The Sacral Laminar Slope Is an Anatomic Landmark for Freehand S2AI Screw Insertion

2017 ◽  
Vol 17 (10) ◽  
pp. S262 ◽  
Author(s):  
James D. Lin ◽  
Lee A. Tan ◽  
Jamal Shillingford ◽  
Joseph L. Laratta ◽  
Yongjung Kim ◽  
...  
Keyword(s):  
Screw Insertion ◽  
Anatomic Landmark

scholarly journals The proximal humeral locking plate positioning to the pectoralis major tendon in achieving the proper calcar screw location: a cadaveric study

2022 ◽  
Vol 17 (1) ◽  
Author(s):  
Nattha Kulkamthorn ◽  
Naruebade Rungrattanawilai ◽  
Thanakorn Tarunotai ◽  
Nantaphon Chuvetsereporn ◽  
Piyachat Chansela ◽  
...  
Keyword(s):  
Locking Plate ◽  
Humeral Fracture ◽  
Pectoralis Major ◽  
Clinical Anatomy ◽  
Osteoarthritic Change ◽  
Screw Insertion ◽  
Anatomic Landmark ◽  
Screw Position ◽  
Inferior Border ◽  
Locking Plate System

Abstract Background Proximal humeral fracture is the third most common of osteoporotic fracture. Most surgical cases were treated by fixation with anatomical locking plate system. The calcar screw plays a role in medial support and improving varus stability. Proximal humerus fracture in elderly patients are commonly seen with greater tuberosity (GT) fracture. The GT fragment is sometimes difficult to use as an anatomic landmark for proper plate and screw position. Therefore, the insertion of pectoralis major tendon (PMT) may be used as an alternative landmark for appropriate plate and calcar screw position. The purpose of study is going to identify the vertical distance from PMT to a definite point on the position of locking plate. Methods 30 cadaveric shoulders at the department of clinical anatomy were performed. Shoulders with osteoarthritic change (n = 5) were excluded. Finally, 25 soft cadaveric shoulders were recruited in this study. The PHILOS™ plate was placed 2 mm posterior to the bicipital groove. A humeral head (HH) was cut in the coronal plane at the level of the anterior border of the PHILOS plate with a saw. A calcar screw was inserted close to the inferior cortex of HH. Distance from the upper border of elongated combi-hole (UB-ECH) to the upper border of pectoralis major tendon (UB-PMT) was measured. The plate was then moved superiorly until the calcar screw was 12 mm superior to the inferior border of HH and the distance was repeatedly measured. Results The range of distance from UB-PMT to the UB-ECH was from − 4.50 ± 7.95 mm to 6.62 ± 7.53 mm, when calcar screw was close to inferior border of HH and when the calcar screw was 12 mm superior to the inferior border of HH, respectively. The highest probability of calcar screw in proper location was 72% when UB-ECH was 3 mm above UB-PMT. Discussion and conclusion The GT fragment is sometimes difficult to use as an anatomic landmark for proper plate and screw position. PMT can be used as an alternative anatomic reference. UB-PMT can serve as a guide for proper calcar screw insertion. UB-ECH should be 3 mm above UB-PMT and three-fourths of cases achieved proper calcar screw location.

Pullout Strength of Screws in Foal Third Metacarpal Bone after Overdrilling a 4.5 mm Hole

1998 ◽  
Vol 11 (04) ◽  
pp. 200-204 ◽  
Author(s):  
K. Kelly ◽  
G. S. Martin ◽  
D. J. Burba ◽  
S. A. Sedrish ◽  
R. M. Moore
Keyword(s):  
Cortical Bone ◽  
Metacarpal Bone ◽  
Pullout Strength ◽  
Cancellous Screw ◽  
Bone Screw ◽  
Screw Insertion ◽  
Holding Power ◽  
Cortical Screw ◽  
Metaphyseal Bone

