Minimally Invasive Calcaneal Displacement Osteotomy Site Using a Reference Kirschner Wire: A Technique Tip

Background: The Conventus Distal Radius System (DRS) is an intramedullary fixation scaffold inserted into the lateral aspect of the distal radius. The purpose of this study was to identify insertion site anatomy to illustrate risks associated with the minimally invasive nature of radial-sided implant application. Methods: Ten cadavers were utilized. Using fluoroscopy, the 1.1-mm Kirschner wire and template was introduced per manufacturer’s guidelines, access guide assembled, and dissection carried out to the superficial radial nerve (SRN) with preservation of the native location. The access guide marked the insertion location for the side-cut drill. This point was measured in relationship to structures nearby, including the SRN, brachioradialis (BR), lateral antebrachial cutaneous nerve (LABCN), and radial styloid (RS). Results: The large guide contacted the SRN in 4 of 10 cadavers and was volar to it in 6 of 10. When volar, the mean distance was 1.7 mm. The tip of the RS to the large access guide averaged 44.5 mm. The small guide contacted the SRN in 2 of 10, was volar to it in 4 of 10, and between the bifurcation in 4 of 10. When volar, the distance averaged 3.25 mm. When bifurcated, the distance from the small guide to both the dorsal and volar branches was 3.5 mm. The distance from the RS to the small guide averaged 37.8 mm. The LABCN was found in the field of dissection in 4 of 10 cadavers. Conclusions: Several structures are at risk during insertion of the Conventus DRS; thus, knowledge of the relevant anatomy of this minimally invasive approach is crucial to optimize outcomes and patient satisfaction, and to avoid nerve injury.

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Medial Displacement Calcaneal Osteotomy: Loss of Correction with Varying Drilling Techniques

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00471 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0047

Author(s):

Benjamin D. Umbel ◽

B. Dale Sharpe ◽

Adam L. Halverson ◽

Mark A. Prissel

Keyword(s):

Screw Fixation ◽

Cadaveric Study ◽

Matched Pair ◽

Osteotomy Site ◽

Control Group ◽

Posterior Tibial Tendon ◽

Loss Of Correction ◽

Calcaneal Osteotomy ◽

Displacement Osteotomy ◽

Simultaneous Group

Category: Hindfoot Introduction/Purpose: Surgical correction of Stage 2 posterior tibial tendon dysfunction typically involves a combination of soft tissue and bony corrections, often including a medial displacement calcaneal osteotomy (MDCO). This osteotomy is often fixated utilizing two parallel screws; however, it remains unknown how much correction is lost based on various accepted drilling techniques for common fixation of this osteotomy. Our cadaveric study compares three different surgical drilling techniques, using two parallel cannulated screws for fixation, to best maintain desired translation of the MDCO. Methods: Fifteen above knee, fresh-frozen, matched pair cadaveric specimens (30 limbs) were randomized equally into three groups. Calcanealosteotomies were performed, followed by manual 10 mm medial translation of the tuberosity. Two parallel 2.5mm guide wires were advanced across the osteotomy site under fluoroscopy. The first group involved a ‘staggered’ drilling technique in which one guide wire was over drilled to the osteotomy site with a 4.5mm cannulated drill and then a 7.0 mm cannulated screw was placed across the osteotomy, followed by a second screw in similar fashion. The second, ‘simultaneous’ group consisted of over drilling both guide wires sequentially followed by placement of both screws. The third control group involved simultaneously over drilling only the near cortex, followed by placement of the 2 screws. Following screw fixation, the calcaneal tuberosity was manually translated in a lateral direction. The loss of correction was then marked and measured in millimeters. Results: All thirty cadaveric specimens underwent standard medializing calcaneal displacement osteotomy without significant variation, or complication. Loss of medialization was measured in millimeters following a manual lateral displacing force after the screw fixation of the osteotomy. The ‘simultaneous’ drilling group experienced the greatest loss of medial displacement with the mean loss of correction being 2.6 mm (range 1.37 - 3.48 mm) following manual lateral translation. The ‘staggered’ group showed an average loss of 1.16 mm (range 0.36 - 2.67 mm). The control group, that simply involved drilling of the near cortex, demonstrated the greatest maintenance of medial displacement with a mean loss of only 0.036 mm (range 0.01 - 0.06 mm). Conclusion: Our cadaveric study comparing three different drilling techniques for maintaining the intended correction following MDCO demonstrates that simultaneous over drilling of only the tuberosity near cortex prior to screw fixation was the most resistant to loss of medial displacement; whereas mean loss of correction with simultaneous drilling of both wires to the osteotomy resulted in the greatest loss of correction at an average of 26%.

