Trans-ilial and transsacral brace fixation of sacral fractures and sacro-iliac luxations (seven cases)

2004 ◽  
Vol 17 (04) ◽  
pp. 210-215 ◽  
Author(s):  
R. B. Fitch ◽  
S. T. Kudnig
Keyword(s):  
Screw Fixation ◽  
Primary Repair ◽  
Sacral Fracture ◽  
Sacral Fractures ◽  
Lag Screw ◽  
Radiographic Parameters ◽  
Concurrent Use ◽  
The Stability

SummaryTrans-ilial brace fixation was used as the primary repair of two sacral fractures and in conjunction with a trans-sacral pin for the repair of a bilateral sacro-iliac luxation and a sacral fracture with contralateral sacroiliac luxation. Trans-ilial brace fixation was also used as a secondary fixation for two unilateral sacro-iliac luxations and a bilateral sacro-iliac luxation. Follow-up radiographic parameters were compared to post-operative radiographic parameters to assess the stability of the fixation and the progression of healing. There was not any morbidity associated with the trans-ilial brace technique and all of the cases healed uneventfully. Indications for the use of the trans-ilial brace include sacro-iliac injuries where an additional means of stability may be indicated, comminuted sacral fractures in which the landmarks for lag screw fixation are obscured and bilateral sacro-iliac injuries with the concurrent use of a trans-sacral pin.

scholarly journals Biomechanical Evaluation of Tarsometatarsal Fusion Comparing Crossing Lag Screws and Lag Screw With Locking Plate

2021 ◽  
pp. 107110072110335
Author(s):  
Sarah Ettinger ◽  
Lisa-Christin Hemmersbach ◽  
Michael Schwarze ◽  
Christina Stukenborg-Colsman ◽  
Daiwei Yao ◽  
...  
Keyword(s):  
Locking Plate ◽  
Screw Fixation ◽  
Operative Procedure ◽  
Fixation Technique ◽  
Lag Screw ◽  
Group 15 ◽  
Fresh Frozen ◽  
Biomechanical Evaluation ◽  
The Stability ◽  
End Stage

Background: Tarsometatarsal (TMT) arthrodesis is a common operative procedure for end-stage arthritis of the TMT joints. To date, there is no consensus on the best fixation technique for TMT arthrodesis and which joints should be included. Methods: Thirty fresh-frozen feet were divided into one group (15 feet) in which TMT joints I-III were fused with a lag screw and locking plate and a second group (15 feet) in which TMT joints I-III were fused with 2 crossing lag screws. The arthrodesis was performed stepwise with evaluation of mobility between the metatarsal and cuneiform bones after every application or removal of a lag screw or locking plate. Results: Isolated lag-screw arthrodesis of the TMT I-III joints led to significantly increased stability in every joint ( P < .05). Additional application of a locking plate caused further stability in every TMT joint ( P < .05). An additional crossed lag screw did not significantly increase rigidity of the TMT II and III joints ( P > .05). An IM screw did not influence the stability of the fused TMT joints. For TMT III arthrodesis, lag-screw and locking plate constructs were superior to crossed lag-screw fixation ( P < .05). TMT I fusion does not support stability after TMT II and III arthrodesis. Conclusion: Each fixation technique provided sufficient stabilization of the TMT joints. Use of a lag screw plus locking plate might be superior to crossed screw fixation. An additional TMT I and/or III arthrodesis did not increase stability of an isolated TMT II arthrodesis. Clinical Relevance: We report the first biomechanical evaluation of TMT I-III arthrodesis. Our results may help surgeons to choose among osteosynthesis techniques and which joints to include in performing arthrodesis of TMT I-III joints.

Transverse Lag Screw Fixation in Midline Mandibulotomy

2000 ◽  
Vol 109 (3) ◽  
pp. 334-339 ◽  
Author(s):  
Joseph M. Serletti ◽  
John U. Coniglio ◽  
Salvatore J. Pacella ◽  
John D. Norante
Keyword(s):  
Reliable Method ◽  
Screw Fixation ◽  
Postoperative Radiotherapy ◽  
Major Complication ◽  
Recurrent Tumor ◽  
Minor Complication ◽  
Anterior Cortex ◽  
Lag Screw ◽  
The Mean