SummaryThe purpose of the study was to determine and to compare the in vitro pullout strength of 5.5 mm cortical versus 6.5 mm cancellous bone screws inserted in the diaphysis and metaphysis of foal third metacarpal (MCIII) bones in threaded 4.5 mm cortical bone screw insertion holes that were then overdrilled with a 4.5 mm drill bit. This information is relevant to the selection of a replacement screw if a 4.5 mm cortical screw is stripped during orthopaedic surgery. In vitro pullout tests were performed in two independent cadaver studies, each consisting of 12 foal MCIII bones. Two 4.5 mm cortical screws were placed either in the mid-diaphysis (study 1) or distal metaphysis (study 2) of MCIII bones. The holes were then overdrilled with a 4.5 mm bit and had either a 5.5 mm cortical or a 6.5 mm cancellous screw inserted; screw pullout tests were performed at a rate of 0.04 mm/s until screw or bone failure occurred.The bone failed in all of the tests in the diaphyseal and metaphyseal bone. The holding power for 6.5 mm cancellous screws was significantly (p <0.05) greater than for 5.5 mm cortical screws in both the diaphysis and metaphysis. There was not any difference in the holding power of screws in either the diaphysis or the metaphysis between proximal and distal screw holes.If a 4.5 mm cortical bone screw strips in MCIII diaphyseal or metaphyseal bone of foals, a 6.5 mm cancellous screw would provide greater holding power than a 5.5 mm cortical screw.In order to provide information regarding selection of a replacement screw if a 4.5 mm cortical screw is stripped, the in vitro pullout strength was determined for 5.5 mm cortical and 6.5 mm cancellous screws inserted in third metacarpal diaphyseal and metaphyseal bone of foals in which threaded 4.5 mm cortical bone screw insertion holes had been overdrilled with a 4.5 mm bit. The holding power of the 6.5 mm cancellous screw was significantly greater than the 5.5 mm cortical screw in both the diaphysis and metaphysis of foal third metacarpal bone. Thus, it appears that if a 4.5 mm cortical screw is stripped during orthopaedic surgery in foals, a 6.5 mm cancellous screw would provide superior holding power.

The Intersphenoid Sinus Septum: An Impractical Anatomic Landmark in Transsphenoidal Endoscopic Pituitary Surgery

Skull Base ◽  
2011 ◽  
Vol 21 (S 01) ◽  
Author(s):  
Justin Poirier ◽  
Donald Lee ◽  
Neil Duggal ◽  
Brian Rotenberg
Keyword(s):  
Pituitary Surgery ◽  
Anatomic Landmark

Surgical treatment of cervical spine fractures in ankylosing spondylitis patients: posterior stabilization using intraoperative CT scanner-based navigation

2020 ◽  
Vol 99 (5) ◽  
pp. 212-218
Keyword(s):  
Cervical Spine ◽  
Ankylosing Spondylitis ◽  
Ct Imaging ◽  
Spine Fracture ◽  
Cervical Spine Fracture ◽  
Posterior Stabilization ◽  
Visceral Injury ◽  
Intraoperative Ct ◽  
Screw Insertion ◽  
Spinal Navigation

Introduction: The authors analyzed a series of ankylosing spondylitis patients with cervical spine fracture undergoing posterior stabilization using spinal navigation based on intraoperative CT imaging. The purpose of this study was to evaluate the accuracy and safety of navigated posterior stabilization and to analyze the adequacy of this method for treatment of fractures in ankylosed cervical spine. Methods: Prospectively collected clinical data, together with radiological documentation of a series of 8 consecutive patients with 9 cervical spine fracture were included in the analysis. The evaluation of screw insertion accuracy based on postoperative CT imaging, description of instrumentation- related complications and evaluation of morphological and clinical results were the subjects of interest. Results: Of the 66 implants inserted in all cervical levels and in upper thoracic spine, only 3 screws (4.5%) did not meet the criteria of anatomically correct insertion. Neither screw malposition nor any other intraoperative events were complicated by any neural, vascular or visceral injury. Thus we did not find a reason to change implant position intraoperatively or during the postoperative period. The quality of intraoperative CT imaging in our group of patients was sufficient for reliable trajectory planning and implant insertion in all segments, irrespective of the habitus, positioning method and comorbidities. In addition to stabilization of the fracture, the posterior approach also allows reducing preoperative kyphotic position of the cervical spine. In all patients, we achieved a stable situation with complete bone fusion of the anterior part of the spinal column and lateral masses at one year follow-up. Conclusion: Spinal navigation based on intraoperative CT imaging has proven to be a reliable and safe method of stabilizing cervical spine with ankylosing spondylitis. The strategy of posterior stabilization seems to be a suitable method providing high primary stability and the conditions for a subsequent high fusion rate.

