Ankle syndesmosis injuries – Comparison of complication rate following traditional screw fixation to tight rope surgical fixation

Background. One of the reasons for the lack of standardized approaches for treatment of lumbar and thoracolumbar spine traumatic injuries is inconclusive information on relative contribution of various factors to pedicle screw fixation stability.Objective. To determine risk factors that influence pedicle screw fixation stability in patients with unstable traumatic injuries of a lumbar spine and thoracolumbar junction.Material and methods. This was a retrospective evaluation of 192 spinal instrumentations. Patients with type А3, A4, B1, B2 and C injuries of lumbar and thoracolumbar spine were enrolled. Pedicle screw fixation was used either as a stand-alone technique or in combination with anterior column reconstruction. If required, decompression of nerve roots and spinal cord was performed. Cases with pedicle screw fixation failure were registered. Logistic regression analysis was used to assess predictive significance of potential risk factors. Results. Complication rate growth was associated with a decrease in bone radiodensity, posterior decompression extensiveness, lumbosacral fixation and residual kyphotic deformity. Anterior column reconstruction and additional pedicle screw installation led to a decline in complication rate while anterior decompression and fixation length did not influence fixation stability. Conclusion. In most cases, pedicle screw fixation system failure is associated with altered bone quality; however, surgical approach may also impact complication rate and should be taken into account planning surgical intervention. Anterior column reconstruction and additional pedicle screw installation are associated with the decline in complication rate; the influence of those options is comparable. Anterior decompression does not influence pedicle screw fixation stability; consequently, it is preferable in cases with considerable risk of pedicle screw fixation failure.

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Combined Fractures of the Scaphoid and Distal Radius: Evaluation of Early Surgical Fixation (21 Patients with 22 Wrists)

Journal of Wrist Surgery ◽

10.1055/s-0037-1603319 ◽

2017 ◽

Vol 07 (01) ◽

pp. 011-17

Author(s):

Tahir Sügün ◽

Murat Kayalar ◽

Yusuf Gürbüz

Keyword(s):

Distal Radius ◽

Screw Fixation ◽

Functional Results ◽

High Energy ◽

Activity Level ◽

Type B ◽

Fixation Technique ◽

Scaphoid Fractures ◽

Surgical Fixation ◽

The Mean

Introduction The purpose of this retrospective study, is to evaluate the clinical and functional results of early surgical fixation of the ipsilateral distal radius and scaphoid fractures in 22 of 21 patients. Patients and Methods Overall, 22 combined ipsilateral scaphoid, and distal radius fracture treatments between 2002 and 2015 were evaluated. The mean age was 34.9 (range: 19–82) years. One patient had bilateral injuries. In 17 patients the injury was due to a fall from a height, and in 4 patients due to a motorcycle accident. According to the AO classification, there were 2 type B and 20 type C fractures of the distal radius. The volar locking plate fixation technique was applied in 14 wrists, screw fixation technique in 1, external fixation combined with Kirschner wires (K-wire) stabilization technique was used in 3 wrists, and only K-wire pinning technique was used in 4 wrists. All scaphoid fractures were type B (21 type B2, 1 type B1) according to the Herbert–Fischer classification. K-wire fixation was applied in 2 and cannulated screw fixation was performed in 20 fractures. Clinical evaluation was performed with measuring the pinch power, grip power, and range of motions. Functional evaluation was performed using patient-rated wrist evaluation score (PRWE). Results The average follow-up period was 25 (range: 12–97) months. All radius and scaphoid fractures healed. The mean active wrist motions were found to be 45 degrees of flexion, 48.5 degrees of extension, 20 degrees of radial deviation, and 43 degrees ulnar deviation. Mean grip/pinch strengths were 31/8.5 kg. Mean PRWE score was 5.5 (range: 0–8.5). All patients returned to preoperative activity level and can do preinjury jobs. Conclusion Combined ipsilateral fractures of distal radius and scaphoid are complex and rare injuries due to high energy traumas. Stable early primary fracture fixation in these injuries can be expected with good functional results. Level of Evidence Level IV.

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Distal Radius Fractures in Diabetic Patients: An Analysis of Surgical Timing and Other Factors That Affect Complication Rate

Hand ◽

10.1177/1558944720944262 ◽

2020 ◽

pp. 155894472094426

Author(s):

Ajith Malige ◽

Andrew Konopitski ◽

Chinenye O. Nwachuku ◽

Kristofer S. Matullo

Keyword(s):