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Minimally invasive guidewireless, navigated pedicle screw placement: a technical report and case series

Neurosurgical FOCUS ◽

10.3171/2017.5.focus17200 ◽

2017 ◽

Vol 43 (2) ◽

pp. E9 ◽

Cited By ~ 8

Author(s):

Brandon W. Smith ◽

Jacob R. Joseph ◽

Michael Kirsch ◽

Mary Oakley Strasser ◽

Jacob Smith ◽

...

Keyword(s):

Minimally Invasive ◽

Pedicle Screw ◽

Kirschner Wire ◽

Case Series ◽

Pedicle Screws ◽

Screw Placement ◽

Pedicle Screw Placement ◽

Minimally Invasive Spinal Surgery ◽

Screw Insertion ◽

Percutaneous Pedicle Screw

OBJECTIVEPercutaneous pedicle screw insertion (PPSI) is a mainstay of minimally invasive spinal surgery. Traditionally, PPSI is a fluoroscopy-guided, multistep process involving traversing the pedicle with a Jamshidi needle, placement of a Kirschner wire (K-wire), placement of a soft-tissue dilator, pedicle tract tapping, and screw insertion over the K-wire. This study evaluates the accuracy and safety of PPSI with a simplified 2-step process using a navigated awl-tap followed by navigated screw insertion without use of a K-wire or fluoroscopy.METHODSPatients undergoing PPSI utilizing the K-wire–less technique were identified. Data were extracted from the electronic medical record. Complications associated with screw placement were recorded. Postoperative radiographs as well as CT were evaluated for accuracy of pedicle screw placement.RESULTSThirty-six patients (18 male and 18 female) were included. The patients’ mean age was 60.4 years (range 23.8–78.4 years), and their mean body mass index was 28.5 kg/m2 (range 20.8–40.1 kg/m2). A total of 238 pedicle screws were placed. A mean of 6.6 pedicle screws (range 4–14) were placed over a mean of 2.61 levels (range 1–7). No pedicle breaches were identified on review of postoperative radiographs. In a subgroup analysis of the 25 cases (69%) in which CT scans were performed, 173 screws were assessed; 170 (98.3%) were found to be completely within the pedicle, and 3 (1.7%) demonstrated medial breaches of less than 2 mm (Grade B). There were no complications related to PPSI in this cohort.CONCLUSIONSThis streamlined 2-step K-wire–less, navigated PPSI appears safe and accurate and avoids the need for radiation exposure to surgeon and staff.

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Intraoperative Kirschner Wire Migration during Robotic Minimally Invasive Spine Surgery

Case Reports in Anesthesiology ◽

10.1155/2019/9581285 ◽

2019 ◽

Vol 2019 ◽

pp. 1-3

Author(s):

Ashley Peterson ◽

Lynn K. Ngai ◽

Mark A. Burbridge

Keyword(s):

Minimally Invasive ◽

Spine Surgery ◽

Abdominal Cavity ◽

Kirschner Wire ◽

Perioperative Period ◽

Exploratory Laparotomy ◽

Case Description ◽

Robotic Assisted ◽

Minimally Invasive Spine ◽

And Migration

We present the case of a 58-year-old woman who underwent a minimally invasive robotic-assisted L4-S1 instrumentation and fusion which was complicated by a Kirschner wire (K-wire) fracture and migration into the abdominal cavity necessitating emergent exploratory laparotomy. Retrieval of the K-wire proceeded without incident, and the patient had an otherwise uneventful surgery and recovery. This is the first such case description reported in the literature. As minimally invasive robotic-assisted spine procedures become more common, it is essential for the anesthesiologist to be familiar with potential complications to manage such patients in the perioperative period optimally.