Augmented reality–assisted pedicle screw insertion: a cadaveric proof-of-concept study

2019 ◽  
Vol 31 (1) ◽  
pp. 139-146 ◽  
Author(s):  
Camilo A. Molina ◽  
Nicholas Theodore ◽  
A. Karim Ahmed ◽  
Erick M. Westbroek ◽  
Yigal Mirovsky ◽  
...  
Keyword(s):  
Augmented Reality ◽  
Pedicle Screw ◽  
User Experience ◽  
Pedicle Screws ◽  
Screw Insertion ◽  
Pedicle Screw Insertion ◽  
Insertion Method ◽  
Comparative Accuracy ◽  
Placement Accuracy ◽  
Surgical Field

OBJECTIVEAugmented reality (AR) is a novel technology that has the potential to increase the technical feasibility, accuracy, and safety of conventional manual and robotic computer-navigated pedicle insertion methods. Visual data are directly projected to the operator’s retina and overlaid onto the surgical field, thereby removing the requirement to shift attention to a remote display. The objective of this study was to assess the comparative accuracy of AR-assisted pedicle screw insertion in comparison to conventional pedicle screw insertion methods.METHODSFive cadaveric male torsos were instrumented bilaterally from T6 to L5 for a total of 120 inserted pedicle screws. Postprocedural CT scans were obtained, and screw insertion accuracy was graded by 2 independent neuroradiologists using both the Gertzbein scale (GS) and a combination of that scale and the Heary classification, referred to in this paper as the Heary-Gertzbein scale (HGS). Non-inferiority analysis was performed, comparing the accuracy to freehand, manual computer-navigated, and robotics-assisted computer-navigated insertion accuracy rates reported in the literature. User experience analysis was conducted via a user experience questionnaire filled out by operators after the procedures.RESULTSThe overall screw placement accuracy achieved with the AR system was 96.7% based on the HGS and 94.6% based on the GS. Insertion accuracy was non-inferior to accuracy reported for manual computer-navigated pedicle insertion based on both the GS and the HGS scores. When compared to accuracy reported for robotics-assisted computer-navigated insertion, accuracy achieved with the AR system was found to be non-inferior when assessed with the GS, but superior when assessed with the HGS. Last, accuracy results achieved with the AR system were found to be superior to results obtained with freehand insertion based on both the HGS and the GS scores. Accuracy results were not found to be inferior in any comparison. User experience analysis yielded “excellent” usability classification.CONCLUSIONSAR-assisted pedicle screw insertion is a technically feasible and accurate insertion method.

scholarly journals A useful intraoperative technique for transiliac-transsacral screws: a point-to-point coaxial guide apparatus

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Ze-hang Zheng ◽  
Fei Xu ◽  
Zheng-qiang Luo ◽  
Ye Ren ◽  
Tao Fu ◽  
...  
Keyword(s):  
Radiation Exposure ◽  
Pelvic Fracture ◽  
Operative Time ◽  
Screw Placement ◽  
Screw Insertion ◽  
Average Operative Time ◽  
Free Hand Technique ◽  
Point To Point ◽  
Postoperative Fracture

