Ankle fusion percutaneous home run screw fixation: Technical aspects and soft tissue structures at risk

The Foot ◽  
2019 ◽  
Vol 40 ◽  
pp. 39-42
Author(s):  
L. Roberts ◽  
A.L. Godoy-Santos ◽  
P.W. Hudson ◽  
S. Phillips ◽  
D.R.C. Nishikawa ◽  
...  
Keyword(s):  
At Risk ◽  
Soft Tissue ◽  
Screw Fixation ◽  
Technical Aspects ◽  
Ankle Fusion ◽  
Tissue Structures

scholarly journals Ankle Fusion Percutaneous Home Run Screw Fixation

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0020
Author(s):  
Cesar de Cesar Netto ◽  
Lauren Roberts ◽  
Jackson Staggers ◽  
Walter Smith ◽  
Sung Lee ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Screw Fixation ◽  
Cadaver Study ◽  
Neurovascular Bundle ◽  
Neutral Position ◽  
Ankle Fusion ◽  
Close Proximity ◽  
Fresh Frozen ◽  
The Mean ◽  
Tissue Structures

Category: Ankle Arthritis Introduction/Purpose: During internal fixation of ankle fusions, besides the standard crossed screw fixation pattern, the use of a percutaneously placed augmenting screw, directed from the posterolateral tibial metaphysis proximally across the ankle into the talar neck (“ankle fusion home run screw”), is a widely used technique. The placement of this screw is technically demanding and multiple attempts under fluoroscopy guidance are frequently needed to achieve a perfect positioning of the implant. Injuries to local neurovascular and tendinous structures might happen. The objective of this cadaver study was to identify the number of attempts necessary for a perfect positioning of the ankle fusion home run screw and the neurovascular and tendinous structures at risk. Methods: Eleven fresh frozen cadaver limbs were used. Guide wires (3.2 mm) from the Stryker (Selzach, Switzerland) 7.0-mm headless cannulated set were percutaneously placed into the distal posterolateral aspect of the leg, under fluoroscopic guidance, with the ankle held in neutral position. Mal positioned pins were not removed and served as guidance for the following pins. The number of guide wires needed to achieve an acceptable positioning of the implant was noted. After a layered dissection from the skin to the tibia, we evaluated neurovascular and tendinous injuries, and measured the shortest distance between the closest guide pin and the soft tissue structures, using a precision digital caliper. Results: The mean number of guide wires needed to achieve and acceptable positioning of the implant was 2.09 (SD 0.83, range 1- 4). The mean distances between the closest guide pin and the soft tissue structures of interest were: Achilles tendon 6.90 mm (SD 3.74 mm); peroneal tendons 9.65 mm (SD 3.99 mm); sural neurovascular bundle 0.97 mm (SD 1.93 mm); posteromedial neurovascular bundle 14.26 mm (SD 4.56 mm). Sural bundle was in contact with the guide pin in 5/11 specimens (45.5%) and transected in 3/11 specimens (27.3%). Conclusion: The placement of percutaneous ankle fusion home run screws is technically demanding and multiple guide pins are needed. Our cadaveric study showed that important tendinous and neurovascular structures are in close proximity with the guide pins and that the sural bundle is injured in approximately 73% of the cases. Caution should be taken during percutaneous placing of screws and an appropriate approach and surgical dissection to bone is advised.

scholarly journals TL 18104 - Ankle fusion percutaneous home run screw fixation

2019 ◽  
Vol 13 (Supl 1) ◽  
pp. 83S
Author(s):  
Alexandre Leme Godoy-Santos ◽  
Sierra Phillips ◽  
Lauren Roberts ◽  
Sameer Naranje ◽  
Ashish Shah ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Screw Fixation ◽  
Average Distance ◽  
Neutral Position ◽  
Ankle Fusion ◽  
Shortest Distance ◽  
Close Proximity ◽  
Fresh Frozen ◽  
The Mean ◽  
Tissue Structures