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Minimally Invasive Distal Metatarsal Metaphyseal Osteotomy (DMMO) of the Fifth Metatarsal for Bunionette Correction

Foot & Ankle International ◽

10.1177/1071100717745536 ◽

2018 ◽

Vol 39 (4) ◽

pp. 450-457 ◽

Cited By ~ 5

Author(s):

Kar Hao Teoh ◽

Kartik Hariharan

Keyword(s):

Minimally Invasive ◽

Callus Formation ◽

Case Series ◽

Clinical Results ◽

Osteotomy Site ◽

Retrospective Case ◽

Level Of Evidence ◽

Average Improvement ◽

The Mean

Background: Different osteotomies have been proposed for the treatment of bunionette deformity. Minimally invasive surgery is now increasingly popular for a variety of forefoot conditions. The aim of this study was to evaluate the outcome following fifth minimally invasive distal metatarsal metaphyseal osteotomy (DMMO) for bunionette deformity. Methods: Nineteen patients (21 feet) who had symptomatic bunionette deformity and failed conservative treatment between 2014 and 2016 were included in this retrospective study. Clinical data were recorded, and pre- and postoperative Manchester-Oxford Foot Questionnaire (MOXFQ) scores and visual analog scale (VAS) pain score were collected. The mean follow-up was 28 months (range, 12-47). Results: The mean MOXFQ summary index score decreased from 71 (range, 59-81) preoperatively to 10 (range, 0-30) postoperatively. All 3 MOXFQ domains also improved. The average improvement in VAS score was 7. Forefoot swelling and some painful symptoms took an average of 3 months to settle. There were no wound or nerve complications. One patient required a dorsal cheilectomy for a symptomatic prominent dorsolateral callus formation. Conclusion: The minimally invasive fifth DMMO for bunionette deformity was a safe and effective technique. It had relatively few complications and led to good clinical results. We believe it is important to warn patients that the forefoot swelling will take months to settle compared to an osteotomy with fixation, and there is a 10% chance of a prominent callus over the osteotomy site. Level of Evidence: Level IV, retrospective case series.

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Controversies in Orthopaedic Trauma- Management of Fractures of Shaft of Femur in Children Between 6 and 12 Years of Age

Kathmandu University Medical Journal ◽

10.3126/kumj.v12i1.13647 ◽

2015 ◽

Vol 12 (1) ◽

pp. 77-84 ◽

Cited By ~ 4

Author(s):

A Jain ◽

A Aggarwal ◽

D Gulati ◽

MP Singh

Keyword(s):