Distal Radius ◽

Complication Rate ◽

Distal Radius Fractures ◽

Diabetic Patients ◽

Complication Rates ◽

Radius Fractures ◽

Surgical Timing ◽

Surgical Delay ◽

Surgical Fixation ◽

Total P

Background While not studied for distal radius fractures, the effect of surgical timing on complication rate has been extensively analyzed in the treatment of pilon fractures. The primary aim of this study was to identify any effect surgical timing has on postoperative complication rates after surgical fixation of distal radius fractures in diabetic patients. Methods All patients who underwent surgical fixation of distal radius fractures at a single suburban academic hospital between 2012 and 2019 were reviewed. For each patient, demographics, comorbidities, injury details, fixation method, and postoperative complications were noted. The effect surgical delay, among other factors, had on complication rate in diabetic and nondiabetic patients was explored. Results Overall, 124 diabetic and 371 nondiabetic distal radius fractures were included. While diabetics had a statistically higher rate of total complications (21.0 vs. 13.5%, P = .045) but similar major complications requiring surgery ( P = .12), there was no difference in surgical delay between groups among patients who had total ( P = .31) or major ( P = .69) complications. Surgical timing was not a risk factor for total ( P = .50) or major complications ( P = .32) in diabetic fracture bivariate or multivariate analysis. Only younger age and higher energy injuries were significant risk factors for total complications in bivariate ( P = .02, P = .03) and multivariate ( P = .04, P < .05) analysis. Conclusion Complication rates after surgically stabilized distal radius fractures in diabetic patients are higher than in nondiabetic patients. However, this rate is not affected by surgical timing. Instead, surgeons should consider factors such as diabetic control in an effort to maximize outcomes and decrease complications. Level of Evidence Prognostic Level III

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Iatrogenic Fracture Gapping During Fixation of Jones Fractures

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00276 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0027

Author(s):

Philip Kaiser ◽

Matthew Riedel ◽

Rameez Qudsi ◽

John Kwon

Keyword(s):

Screw Fixation ◽

Fracture Location ◽

Fracture Displacement ◽

Fresh Frozen ◽

Surgical Fixation ◽

Group 2 ◽

Distal Aspect ◽

Intramedullary Screw ◽

Cadaveric Model ◽

Group 1

Category: Trauma Introduction/Purpose: Surgical fixation of Jones fractures is often recommended to facilitate recovery and achieve union. Iatrogenic fracture displacement during intramedullary screw fixation is a commonly encountered technical issue. This may be related to fracture location in relation to the surrounding ligamentous attachments, namely the robust intermetatarsal ligaments found at the proximal articulation of the 4th and 5th metatarsals. This study examines the relationship between fracture line and its location in regards to the surrounding ligamentous structures and its effect on Jones fracture displacement, reduction and fixation in a cadaveric model. Methods: Eighteen fresh-frozen cadaveric feet were dissected with preservation of all ligamentous attachments. Given the similar anatomic distal extent of the dorsal and plantar intermetatarsal ligaments on the 5th metatarsal, measurements were obtained detailing the anatomic position of the dorsal intermetatarsal ligament (DIL) only. The specimens were divided into two groups with modelled fractures created at the 4th & 5th metatarsal articulation proximal to the distal extent of the DIL (Group 1) or just distal to the DIL (Group 2). Fractures were fixed in standard fashion with serial fluoroscopic images obtained to study fracture gapping and rotation. Results: There was approximately 5 mm of fracture gapping created iatrogenically during tapping with no statistically significant differences between Group 1 and Group 2 (4.53 mm versus 5.25 mm, p=0.5430). The distal aspect of the DIL was anatomically located 2.77 mm (Range 1.58 mm – 4.46 mm) distal to the 4th & 5th metatarsal articulation. Conclusion: Considerable iatrogenic fracture gapping occurs during intramedullary screw fixation of Jones fractures in a cadaveric model regardless of fracture location in relation to the intermetatarsal ligamentous attachments. Intraoperative displacement may be related to iatrogenic distraction caused by canal tapping when utilizing a common surgical method. Specific techniques may be required to maintain anatomic alignment during tapping and screw fixation to prevent iatrogenic displacement.

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The financial impact of diastasis screw fixation versus tight-rope fixation of injuries to the syndesmosis with fractures of the ankle

Injury Extra ◽

10.1016/j.injury.2010.07.372 ◽

2010 ◽

Vol 41 (12) ◽

pp. 184 ◽

Cited By ~ 2

Author(s):

S. Rajagopalan ◽

J.D. Craik ◽

J. Lloyd ◽

A. Sangar ◽

V. Upadhyay ◽

...

Keyword(s):

Screw Fixation ◽

Financial Impact ◽

Tight Rope

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Surgical fixation of posterior cruciate ligament avulsion fracture from tibial attachment using cannulated cancellous screw: a clinical, radiological and functional outcome evaluation

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20211941 ◽

2021 ◽

Author(s):

Aniruddha Mondal ◽

Ayon Das

Keyword(s):

