Fracture of the Neck of the Femur within the capsular ligament, followed by perfect bony union

We developed a new method of posterior lumbar interbody fusion (PLIF) using an en-bloc resected lamina with or without a hydroxyapatite block as an interbody spacer instead of auto-iliac bone, in combination with rigid-type spinal instrumentation. The purpose of this study was to evaluate the effectiveness of our method. There were 23 patients (13 males, 10 females, age at the time of operation: 21–71 years, mean 50.5 years; follow-up: 1–4 years, mean 2 years and 3 months). In 10 patients with spondylolitic spondylolisthesis and 3 patients with spondylolysis, the floating lamina was resected enbloc by mid-line splitting. In 7 patients with degenerative spondylolisthesis and 3 patients with unstable spine, a cleavage was made at the isthmus and then the complex of lamina and inferior spinous process was resected en-bloc. Seventeen patients with olisthesis underwent reduction. PLIF was performed at the L4/L5 level in 10 patients and the L5/S1 level in 13 patients. Sixteen patients with preoperative low back pain recovered, except for one patient with instability at the adjacent vertebra. All of the seven patients with preoperative gait disturbance recovered. The ratio of olisthesis changed from preoperative 30% to postoperative 18% on average. Good bony union was obtained in both the patients with and those without a hydroxyapatite spacer. Posterior lumbar interbody fusion using an en-bloc resected lamina as an interbody spacer in combination with rigid-type spinal instrumentation was useful.

Download Full-text

Cervical facet capsular ligament yield defines the threshold for injury and persistent joint-mediated neck pain

Journal of Biomechanics ◽

10.1016/j.jbiomech.2006.10.015 ◽

2007 ◽

Vol 40 (10) ◽

pp. 2299-2306 ◽

Cited By ~ 43

Author(s):

Kyle P. Quinn ◽

Beth A. Winkelstein

Keyword(s):

Neck Pain ◽

Capsular Ligament ◽

Cervical Facet

Download Full-text

The influence of timing and rigidity of internal fixation on bony union of fractures of the forearm

Injury ◽

10.1016/0020-1383(83)90163-8 ◽

1983 ◽

Vol 15 (1) ◽

pp. 53-56 ◽

Cited By ~ 3

Author(s):

G. Lyritis ◽

Th. Ioannidis ◽

G. Hartofylakidis-Garofalidis

Keyword(s):

Internal Fixation ◽

Bony Union

Download Full-text

Distal interphalangeal Joint Arthrodesis using only Kirschner Wires in small distal Phalanges

Handchirurgie · Mikrochirurgie · Plastische Chirurgie ◽

10.1055/a-1559-2684 ◽

2021 ◽

Vol 53 (05) ◽

pp. 462-466

Author(s):

Jun-Ku Lee ◽

Soonchul Lee ◽

SeongJu Choi ◽

Dong Hun Han ◽

Jongbeom Oh ◽

...

Keyword(s):

Distal Phalanx ◽

Bony Union ◽

Dash Score ◽

Medical Database ◽

X Ray ◽

Wire Fixation ◽

Distal Interphalangeal ◽

K Wires ◽

Quick Dash

Abstract Purpose To report the clinical and radiographic results of arthrodesis of relatively small-sized distal interphalangeal joints (DIPJs) using only K-wire fixation. Patients and methods Between January 2000 and December 2018 28 arthrodesis in 21 patients (9 males and 12 females with an average age of 52.1 years) with relatively small-sized DIPJs were performed using only K-wires. Data on patient’s characteristics, such as age, sex, affected finger, and the number and size of the used k-wires were collected from the medical database. The narrowest diameter of the cortex and medulla of the distal phalanx was measured on preoperative plain radiographs. The time to union and the arthrodesis angle was determined using serial X-ray radiography follow-up. Preoperatively and at the latest follow-up examination, pain using the visual analogue scale (VAS) and the quick DASH score was registered. In addition, complications were investigated. Results Average follow-up period was 11.4 months. The small finger was mostly affected (n = 12; 42.9 %). The narrowest diameters of the distal phalanx cortex and the medulla measured on preoperative X-ray images were 2.8 mm (SD 0.5) and 1.2 mm (SD 0.4), respectively. Seven fusions were done with use of 1 K-wire, 20 with 2 (71.4 %), and 1 with 3 K-wires. The most common K-wire sizes were 1.1-inch (24 K-wires = 48 %), and 0.9 inch (21 K-wires = 42 %) The preoperative VAS score and quick DASH score improved from 6.1 (range: 0–9) and 25.8 (range: 2–38) to 0.4 (range: 0–2) and 3.4 (range: 0–10.2), respectively. 25 (89.3 %) out of 28 fingers achieved bony union in an average of 96.1 days (range: 58–114) with three non-union. Conclusion Arthrodesis of small DIPJs with K-wire fixation has a high success rate. Therefore, we suggest K-wire fixation as an acceptable alternative for patients with a small phalanx which may be at risk of mismatch with bigger implants. However, concerns remain in terms of fusion delay with K-wire only fixation.