Minimally Invasive ◽

Intramedullary Nailing ◽

Operative Treatment ◽

External Fixator ◽

Kirschner Wire ◽

Femoral Shaft ◽

Treatment Modalities ◽

Age Group ◽

Femoral Shaft Fractures ◽

Shaft Fractures

The management of femoral shaft fractures in children is largely directed by the age and built of the child. There is wide consensus on the non operative treatment of children less than six years of age. Operative treatment is recommended for children more than 12 years of age, only the surgical options vary. The age group of 6-12 years remains a controversial area with multiple studies advocating different lines of treatment.We studied the literature on treatment of femoral shaft fractures in 6 to 12 year age group over the past 25 years through PubMed search and found 79 studies dealing with management of paediatric shaft femur fractures in this age group. Studies dealing with other age groups, animal studies and languages other than English were excluded. The treatment modalities included early or immediate hip spica, traction alone, external fixator, plating (open/minimally invasive), intramedullary nailing- rigid/flexible and intramedullary Kirschner wire. The short listed articles were studied for rate and time of union, complications such as non-union and malunion, leg length discrepancy, infection, implant impingement, refracture and cost analysis.Operative treatment is usually the preferred treatment option in this age group, as it decreases hospitalization time, decreases morbidity and allows early return of child to school. Flexible intramedullary nailing is recommended for length stable fractures. Submuscular bridge plating (minimally invasive) is reserved for comminuted fractures. External fixator is reserved for open fractures and initial stabilization of femoral shaft fractures in polytrauma pediatric patients. Intramedullary K wire is a viable option in resource contrained centres where specialized implants and instrumentation is not available.Kathmandu University Medical Journal Vol.12(1) 2014: 77-84

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Biomechanical Comparison of 2 Common Techniques of Minimally Invasive Hallux Valgus Correction

Foot & Ankle International ◽

10.1177/1071100720959029 ◽

2020 ◽

pp. 107110072095902

Author(s):

Amiethab Aiyer ◽

Dustin H. Massel ◽

Noman Siddiqui ◽

Jorge I. Acevedo

Keyword(s):

Minimally Invasive ◽

Hallux Valgus ◽

Ultimate Load ◽

Biomechanical Testing ◽

Osteotomy Site ◽

Yield Load ◽

Chevron Osteotomy ◽

Significant Difference ◽

Load To Failure ◽

Biomechanical Strength

Background: Hallux valgus is one of the most common surgically corrected forefoot deformities. Compared to open procedures, minimally invasive (MIS) treatment of hallux valgus has resulted in decreased operative time, reduced complication rates, and greater patient satisfaction. Historically, distal chevron osteotomies are the standard for moderate hallux valgus correction. To our knowledge, no studies have evaluated biomechanical strength of transverse and chevron distal first metatarsal osteotomy (DMO) constructs. The purpose of this study was to evaluate the biomechanical strength of these techniques. Methods: Eighteen cadaveric specimens (9 matched pairs) were randomized to transverse or chevron DMO. Each technique was performed by a separate fellowship-trained orthopedic foot and ankle surgeon. Radiographic images were analyzed. Biomechanical testing was performed using Instron Mechanical System. Ultimate load to failure, yield load, and stiffness were assessed. A 10-N preload was applied to the sesamoid bones for stability. A coaxial compression rate (10 mm/min) was applied until failure was observed. Mean and standard deviations were compared. All cadaveric specimens were male. Results: There was no significant difference in percent metadiaphyseal shift between osteotomies ( P = .453). The most common mode of failure was fracture at screw insertion site (55.6%), followed by failure at osteotomy site (44.4%). A trend toward increased ultimate load to failure ( P = .480), yield load ( P = .054), and stiffness ( P = .438) among transverse compared to chevron osteotomy was observed, but this difference was not statistically significant. Conclusion: Biomechanical testing demonstrated no significant difference in ultimate load, yield load, and stiffness between MIS transverse and chevron osteotomy constructs; a trend toward increased strength in the transverse osteotomy cohort was observed. Chevron osteotomies may result in early failure by relative ease of cutout through cancellous bone compared to transverse osteotomies in which failure requires cortical cutout. Clinical Relevance: Use of MIS techniques for hallux valgus correction is gaining clinical traction. Although various clinical studies have evaluated outcomes of these MIS techniques, biomechanical studies have been minimal. Specifically, the potential biomechanical benefits of various MIS hallux valgus osteotomy techniques have not been delineated to date. The content of this manuscript is quite timely, given the rise in use of these MIS techniques.