Abstract Background The transiliac-transsacral screw placement is a clinical challenge for surgeons. This study explored a point-to-point coaxial guide apparatus assisting the transiliac-transsacral screw insertion and aimed to investigate the feasibility and accuracy of the guide apparatus in the treatment of posterior ring unstable pelvic fracture compared with a free-hand technique. Methods A retrospective study was performed to evaluate patients treated with transiliac-transsacral screws assisted by the point-to-point coaxial guide apparatus or free-hand technique. The intraoperative data of operative time and radiation exposure times were recorded. Postoperative radiographs and CT scans were performed to scrutinize the accuracy of screws position. The quality of the postoperative fracture reduction was assessed according to Matta radiology criteria. The pelvic function was assessed according to the Majeed scoring criteria at 6 months postoperatively. Results From July 2017 to December 2019, a total of 38 patients were included in this study, 20 from the point-to-point guide apparatus group and 18 from the free-hand group. There were no significant differences between the two groups in gender, age, injury causes, pelvic fracture type, screws level, and follow-up time (P > 0.05). The average operative time of the guide apparatus group for each screw was significantly less than that in the free-hand group (25.8 ± 4.7 min vs 40.5 ± 5.1, P < 0.001). The radiation exposure times were significantly lower in the guide apparatus group than that in the free-hand group (24.4 ± 6.0 vs 51.6 ± 8.4, P < 0.001). The intraosseous and juxtacortical rate of screw placement (100%) higher than in the free-hand group (94.4%). Conclusion The point-to-point coaxial guide apparatus is feasible for assisting the transiliac-transsacral screw in the treatment of posterior unstable pelvic fractures. It has the advantages of simple operation, reasonable design and no need for expensive equipment, and provides an additional surgical strategy for the insertion of the transiliac-transsacral screw.

scholarly journals Concomitant Partial Achilles Tendon Rupture and Lateral Luxation of the Superficial Digital Flexor Muscle Tendon in a Dog

VCOT Open ◽  
2021 ◽  
Vol 04 (01) ◽  
pp. e37-e40
Author(s):  
Hélène Dosseray ◽  
Claire Deroy-Bordenave
Keyword(s):  
Achilles Tendon ◽  
Achilles Tendon Rupture ◽  
Simultaneous Occurrence ◽  
Flexor Muscle ◽  
Screw Insertion ◽  
Superficial Digital Flexor Tendon ◽  
Fixation Screw ◽  
Pelvic Limb ◽  
The Right

AbstractThe aim of this study was to report a posttraumatic partial Achilles tendon (AT) rupture associated with lateral luxation of the superficial digital flexor tendon (SDFT) in a Whippet. This article is a brief communication. A Whippet was presented with posttraumatic plantigrade stance and non-load-bearing lameness of the right pelvic limb. The objective findings consisted in partial AT rupture and SDFT lateral luxation. Surgical treatment ensued: tenorrhaphy of the torn tendons and calcaneo-tibial screw insertion for tarsal immobilization, followed by suturing of the SDFT retinaculum. A casting bandage was employed for additional immobilization. Nonetheless, a bandage complication prompted the premature removal of the fixation screw and casting wrap. Complete functional recovery was achieved by the 20th postoperative week. The simultaneous occurrence of SDFT luxation and partial AT tear has not been reported in the literature before. The long-term postoperative functional outcome was highly satisfactory.

scholarly journals Two-Dimensional Visualization of the Three-Dimensional Planned Sacroiliac Screw Corridor with the Slice Fusion Method

2021 ◽  
Vol 10 (2) ◽  
pp. 184
Author(s):  
Maximilian Kerschbaum ◽  
Siegmund Lang ◽  
Florian Baumann ◽  
Volker Alt ◽  
Michael Worlicek
Keyword(s):  
Pelvic Ring ◽  
Three Dimensional ◽  
Fusion Method ◽  
Two Dimensional ◽  
Posterior Pelvic Ring ◽  
Simple Method ◽  
Sacroiliac Screw ◽  
Screw Insertion ◽  
Multiplanar Reconstructions ◽  
Screw Position

Insertion of sacro-iliac (SI) screws for stabilization of the posterior pelvic ring without intraoperative navigation or three-dimensional imaging can be challenging. The aim of this study was to develop a simple method to visualize the ideal SI screw corridor, on lateral two-dimensional images, corresponding to the lateral fluoroscopic view, used intraoperatively while screw insertion, to prevent neurovascular injury. We used multiplanar reconstructions of pre- and postoperative computed tomography scans (CT) to determine the position of the SI corridor. Then, we processed the dataset into a lateral two-dimensional slice fusion image (SFI) matching head and tip of the screw. Comparison of the preoperative SFI planning and the screw position in the postoperative SFI showed reproducible results. In conclusion, the slice fusion method is a simple technique for translation of three-dimensional planned SI screw positioning into a two-dimensional strict lateral fluoroscopic-like view.

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