Introduction: During internal fixation of ankle fusions, in addition to the standard crossed screw fixation pattern, the use of a percutaneously placed augmenting screw, directed from the posterolateral tibial metaphysis proximally across the ankle into the talar neck (“home run screw”), is a widely used technique. The placement of this screw is technically demanding, and for the majority of surgeons, multiple attempts under fluoroscopy guidance are frequently needed to achieve perfect positioning of the implant. There is a risk of injury to local neurovascular and tendinous structures. Objective: To identify the number of attempts necessary for perfect positioning of the ankle fusion home run screw and the neurovascular and tendinous structures at risk. Methods: Eleven fresh-frozen cadaver limbs were used. Guide wires for cannulated screw placement were percutaneously placed into the distal posterolateral aspect of the leg under fluoroscopic guidance, with the ankle held in the neutral position. Malpositioned guidewires were not removed and served as guidance for the following pins. The number of guide wires needed to achieve acceptable positioning of the implant was noted. After a layered dissection from the skin to the tibia, we evaluated neurovascular and tendinous injuries and measured the shortest distance between the closest guidewire and the soft tissue structures using a precision digital caliper.  Results: The mean number of guide wires needed to achieve an acceptable positioning of the implant was 2.34 (SD 0.81, range 2 – 4). The mean distances between the closest guide pin and soft tissue structures of interest were as follows: Achilles tendon 5.35 mm (SD 2.74 mm); peroneal tendons 9.65 mm (SD 5.19 mm); posteromedial neurovascular bundle 12.78 mm (SD 7.14 mm). The sural bundle was in contact with the guide pin in 5/11 specimens (45.5%) and impaled in 3/11 specimens (27.3%). In the remaining 3 specimens, the average distance from the sural nerve bundle was 3.58 mm (SD 2.16 mm). Conclusion: The placement of percutaneous ankle fusion home run screws is technically demanding, requiring multiple attempts to achieve acceptable placement. We have shown that important tendinous and neurovascular structures are in close proximity to the guidewires and that the sural bundle is injured in approximately 73% of cases.

Soft Tissue Structures at Risk With Percutaneous Posterior to Anterior Screw Fixation of the Talar Neck

2018 ◽  
Vol 39 (10) ◽  
pp. 1237-1241
Author(s):  
Lauren E. Roberts ◽  
Martim Pinto ◽  
Jackson R. Staggers ◽  
Alexandre Godoy-Santos ◽  
Ashish Shah ◽  
...  
Keyword(s):  
At Risk ◽  
Soft Tissue ◽  
Sural Nerve ◽  
Injury Rate ◽  
Optimal Placement ◽  
Anatomic Structure ◽  
Shortest Distance ◽  
Fresh Frozen ◽  
Tissue Structures ◽  
Percutaneous Screws

Background: Fractures of the talar neck and body can be fixed with percutaneously placed screws directed from anterior to posterior or posterior to anterior. The latter has been found to be biomechanically and anatomically superior. Percutaneous guidewire and screw placement poses anatomic risks for posterolateral and posteromedial neurovascular and tendinous structures. The objective of this study was to determine the injury rate to local neurovascular and tendinous structures using this technique in a cadaveric model. In addition, we aimed to determine the number of attempts at passing the guidewires required to achieve acceptable placement of 2 parallel screws. Methods: Eleven fresh frozen cadaver limbs were used. Two 2.0-mm guidewires were placed under fluoroscopic guidance, posterior to anterior centered within the talus. The number of attempts required was recorded. A layered dissection was then performed to identify injury to any local anatomic structure. The shortest distance between the closest guidewire and the soft tissue structures was measured. Results: The mean total number of guidewires passed to obtain optimal placement of 2 parallel screws was 2.9 ± 0.7. Direct contact between the guidewire and the sural nerve was seen in 100% of the specimens, with the nerve impaled by the guidewire in 3 of 11 (27.2%) cases. The peroneal tendons were impaled in 1 of 11 (9%) specimens and the Achilles tendon was in contact with the guidewire in 8 of the 11 (72.7%) specimens, and impaled at its most lateral border with the guidewire in 2 specimens (18.2%). Conclusion: The placement of posterior to anterior percutaneous screws for talar neck fixation is technically demanding, and multiple guidewires are needed. Our cadaveric study showed that important tendinous and neurovascular structures were in proximity with the guidewires and that the sural nerve was injured in 100% of the cases. Clinical Relevance: Given the risk of injury to these structures, we recommend a formal posterolateral incision for proper visualization and retraction of the anatomic structures at risk.

