study, patients with ILL injuries were divided into 2 groups according to the treatment method: 32 conventional screw group and 31 suture button group. The clinical and radiologic outcomes at preoperation, 6 months and 1 year postoperation, and last follow-up period were measured. Plantar foot pressure was measured at postoperative month 6 months. Postoperative complications at the last follow-up were evaluated. Result: The suture button group showed better American Orthopaedic Foot & Ankle Society midfoot scale ( P < .001) and visual analog scale ( P < .001) scores compared with the conventional screw fixation group at the postoperative month 6 period before screw removal. However, no significant difference in clinical outcome between the 2 groups was found at postoperative year 1 or last follow-up. No differences in radiologic outcomes were found between the 2 groups. Plantar foot pressure was significantly elevated in the conventional screw group at the great toe and first metatarsal head area compared with the contralateral foot just before screw removal. Recurrent Lisfranc joint diastasis was found in a single case in the conventional screw group and 2 cases in the suture button group. Conclusion: Suture button fixation in the treatment of ILL injuries may provide comparable fixation stability and clinical outcome with conventional screw fixation in the early postoperative period. Level of Evidence: Level III, retrospective case-control study, therapeutic.

Download Full-text

Comparative Biomechanical Study of Screw Fixation Techniques in Periacetabular Osteotomy

Biomechanics ◽

10.3390/biomechanics1010010 ◽

2021 ◽

Vol 1 (1) ◽

pp. 131-144

Author(s):

Mahsan Bakhtiarinejad ◽

Amirhossein Farvardin ◽

Ryan J. Murphy ◽

Robert B. Grupp ◽

John E. Tis ◽

...

Keyword(s):

Screw Fixation ◽

Periacetabular Osteotomy ◽

Developmental Dysplasia ◽

Biomechanical Study ◽

Pelvic Bone ◽

Optimal Method ◽

Yield Load ◽

Acetabular Fragment ◽

Significant Difference ◽

Fixation Techniques

Periacetabular osteotomy (PAO) is a common surgical treatment for developmental dysplasia of the hip. To obtain the optimal method of fixation during PAO, different screw fixation techniques have been proposed for stabilizing the acetabular fragment. This study assesses the biomechanical performance of two popular 3-screw fixation techniques: iliac (IS) and transverse (IT) configurations, through finite element simulations. Additionally, different 2-screw combinations are simulated to investigate the biomechanical significance of each screw of the fixation configurations. The study findings show that yield load of the pelvic bone subject to gait loading for IT configuration is on average 7% higher compared to that of the IS. Although the yield load of the IT is predicted to be slightly higher, no significant difference in bone stiffness and displacement of the acetabular fragment are found between two configurations. Simulation results, therefore, do not demonstrate a significant biomechanical advantage of the IT configuration over the IS. Furthermore, the biomechanical comparison between the 2-screw combinations of IS and IT fixations demonstrates that the most anterior screw in IS, located at the iliac crest, and the most medial screw in the IT are the most critical elements in providing sufficient stability and support for acetabular fragment.

Download Full-text

Suture versus screw fixation technique for tibial eminence fracture: A meta-analysis of laboratory studies

Journal of Orthopaedic Surgery ◽

10.1177/2309499020907977 ◽

2020 ◽

Vol 28 (1) ◽

pp. 230949902090797

Author(s):

Mao Ye ◽

Jun Chen ◽

Feng Hu ◽

Yanxi Liu ◽

Yang Tan

Keyword(s):

Failure Load ◽

Screw Fixation ◽

Laboratory Studies ◽

Cyclic Testing ◽

Fixation Technique ◽

Ultimate Failure Load ◽

Significant Difference ◽

Suture Group ◽

Ultimate Failure ◽

Screw Group

Purpose: The aim of this study was to compare the biomechanical properties between the suture fixation technique and the screw fixation technique for tibial eminence fracture (TEF). Methods: The current study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The PubMed, Embase, and the Cochrane were searched from inception to January 2019 comparing the suture and the screw fixation technique for TEF. The results of the eligible studies were analyzed in terms of stiffness, ultimate failure load, and displacement after the cyclic testing. Results: Six laboratory studies were included with a total of 114 knees: 57 knees were in the FiberWire suture group and 57 knees were in the single-screw group. The suture group had higher stiffness than the screw group, but there was no statistical difference between these two groups. Ultimate failure load in the suture group was statistically higher than that in the screw group. No statistically significant difference existed in displacement after the cyclic testing between the suture group and the screw group. Conclusion: The FiberWire suture fixation may be biomechanically superior to a single screw fixation in TEF treatment in mature knees regarding ultimate failure load, while no significant difference was found between the two fixations in terms of stiffness and displacement after the cyclic testing.