Posterior Cruciate Ligament ◽

Avulsion Fracture ◽

Screw Fixation ◽

Cruciate Ligament ◽

Tertiary Care ◽

Outcome Evaluation ◽

Cancellous Screw ◽

Avulsion Fractures ◽

Surgical Fixation

Background: PCL (posterior cruciate ligament) is the main posterior stabilizer of the knee and plays a role in central axis controlling and imparting rotational stability to the knee. Injury to PCL presents commonly with avulsion fractures from its tibial attachment. An avulsion fracture of the PCL, if not surgically fixed, may lead to secondary changes in the knee joint. The aim of the study was to evaluate the clinical and functional results in patients with PCL tibial avulsion fractures treated by CC (cannulated cancellous) screw fixation.Methods: This was a prospective study conducted at a tertiary care government hospital in Kolkata, between December 2018 to July 2020 on patients who underwent CC screw fixation for post-traumatic PCL avulsion fracture from tibial site. All patients were followed up for 9 months. Lysholm knee score was used to assess the functional outcomes of the patients.Results: In a total of 10 patients, 9 (90%) patients showed excellent and 1 (10%) patient had good result during the final follow-up. 80% patients did not develop any complications. At the end of 9 months, the mean Lysholm score was 95.6. 8 (80%) patients achieved almost full knee ROM post-operatively by the end of final follow-up.Conclusions: Surgical fixation using CC screws is a simple, easy, safe and reproducible method without requiring significant expertise for achieving good stability in PCL tibial site avulsion fractures, where early intervention prevents significant late disability as it provides an excellent clinical, functional and radiographic outcome along with good joint function.

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Return to Play and Fracture Union After the Surgical Management of Jones Fractures in Athletes: A Systematic Review and Meta-analysis

The American Journal of Sports Medicine ◽

10.1177/0363546521990020 ◽

2021 ◽

pp. 036354652199002

Author(s):

Ahmed Khalil Attia ◽

Tarek Taha ◽

Geraldine Kong ◽

Abduljabbar Alhammoud ◽

Karim Mahmoud ◽

...

Keyword(s):

Surgical Management ◽

Nonoperative Management ◽

Screw Fixation ◽

Meta Analysis ◽

Delayed Union ◽

Return To Play ◽

Cochrane Library ◽

Union Rate ◽

Surgical Fixation ◽

Nonoperative Group

Background: Proximal fifth metatarsal fractures are among the most common forefoot injuries in athletes. The management of this injury can be challenging because of delayed union and refractures. Intramedullary (IM) screw fixation rather than nonoperative management has been recommended in the athletic population. Purpose: To provide an updated summary of the return-to-play (RTP) rate and time to RTP after Jones fractures in athletes with regard to their management, whether operative or nonoperative, and to explore the union rate and time to union as well as the rate of complications such as refractures. Study Design: Meta-analysis. Methods: Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, 2 independent team members searched several databases including PubMed, MEDLINE, Embase, Google Scholar, Web of Science, Cochrane Library, and ClinicalTrials.gov through November 2019 to identify studies reporting on Jones fractures of the fifth metatarsal exclusively in athletes. The primary outcomes were the RTP rate and time to RTP, whereas the secondary outcomes were the number of games missed, time to union, and union rate as well as the rates of nonunion, delayed union, and refractures. Results: Of 168 studies identified, 22 studies were eligible for meta-analysis with a total of 646 Jones fractures. The overall RTP rate was 98.4% (95% CI, 97.3%-99.4%) in 626 of 646 Jones fractures. The RTP rate with IM screw fixation only was 98.8% (95% CI, 97.8%-99.7%), with other surgical fixation methods (plate, Minifix) was 98.4% (95% CI, 95.8%-100.0%), and with nonoperative management was 71.6% (95% CI, 45.6%-97.6%). There were 3 studies directly comparing RTP rates with surgical versus nonoperative management, which showed significant superiority in favor of surgery (odds ratio, 0.033 [95% CI, 0.005-0.215]; P < .001). The RTP rate according to type of sport was 99.0% (95% CI, 97.5%-100.0%) in football, 91.1% (95% CI, 82.2%-99.4%) in basketball, and 96.6% (95% CI, 92.6%-100.0%) in soccer. The overall time to RTP was 9.6 weeks (95% CI, 8.5-10.7 weeks). The time to RTP in the surgical group (IM screw fixation) was 9.6 weeks (95% CI, 8.3-10.9 weeks), which was significantly less than that in the nonoperative group of 13.1 weeks (95% CI, 8.2-18.0 weeks). The pooled union rate in the operative group (excluding refractures) was 97.3% (95% CI, 95.1%-99.4%), whereas the pooled union rate in the nonoperative group was 71.4% (95% CI, 49.1%-93.7%). The overall time to union was 9.1 weeks (95% CI, 7.7-10.4 weeks). The time to union with IM screw fixation (8.2 weeks [95% CI, 7.5-9.0 weeks]) was shorter than that with nonoperative treatment (13.7 weeks [95% CI, 12.7-14.6 weeks]). The rate of delayed union was 2.5% (95% CI, 1.2%-3.7%), and the overall refracture rate was 10.2% (95% CI, 5.9%-14.5%). Conclusion: The RTP rate and time to RTP after the surgical management of Jones fractures in athletes were excellent, regardless of the implant used and type of sport. IM screw fixation was superior to nonoperative management, as it led to a higher rate of RTP, shorter time to RTP, higher rate of union, shorter time to union, and improved functional outcomes. We recommend surgical fixation for all Jones fractures in athletes.

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