Vertical midline mandibulotomy has provided a relatively simple and efficient means of obtaining access to intraoral tumors that are too large or too posterior to be removed transorally. Midline mandibulotomy has had the advantage of nerve and muscle preservation and places the osteotomy outside the typical field of radiotherapy, in contrast to lateral and paramedian osteotomies. Plate and screw fixation has been the usual means of osteosynthesis for these mandibulotomies; however, plate contouring over the symphyseal surface has been a time-consuming process. Unless the plate was contoured exactly, mandibular malalignment and malocclusion in dentulous patients has occurred. Use of parallel transverse lag screws has become a popular method of osteosynthesis for parasymphyseal fractures, and we have extended their use for mandibulotomy fixation. This paper reports our clinical experience with transverse lag screw fixation of midline mandibulotomies in 9 patients from 1994 to 1997. There were 7 men and 2 women with a mean age of 56 (range 35 to 71 years). The pathological diagnosis in all patients was squamous cell carcinoma; 8 cases were primary, and 1 patient presented with recurrent tumor. No tumors involved the mandibular periosteum. One patient had had previous radiotherapy, and 3 patients underwent postoperative radiotherapy. The mean follow-up has been 17 months (range 9 to 27). There was 1 minor complication and 1 major complication related to our technique. The major complication was a delayed nonunion of the mandibulotomy. This occurred because the 2 parallel screws were placed too close to one another, and this placement resulted in a delayed sagittal fracture of the anterior cortex and subsequent nonunion. Transverse lag screw fixation has not affected occlusion in our dentulous patients. Speech and diet were normal in the majority of our patients. Transverse lag screw fixation of the midline mandibulotomy has been a relatively safe, rapid, and reliable method for tumor access and postextirpation mandibular stabilization and has significant advantages over other current methods of mandibulotomy and fixation.

scholarly journals Usefulness of Sacral Sublaminar Wire for Low Transverse Sacral Fractures: Two Cases’ Report

2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
Tatsuro Sasaji ◽  
Hideki Imaizumi ◽  
Taishi Murakami
Keyword(s):  
Molecular Weight ◽  
Screw Fixation ◽  
Ultrahigh Molecular Weight Polyethylene ◽  
Sacral Fracture ◽  
Sacral Fractures ◽  
The Third ◽  
Ultrahigh Molecular Weight ◽  
Sacral Foramina ◽  
Bone Anchors ◽  
One Year

Low transverse sacral fractures are rare, with only two published reports regarding their surgery. The complication associated with surgery for sacral fractures is the prominence of implants. In addition, screw fixation below S3 is impractical. We performed posterior sacral fixation using S2 alar iliac (S2AI) screws and sacral sublaminar wires for low transverse sacral fractures. Case 1 was 65-year-old male with an S2-3 transverse sacral fracture. We performed laminectomy (S2-3) and passed ultrahigh molecular weight polyethylene (UHMWPE) cables from laminectomy area to the third posterior sacral foramina. We inserted S2AI screws and connected rods. We also tightened the UHMWPE cables. The implants did not protrude into skin. One year after surgery, the sacral fracture healed without any displacement. Case 2 was a 42-year-old female with an S2 transverse sacral fracture. We performed laminectomy (S1–3) and passed UHMWPE cables from laminectomy area to the third and fourth posterior sacral foramina. We inserted S1 pedicular screws and S2AI screws and connected rods. We also tightened UHMWPE cables. The implants did not protrude into skin. One year after surgery, the sacral fracture healed without any displacement. We consider sacral sublaminar wires to be useful bone anchors in lower sacrum.

scholarly journals A new transpedicular lag-screw fixation for treatment of unstable Hangman’s fracture: a minimum 2-year follow-up study

2020 ◽  
Author(s):  
Yijie Liu ◽  
Yi Zhu ◽  
Xuefeng Li ◽  
Jie Chen ◽  
Sen Yang ◽  
...  
Keyword(s):  
Spinal Injury ◽  
Screw Fixation ◽  
Biomechanical Testing ◽  
Biomechanical Properties ◽  
Hangman’S Fracture ◽  
Lag Screw ◽  
Associated Lesions ◽  
Cord Injury ◽  
Hangman's Fracture

Abstract Background A new C2 transpedicular lag-screw designed by our team has been used in human cadaver spines for biomechanical testing, and the results showed that the biomechanical properties of the new C2 transpedicular lag-screw were better than ordinary screws. The objective of this study is to analyze the clinical efficacy and safety of the new C2 transpedicular lag-screw fixation for treatment of an unstable Hangman’s fracture. Methods From March 2013 to June 2017, 25 patients who had unstable Hangman’s fractures were operated on with a new C2 transpedicular lag-screw fixation. The patients included 18 males and 7 females whose ages ranged from 31–62 years (average 45.4 ± 9.3 years). The cause of the injury was a traffic accident in 17 patients and a fall from height in 8 patients. Other associated lesions included rupture of the spleen (1 patient) and rib fractures (2 patients). According to the Levine-Edwards classification, 17 patients were Type II and 8 patients were Type IIA, and according to the Frankel Neurological Performance scale, 8 cases and 17 cases were graded as spinal cord injury D and E, respectively. Of the cases, 23 cases received bilateral screw fixation and 2 cases had unilateral screw fixation because another pedicle was chipped. The whole procedure was accomplished with monitoring by“C”-arm fluoroscopy. Results The mean follow-up time was (36 ± 12) months and ranged from 24 to 60 months. No obvious symptomatic or radiologic postoperative complications were found during the follow-up period. 6 cases restored from D to E while 2 cases remained D according to American Spinal Injury Association (ASIA) grade. Osseous union was achieved in all cases, and the range of cervical motion recovered to normal level up to the last follow-up. Conclusions The primary clinical and radiographic efficacies of a new C2 transpedicular lag-screw fixation for treatment of an unstable Hangman’s fracture were satisfactory. This approach could be considered a simple, effective, reliable and economic surgical method for managing unstable Hangman’s fractures.