Download Full-text

Bony Union in Fractures of Neck of Femur-A Question of Priority.

JAMA ◽

10.1001/jama.1896.02430680041014 ◽

1896 ◽

Vol XXVI (16) ◽

pp. 789

Keyword(s):

Bony Union ◽

Neck Of Femur

Download Full-text

Multiscale modelling of the human lumbar facet capsular ligament: analysing spinal motion from the joint to the neurons

Journal of The Royal Society Interface ◽

10.1098/rsif.2018.0550 ◽

2018 ◽

Vol 15 (148) ◽

pp. 20180550

Author(s):

Vahhab Zarei ◽

Rohit Y. Dhume ◽

Arin M. Ellingson ◽

Victor H. Barocas

Keyword(s):

Axial Rotation ◽

Fe Model ◽

Spinal Motion ◽

Capsular Ligament ◽

Segment Model ◽

Motion Segment ◽

Flexion Extension ◽

Vertebral Kinematics ◽

High Level ◽

Lumbar Facet

Due to its high level of innervation, the lumbar facet capsular ligament (FCL) is suspected to play a role in low back pain (LBP). The nociceptors in the lumbar FCL may experience excessive deformation and generate pain signals. As such, understanding the mechanical behaviour of the FCL, as well as that of its underlying nerves, is critical if one hopes to understand its role in LBP. In this work, we constructed a multiscale structure-based finite-element (FE) model of a lumbar FCL on a spinal motion segment undergoing physiological motions of flexion, extension, ipsilateral and contralateral bending, and ipsilateral axial rotation. Our FE model was created for a generic FCL geometry by morphing a previously imaged FCL anatomy onto an existing generic motion segment model. The fibre organization of the FCL in our models was subject-specific based on previous analysis of six dissected specimens. The fibre structures from those specimens were mapped onto the FCL geometry on the motion segment. A motion segment model was used to determine vertebral kinematics under specified spinal loading conditions, providing boundary conditions for the FCL-only multiscale FE model. The solution of the FE model then provided detailed stress and strain fields within the tissue. Lastly, we used this computed strain field and our previous studies of deformation of nerves embedded in fibrous networks during simple deformations (e.g. uniaxial stretch, shear) to estimate the nerve deformation based on the local tissue strain and fibre alignment. Our results show that extension and ipsilateral bending result in largest strains of the lumbar FCL, while contralateral bending and flexion experience lowest strain values. Similar to strain trends, we calculated that the stretch of the microtubules of the nerves, as well as the forces exerted on the nerves' membrane are maximal for extension and ipsilateral bending, but the location within the FCL of peak microtubule stretch differed from that of peak membrane force.

Download Full-text

Wrist Swelling in Kienböck's Disease

Journal of Wrist Surgery ◽

10.1055/s-0038-1661420 ◽

2018 ◽

Vol 07 (05) ◽

pp. 389-393

Author(s):

Hirofusa Ichinose ◽

Etsuhiro Nakao ◽

Takaaki Shinohara ◽

Masahiro Tatebe ◽

Harumoto Yamada ◽

...