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

2021 ◽  
Author(s):  
Vincent Justus Leopold ◽  
Juana Conrad ◽  
Robert Karl Zahn ◽  
Christian Hipfl ◽  
Carsten Perka ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Screw Fixation ◽  
Periacetabular Osteotomy ◽  
Implant Migration ◽  
Major Complications ◽  
Significant Difference ◽  
Duration Of Surgery ◽  
Wire Fixation ◽  
Fixation Stability ◽  
Screw Group

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.

scholarly journals Micro-CT imaging of Thiel-embalmed and iodine-stained human temporal bone for 3D modeling

2021 ◽  
Vol 50 (1) ◽  
Author(s):  
Sebastian Halm ◽  
David Haberthür ◽  
Elisabeth Eppler ◽  
Valentin Djonov ◽  
Andreas Arnold
Keyword(s):  
Soft Tissue ◽  
Temporal Bone ◽  
Middle Ear ◽  
3D Modeling ◽  
Soft Tissues ◽  
Ct Imaging ◽  
Micro Ct ◽  
Data Set ◽  
Iodine Staining ◽  
Tissue Structures

Abstract Introduction This pilot study explores whether a human Thiel-embalmed temporal bone is suitable for generating an accurate and complete data set with micro-computed tomography (micro-CT) and whether solid iodine-staining improves visualization and facilitates segmentation of middle ear structures. Methods A temporal bone was used to verify the accuracy of the imaging by first digitally measuring the stapes on the tomography images and then physically under the microscope after removal from the temporal bone. All measurements were compared with literature values. The contralateral temporal bone was used to evaluate segmentation and three-dimensional (3D) modeling after iodine staining and micro-CT scanning. Results The digital and physical stapes measurements differed by 0.01–0.17 mm or 1–19%, respectively, but correlated well with the literature values. Soft tissue structures were visible in the unstained scan. However, iodine staining increased the contrast-to-noise ratio by a factor of 3.7 on average. The 3D model depicts all ossicles and soft tissue structures in detail, including the chorda tympani, which was not visible in the unstained scan. Conclusions Micro-CT imaging of a Thiel-embalmed temporal bone accurately represented the entire anatomy. Iodine staining considerably increased the contrast of soft tissues, simplified segmentation and enabled detailed 3D modeling of the middle ear.

scholarly journals Optical-Based Analysis of Soft Tissue Structures

2016 ◽  
Vol 18 (1) ◽  
pp. 357-385 ◽  
Author(s):  
Will Goth ◽  
John Lesicko ◽  
Michael S. Sacks ◽  
James W. Tunnell
Keyword(s):  
Soft Tissue ◽  
Tissue Structures

scholarly journals 3DMRI Modeling of Thin and Spatially Complex Soft Tissue Structures without Shrinkage: Lamprey Myosepta as an Example

2018 ◽  
Vol 301 (10) ◽  
pp. 1745-1763
Author(s):  
Bradley M. Wood ◽  
Guang Jia ◽  
Owen Carmichael ◽  
Kevin Mcklveen ◽  
Dominique G. Homberger
Keyword(s):  
Soft Tissue ◽  
Tissue Structures

scholarly journals Defining Norms for the Upper and Lower Lips of the Himachali Ethnic Population: A Cephalometric Study

2016 ◽  
Vol 04 (03) ◽  
pp. 189-194
Author(s):  
Isha Aggarwal ◽  
Manu Wadhawan
Keyword(s):  
Soft Tissue ◽  
Ethnic Groups ◽  
Normal Subjects ◽  
Facial Features ◽  
Ethnic Population ◽  
Soft Tissue Profile ◽  
Lateral Cephalograms ◽  
Males And Females ◽  
Tissue Structures ◽  
Cephalometric Study

Abstract Introduction: The great variance in soft-tissue drape of the human face complicates accurate assessment of the soft-tissue profile and it is a known fact that facial features of different ethnic groups differ significantly. This study was undertaken to establish soft tissue norms for Himachali ethnic population. Method: The sample comprised lateral cephalograms taken in natural head position of 100 normal subjects (50 males, 50 females). The cephalograms were analyzed by Arnett soft tissue cephalometric analysis for orthodontic diagnosis and treatment planning. The Student t test was used to compare the means of the 2 groups. Results: Statistically significant differences were found between Himachali males and females in certain key parameters. Males have thicker soft-tissue structures than females. Whereas females have greater interlabial gap when compared with Himachali males. When compared with other ethnic groups, Himachali subjects have thicker soft tissue structures. Conclusions: Statistically significant differences were found between Himachali males and females in certain key parameters. Differences were also noted between other ethnic groups and Himachali faces.

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