scholarly journals Reduction and Association of the Lunotriquetral Ligament for Reverse Perilunate Dislocation

2019 ◽  
Vol 08 (06) ◽  
pp. 508-512
Author(s):  
Hui-Kuang Huang ◽  
Tung-Yeh Tsai ◽  
Jung-Pan Wang
Keyword(s):  
Functional Outcomes ◽  
Screw Fixation ◽  
Case Series ◽  
Compression Screw ◽  
Perilunate Dislocation ◽  
Motorcycle Accident ◽  
Lunotriquetral Ligament ◽  
The Stability ◽  
Radiographic Result

Abstract Background Reverse perilunate injuries are rare. Contrary to perilunate injuries, the violent force would start from the lunotriquetral ligament, go reversely toward the radial side, and cause the reverse or ulnar-sided perilunate dislocation. Case Description We describe a 31-year-old man with a reverse perilunate dislocation, who presented to our institution 3 weeks after a motorcycle accident. The patient was successfully treated with the reduction and association of the lunate and triquetrum (RALT) procedure by using closed maneuver and percutaneous headless compression screw fixation. The patient can obtain a good radiographic result and satisfactory function at the 30-month follow-up. Literature Review Many case series were reported concerning the perilunate injuries. However, few cases of reverse perilunate dislocation have been reported in the literature. No cases of reverse perilunate dislocation treated 3 weeks after the injury with the RALT procedure have been reported. Clinical Relevance In this case, we found that the dislocation could still be reduced with the closed maneuver. With the RALT procedure, the carpal alignment can be maintained and the stability can be regained. Also, the functional outcomes are good.

scholarly journals Surgical Technique of Percutaneous Iliosacral Screw Fixation in S3 Level in Unstable Pelvic Fracture with Closed Degloving Injury and Morrell Lavallee Lesion: Two Case Reports

2020 ◽  
Vol 8 (5_suppl5) ◽  
pp. 2325967120S0005
Author(s):  
Ismail H. Dilogo ◽  
Jessica Fiolin
Keyword(s):  
Pelvic Fracture ◽  
Sacroiliac Joint ◽  
Screw Fixation ◽  
Pelvic Ring ◽  
Sacral Fracture ◽  
Pelvic Fractures ◽  
Pelvic Injury ◽  
Unstable Pelvic Fracture ◽  
Percutaneous Screws

Unstable pelvic ring fractures raise treatment challenges in severely injured patients. Beside patient survival, demanding surgical technique also required. Classic technique of internal fixation requires extensive surgical exposure that leads to most complications of the pelvic fractures fixation. Therefore less invasive technique is a reasonable alternative especially in unstable pelvic fracture with soft tissue injury or potential infection. Unfortunately in sacral dysmorphism pelvic injury or in complete vertical sacral fracture, we need S3 level insertion to improve stability of iliosacral (IS) screw in S1 or S2. Purpose of this study was to show feasibility technically inserting IS screw in S3 level. Methods: We reported 2 cases of unstable pelvic injury. First case was an 11 years old boy with Torode and Zieg IV or Marvin Tile C1 pelvic fracture with right sacroiliac joint disruption and soft tissue injuries of skin avulsion on the left hip and Morel-Lavallée lesion on the right hip. He was managed with early anatomic reduction and fixation with percutaneous screws on both pubic rami and IS screw (sacroiliac lag screw type) on S1 and S3. Second case was a 30 years old male with open pelvic fracture Faringer zone III type, Marvin Tile B2 or YoungBurgess LC I and also with vertical sacral fracture Denis zone 1. This polytrauma case had associated injuries includes Morel-Lavallée lesion, intraperitoneal bladder rupture, infected laparotomy wound dehiscence, and immunocompromised. The same minimal invasive management of pelvic fracture was performed in this case by inserting percutaneous screws on pubic rami and IS (sacral screw type) on S1 and S3. Functional outcome was evaluated using Majeed and Hannover pelvic scoring system. Results: All patients survived and considered to have good reduction, with no residual displacement on the sacroiliac joint. The former case, at 21-month follow up, present with excellent outcome (80 out of 80) by Majeed score and very good outcome (4 out of 4) by Hannover score; while the latter case, at 18-month follow up, present with poor outcome (50 out of 100) by Majeed score and fair outcome (2 out of 4) by Hannover score. Conclusion: Percutaneous screw fixation for pelvic ring injury is a less invasive alternative that can be used for early stabilization of unstable anterior and posterior pelvic fractures and provide stable internal fixation. IS screw is feasible to be inserted in S3 level either sacroiliac joint type or sacral screw type.