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Minimally Invasive Screw Fixation of Unstable Pelvic Fractures Using the “Blunt End” Kirschner Wire Technique Assisted by 3D Printed External Template

BioMed Research International ◽

10.1155/2019/1524908 ◽

2019 ◽

Vol 2019 ◽

pp. 1-9 ◽

Cited By ~ 2

Author(s):

Kaifang Chen ◽

Sheng Yao ◽

Fan Yang ◽

Deepak Drepaul ◽

Dionne Telemacque ◽

...

Keyword(s):

Minimally Invasive ◽

Functional Recovery ◽

Pelvic Ring ◽

Kirschner Wire ◽

Pelvic Fractures ◽

Invasive Treatment ◽

Surgical Time ◽

3D Printed ◽

Surgical Duration

Objective. This study aimed to determine the accuracy and safety of the “blunt end” Kirschner wire (KW) technique for the minimally invasive treatment of unstable pelvic fractures with the assistance of a 3D printed external template. Methods. Clinical data of 28 patients with unstable pelvic fractures between January 2016 and January 2018 were retrospectively analyzed. There were 6 cases of B1, 10 of B2, 8 of C1, and 4 of C2 fractures, all of which received surgical treatment. The “blunt end” KW technique with a 3D template was adopted for the minimally invasive placement of the iliosacral (IS) or superior ramus screws. The number of intraoperative fluoroscopies, surgical time, and complications were recorded. Postoperative reduction was assessed using the Matta criteria, and the Majeed score system was used to evaluate postoperative functional recovery. Results. The average number of fluoroscopies was 35 per patient, and the average surgical time was 85.2 min. A total of 19 S1 and 28 S2 IS screws were inserted. Eleven antegrade superior ramus screws and 4 retrograde screws were placed in 11 patients, and anterior subcutaneous internal fixation (INFIX) was used to fix the anterior pelvic ring in 17 patients. All patients were followed up for an average of 18 months. Postoperative reduction was evaluated by Matta’s criteria: excellent in 16 cases, good in 9 cases, and fair in 3 cases. The Majeed score was used in the last follow-up to evaluate functional recovery: excellent in 13 cases, good in 10 cases, fair in 4 cases, and poor in 1 case. There were no cases of operative vascular injury. Conclusion. The “blunt end” KW technique with a 3D printed external template is a safe and effective method for the placement of IS and superior ramus screws in unstable pelvic fractures with minimized surgical duration and radiation exposure.

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Minimally Invasive Surgery for Correction of Adult Acquired Flat Foot Deformity: An Anatomic Study

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00446 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0044

Author(s):

Ademola I. Shofoluwe ◽

Erroll J. Bailey ◽

Gary W. Stewart

Keyword(s):