Download Full-text

Fixation Comparison for Chevron Osteotomies

Foot & Ankle International ◽

10.1177/107110079801900108 ◽

1998 ◽

Vol 19 (1) ◽

pp. 41-43 ◽

Cited By ~ 28

Author(s):

Lynn A. Crosby ◽

Gordon R. Bozarth

Keyword(s):

Patient Satisfaction ◽

Hallux Valgus ◽

Screw Fixation ◽

Chevron Osteotomy ◽

Significant Difference ◽

Wire Fixation ◽

Permanent Fixation ◽

Student’S T ◽

Operative Costs ◽

Cost Studies

A comparison study of temporary K-wire fixation, permanent Herbert Whipple screw fixation, versus no osteotomy fixation was performed on distal chevron osteotomies for hallux valgus deformities. Nineteen chevron osteotomies were performed on 17 patients. Six patients received a Herbert Whipple screw for fixation, seven patients received temporary K-wire fixation, and six patients received no fixation for the chevron osteotomy. The average postoperative hallux valgus (HV) angle improved by 7.1° with no fixation, 6.3° with temporary K-wire fixation, and 9.5° with Herbert Whipple screw fixation. Comparison of the three groups using the Student's t-test revealed no statistical difference between the three groups ( P = 0.6). The increased anesthesia time and operative costs for Herbert Whipple screw fixation was found to be statistically significant in comparison with the use of no fixation ( P = <0.001). Time and cost studies were not significantly different for the K-wire and no fixation groups. Follow-up averaged 3.3 years. All patients reported satisfaction with the procedure and an improvement of their preoperative complaints. No significant difference in patient satisfaction was found to exist between the groups receiving fixation and those who did not have fixation. The results of this study can find no long-term benefit when comparing costs and patient satisfaction with the use of any temporary or permanent fixation of osteotomy sites when performing chevron osteotomies.

Download Full-text

Single Versus Dual Headless Compression Screw Fixation of Scaphoid Nonunions: A Biomechanical Comparison

Hand ◽

10.1177/1558944720974111 ◽

2021 ◽

pp. 155894472097411

Author(s):

Luke T. Nicholson ◽

Kristen M. Sochol ◽

Ali Azad ◽

Ram Kiran Alluri ◽

J. Ryan Hill ◽

...

Keyword(s):

Screw Fixation ◽

Qualitative Assessment ◽

Secondary Outcome ◽

Scaphoid Nonunion ◽

Compression Screw ◽

Single Screw ◽

Headless Compression Screw ◽

Significant Difference ◽

Load To Failure ◽

Headless Compression Screws

Background: Management of scaphoid nonunions with bone loss varies substantially. Commonly, internal fixation consists of a single headless compression screw. Recently, some authors have reported on the theoretical benefits of dual-screw fixation. We hypothesized that using 2 headless compression screws would impart improved stiffness over a single-screw construct. Methods: Using a cadaveric model, we compared biomechanical characteristics of a single tapered 3.5- to 3.6-mm headless compression screw with 2 tapered 2.5- to 2.8-mm headless compression screws in a scaphoid waist nonunion model. The primary outcome measurement was construct stiffness. Secondary outcome measurements included load at 1 and 2 mm of displacement, load to failure for each specimen, and qualitative assessment of mode of failure. Results: Stiffness during load to failure was not significantly different between single- and double-screw configurations ( P = .8). Load to failure demonstrated no statistically significant difference between single- and double-screw configurations. Using a qualitative assessment, the double-screw construct maintained rotational stability more than the single-screw construct ( P = .029). Conclusions: Single- and double-screw fixation constructs in a cadaveric scaphoid nonunion model demonstrate similar construct stiffness, load to failure, and load to 1- and 2-mm displacement. Modes of failure may differ between constructs and represent an area for further study. The theoretical benefit of dual-screw fixation should be weighed against the morphologic limitations to placing 2 screws in a scaphoid nonunion.