Central Tarsal Bone Fracture in Two Dalmatians

1995 ◽  
Vol 08 (04) ◽  
pp. 222-225 ◽  
Author(s):  
C. W. Hay ◽  
P. Muir ◽  
K. A. Johnson
Keyword(s):  
Bone Fractures ◽  
Screw Fixation ◽  
The Other ◽  
Strenuous Exercise ◽  
Bone Fragment ◽  
Cancellous Screw ◽  
Tarsal Bone ◽  
Lag Screw ◽  
Cortical Screw

SummaryTwo adult female Dalmatians had type III fractures of the left central tarsal bone. In one the fracture occurred during strenuous exercise, while the cause was not identified in the other dog. Open reduction and internal fixation of a large medial bone fragment was achieved with a medial-lateral directed lag screw into the fourth tarsal bone. A 2.7 mm cortical screw was used in one animal and a 4.0 mm partially threaded cancellous screw in the other. At follow-up examination both dogs were free from lameness.Central tarsal bone fractures were repaired using lag screw fixation in two Dalmatians. Other than in racing greyhounds, this fracture is rare in dogs.

Ununited anconeal process: lag-screw fixation

1996 ◽  
Vol 32 (1) ◽  
pp. 52-56 ◽  
Author(s):  
SM Fox ◽  
HM Burbidge ◽  
JC Bray ◽  
SR Guerin
Keyword(s):  
Screw Fixation ◽  
Lag Screw ◽  
Radiographic Followup ◽  
Results Of Surgery

A technique of lag-screw fixation for ununited anconeal process is described, and the results of surgery in eight dogs (on 10 elbows) treated by this technique are presented. Approximation of the process was confirmed postoperatively, and union was confirmed by radiographic followup in six of the 10 forelimbs from two-to-six months after surgery. Four other cases were lost to radiographic follow-up. This report of a limited number of cases suggests encouraging results obtained by lag-screw fixation.

scholarly journals S2-alar-iliac screw and S1 pedicle screw fixation for the treatment of non-osteoporotic sacral fractures: a finite element study

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Jianxiong Zheng ◽  
Xiaoreng Feng ◽  
Jie Xiang ◽  
Fei Liu ◽  
Frankie K. L. Leung ◽  
...  
Keyword(s):  
Finite Element ◽  
Pedicle Screw ◽  
Screw Fixation ◽  
Relative Displacement ◽  
Pedicle Screw Fixation ◽  
Sacral Fracture ◽  
Type I ◽  
Vertical Stiffness ◽  
Fixation Methods ◽  
Sacral Fractures

Abstract Background Five different sacral fracture fixation methods were compared using finite element (FE) analysis to study their biomechanical characteristics. Methods Denis type I sacral fractures were created by FE modeling. Five different fixation methods for the posterior pelvic ring were simulated: sacroiliac screw (SIS), lumbopelvic fixation (LPF), transiliac internal fixator (TIFI), S2-alar-iliac (S2AI) screw and S1 pedicle screw fixation (S2AI-S1) and S2AI screw and contralateral S1 pedicle screw fixation (S2AI-CS1). Four different loading methods were implemented in sequence to simulate the force in standing, flexion, right bending and left twisting, respectively. Vertical stiffness, relative displacement and change in relative displacement were recorded and analyzed. Results As predicted by the FE model, the vertical stiffness of the five groups in descending order was S2AI-S1, SIS, S2AI-CS1, LPF and TIFI. In terms of relative displacement, groups S2AI-S1 and S2AI-CS1 displayed a lower mean relative displacement, although group S2AI-CS1 exhibited greater displacement in the upper sacrum than group S2AI-S1. Group SIS displayed a moderate mean relative displacement, although the displacement of the upper sacrum was smaller than the corresponding displacement in group S2AI-CS1, while groups LPF and TIFI displayed larger mean relative displacements. Finally, in terms of change in relative displacement, groups TIFI and LPF displayed the greatest fluctuations in their motion, while groups SIS, S2AI-S1 and S2AI-CS1 displayed smaller fluctuations. Conclusion Compared with SIS, unilateral LPF and TIFI, group S2AI-S1 displayed the greatest biomechanical stability of the Denis type I sacral fracture FE models. When the S1 pedicle screw insertion point on the affected side is damaged, S2AI-CS1 can be used as an appropriate alternative to S2AI-S1.

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