Minimally Invasive Surgery ◽

Minimally Invasive ◽

Sural Nerve ◽

Peroneal Nerve ◽

Osteotomy Site ◽

Superficial Peroneal Nerve ◽

Deep Peroneal Nerve ◽

Dorsalis Pedis Artery ◽

Extensor Hallucis Longus ◽

Neurovascular Structures

Category: Midfoot/Forefoot; Hindfoot Introduction/Purpose: Adult acquired flatfoot deformity (AAFD) is a complex and chronic debilitating condition characterized by a decrease in the medial arch height and, in advanced stages, a decrease in the talonavicular coverage angle as the forefoot drifts into pronation and abduction. Operative treatment of stage II deformity has changed significantly over the past few decades. Joint sparing procedures which aim to realign the hindfoot and augment the diseased tibialis posterior tendon with the flexor digitorum longus transfer are commonly performed. The introduction of minimally invasive surgery (MIS) has been associated with smaller incisions, less blood loss, and quicker recovery times. The purpose of this study was to qualitatively and quantitatively observe the tendinous and neurovascular structures at risk with MIS AAFD osteotomy procedures in cadaveric feet. Methods: MIS technique was used to perform medial displacement calcaneal, Evans, and Cotton osteotomies on nine cadaveric feet under fluoroscopic guidance. The sural nerve, superficial peroneal nerve and its branches, deep peroneal nerve, dorsalis pedis artery, saphenous vein, and peroneal and extensor hallucis longus tendons were carefully dissected from each cadaveric foot and evaluated for injuries following the MIS osteotomy cuts. The distance from the osteotomy cuts and these anatomic structures were measured and recorded. Results: On average, the sural nerve was 8.4 mm and 9 mm from the calcaneal and Evans osteotomy sites, respectively. The intermediate dorsal cutaneous nerve was on average 68.3 mm and 41.1 mm from the calcaneal and Evans osteotomy sites, respectively. The peroneal tendons were on average 16.7 mm and 0 mm from the calcaneal and Evans osteotomy sites, respectively. The extensor hallucis was an average of 1 mm from the Cotton osteotomy site. There was a partial tear injury to the peroneus brevis in four of the cadaveric specimens at the Evans osteotomy site without complete laceration. There was no injury to the sural nerve, superficial peroneal nerve and its branches, saphenous vein, deep peroneal nerve, dorsalis pedis artery, or extensor hallucis longus tendon. Conclusion: Tendinous and neurovascular structures are at risk with MIS AAFD osteotomy procedures. Care should be taken with soft tissue handling and blunt dissection to decrease iatrogenic injuries to these structures. Specifically, extra care and recognition of the peroneal tendons during the Evans osteotomy may prevent damage, as this structure was at greatest risk among the three osteotomy cuts. Future research studies evaluating this technique and the functional outcomes in patients in a clinical setting is warranted. Surgical technique studies are underway to implement smaller, yet appropriate bone grafts through mini incisions.

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The Minimally Invasive Osteotomy “S.E.R.I.” (Simple, Effective, Rapid, Inexpensive) for Correction of Bunionette Deformity

Foot & Ankle International ◽

10.3113/fai.2008.0282 ◽

2008 ◽

Vol 29 (3) ◽

pp. 282-286 ◽

Cited By ~ 55

Author(s):

Sandro Giannini ◽

Cesare Faldini ◽

Francesca Vannini ◽

Vitantonio Digennaro ◽

Roberto Bevoni ◽

...

Keyword(s):

Minimally Invasive ◽

Kirschner Wire ◽

Type Ii ◽

Surgical Time ◽

Aofas Score ◽

Reliable Technique ◽

Intermetatarsal Angle ◽

Final Followup ◽

Time Of Operation ◽

The Ideal

Background: A bunionette is a deformity of the fifth metatarsal bone with a varus deviation of the toe which can require surgical correction. Although numerous bony or soft tissue surgical procedures have been described, the ideal treatment has not yet been identified. The aim of this study was to retrospectively evaluate the results of a series of 50 consecutive feet affected by symptomatic bunionette deformity treated by S.E.R.I. (simple, effective, rapid, inexpensive) osteotomy. Materials and Methods: Between February 1998 and March 2004, 50 feet with symptomatic type II-III bunionette deformity in 32 patients (18 bilateral) underwent S.E.R.I osteotomy. The average age of the patients at the time of operation was 33 ± 13 years. The average followup was 4.8 (range, 2 to 8) years. Results: The average modified lesser toe AOFAS score increased from 62.8 ± 15.2 points preoperatively to 94 ± 6.8 points at last followup ( p < 0.0005). The average fifth metatarsophalangeal (MTP) angle decreased from 16.8 ± 5.1 degrees preoperatively to 7.9 ± 3.1 degrees at final followup ( p < 0.0005). The 4–5 intermetatarsal angle (I.M.A) averaged 12 ± 1.7 degrees preoperatively, while postoperatively was 6.7 ± 1.7 degrees ( p < 0.0005). Complications included a skin inflammatory reaction around the Kirschner wire and 2 symptomatic plantar callosities under the fourth metatarsal heads. Conclusions: The minimally invasive osteotomy is an effective and reliable technique for the treatment of painful bunionette, and it achieved more than 90% excellent and good results with reduced surgical time and complications.

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