Download Full-text

Microsurgical unilateral laminotomy for bilateral decompression of degenerative lumbar canal stenosis: a comparative study

The Egyptian Journal of Neurology Psychiatry and Neurosurgery ◽

10.1186/s41983-019-0125-4 ◽

2019 ◽

Vol 55 (1) ◽

Author(s):

Mohamed I. Refaat ◽

Amr K. Elsamman ◽

Adham Rabea ◽

Mohamed I. A. Hewaidy

Keyword(s):

Patient Satisfaction ◽

Blood Loss ◽

Minimally Invasive ◽

Invasive Technique ◽

Decompression Surgery ◽

Microsurgical Decompression ◽

Significant Difference ◽

Duration Of Surgery ◽

Group A ◽

Group B

Abstract Background The quest for better patient outcomes is driving to the development of minimally invasive spine surgical techniques. There are several evidences on the use of microsurgical decompression surgery for degenerative lumbar spine stenosis; however, few of these studies compared their outcomes with the traditional laminectomy technique. Objectives The aim of our study was to compare outcomes following microsurgical decompression via unilateral laminotomy for bilateral decompression (ULBD) of the spinal canal to the standard open laminectomy for cases with lumbar spinal stenosis. Subjects and methods Cases were divided in two groups. Group (A) cases were operated by conventional full laminectomy; Group (B) cases were operated by (ULBD) technique. Results from both groups were compared regarding duration of surgery, blood loss, perioperative complication, and postoperative outcome and patient satisfaction. Results There was no statistically significant difference between both groups regarding the improvement of visual pain analogue, while improvement of neurogenic claudication outcome score was significant in group (B) than group (A). Seventy-three percent of group (A) cases and 80% of group (B) stated that surgery met their expectations and were satisfied from the outcome. Conclusion Comparing ULBD with traditional laminectomy showed the efficacy of the minimally invasive technique in obtaining good surgical outcome and patient satisfaction. There was no statistically significant difference between both groups regarding the occurrence of complications The ULBD technique was found to respect the posterior spinal integrity and musculature, accompanied with less blood loss, shorter hospital stays, and shorter recovery periods than the open laminectomy technique.

Download Full-text

Soft tissue masses: distribution of entities and rate of malignancy in small lesions

BMC Cancer ◽

10.1186/s12885-020-07769-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Felix G. Gassert ◽

Florian T. Gassert ◽

Katja Specht ◽

Carolin Knebel ◽

Ulrich Lenze ◽

...

Keyword(s):

Soft Tissue ◽

Benign Lesion ◽

Maximum Diameter ◽

Histopathological Diagnosis ◽

Tumor Diameter ◽

Mr Images ◽

Tissue Mass ◽

Malignancy Rate ◽

Significant Difference ◽

Soft Tissue Masses

Abstract Background Small soft tissue masses are often falsely assumed to be benign and resected with failure to achieve tumor-free margins. Therefore, this study retrospectively investigated the distribution of histopathologic diagnosis to be encountered in small soft tissue tumors (≤ 5 cm) in a large series of a tertiary referral center. Methods Patients with a soft tissue mass (STM) with a maximum diameter of 5 cm presenting at our institution over a period of 10 years, who had undergone preoperative Magnetic resonance imaging and consequent biopsy or/and surgical resection, were included in this study. A final histopathological diagnosis was available in all cases. The maximum tumor diameter was determined on MR images by one radiologist. Moreover, tumor localization (head/neck, trunk, upper extremity, lower extremity, hand, foot) and depth (superficial / deep to fascia) were assessed. Results In total, histopathologic results and MR images of 1753 patients were reviewed. Eight hundred seventy patients (49.63%) showed a STM ≤ 5 cm and were therefore included in this study (46.79 +/− 18.08 years, 464 women). Mean maximum diameter of the assessed STMs was 2.88 cm. Of 870 analyzed lesions ≤ 5 cm, 170 (19.54%) were classified as superficial and 700 (80.46%) as deep. The malignancy rate of all lesions ≤ 5 cm was at 22.41% (superficial: 23.53% / deep: 22.14%). The malignancy rate dropped to 16.49% (20.79% / 15.32%) when assessing lesions ≤ 3 cm (p = 0.007) and to 15.0% (18.18% / 13.79%) when assessing lesions ≤ 2 cm (p = 0.006). Overall, lipoma was the most common benign lesion of superficial STMs (29.41%) and tenosynovial giant cell tumor was the most common benign lesion of deep STMs (23.29%). Undifferentiated pleomorphic sarcoma was the most common malignant diagnosis among both, superficial (5.29%) and deep (3.57%) STMs. Conclusions The rate of malignancy decreased significantly with tumor size in both, superficial and deep STMs. The distribution of entities was different between superficial and deep STMs, yet there was no significant difference found in the malignancy rate.

Download Full-text