Keyword(s):

Histological Examination ◽

Resonance Imaging ◽

Synovial Proliferation ◽

Level Of Evidence ◽

Kienböck’S Disease ◽

Capsular Ligament ◽

Kienböck's Disease ◽

Magnetic Resonance Imaging Mri ◽

Common Manifestation ◽

Kienbock’S Disease

Background and Purpose Wrist swelling is a frequent clinical manifestation of Kienböck's disease, but no study has reported the site and pathology of wrist swelling in this disease. The aim of this study is to elucidate the site and pathology of wrist swelling in Kienböck's disease. Materials and Methods Dorsal and palmar soft tissue thicknesses of the wrist were measured on standard lateral radiographs of the wrist in 26 patients with Kienböck's disease and 30 subjects without intra-articular lesion. Axial magnetic resonance imaging (MRI) views were examined to detect the site of swelling. The dorsal capsular ligament in three patients with Kienböck's disease underwent histological examination. Results Radiographic study confirmed dorsal wrist swelling in 24 of 26 (92%) patients examined compared with the contralateral unaffected wrists. MRI demonstrated thickening of the dorsal capsular ligament and extensor layer with synovial proliferation. Histological examination revealed nonspecific chronic inflammation. Conclusion Dorsal wrist swelling in Kienböck's disease is a common manifestation and constitutes a part of pathology of Kienböck's disease, although further study is required to clarify the relation between wrist swelling and etiology of Kienböck's disease. Level of Evidence This is a Level III study.

Download Full-text

Factors associated with failure of bony union after conservative treatment of acute cases of unilateral lumbar spondylolysis

10.21203/rs.3.rs-35702/v3 ◽

2021 ◽

Author(s):

Masaki Tatsumura ◽

Hisanori Gamada ◽

Shun Okuwaki ◽

Fumihiko Eto ◽

Katsuya Nagashima ◽

...

Keyword(s):

Bone Marrow ◽

Bone Marrow Edema ◽

Conservative Therapy ◽

Bony Union ◽

Pathological Stage ◽

Factors Associated ◽

Lumbar Spondylolysis ◽

Lesion Level ◽

Advanced Pathological Stage ◽

Marrow Edema

Abstract Background: If bone union is expected, conservative treatment is generally selected for lumbar spondylolysis. However, sometimes conservative treatments are unsuccessful. We sought to determine the factors associated with failure of bony union in acute unilateral lumbar spondylolysis with bone marrow edema including contralateral pseudoarthrosis.Methods: This study targeted unilateral lumbar spondylolysis treated conservatively in high school or younger students. Conservative therapy was continued until the bone marrow edema disappeared on MRI and bone union was investigated by CT. We conducted a univariate analysis of sex, age, pathological stage, lesion level complicating the contralateral bone defect, lesion level, and intercurrent spina bifida occulta, and variables with p < 0.1 were considered in a logistic regression analysis. An item with p < 0.05 was defined as a factor associated with failure of bony union.Results: We found 92 cases of unilateral spondylolysis with bone marrow edema and 66 cases were successfully treated conservatively. Failure of bony union in unilateral lumbar spondylolysis with bone marrow edema was associated with advanced pathological stage (p = 0.004), contralateral pseudoarthrosis (p < 0.001), and L5 lesion level (p = 0.002). The odds ratio was 20.0 (95% CI 3.0–193.9) for advanced pathological stage, 78.8 (95% CI 13–846) for contralateral pseudoarthrosis, and 175 (95% CI 8.5–8192) for L5 lesion level.Conclusions: Conservative therapy aiming at bony union is contraindicated in cases of acute unilateral spondylolysis when the pathological stage is advanced, the lesion level is L5, or there is contralateral pseudoarthrotic spondylolysis.

Download Full-text

The design of an “H” joystick for closed reduction and its application in segmental and comminuted femoral shaft fractures: an innovative technique

10.21203/rs.3.rs-26674/v2 ◽

2020 ◽

Author(s):

Zhaofeng Jia ◽

Shijin Wang ◽

Tinghui Xiao ◽

Wei Jiang ◽

Tianjian Zhou ◽

...

Keyword(s):

Intramedullary Nailing ◽

Closed Reduction ◽

Lateral Displacement ◽

Femoral Fractures ◽

Femoral Shaft ◽

Limb Length Discrepancy ◽

Bony Union ◽

Femoral Shaft Fractures ◽

Shaft Fractures ◽

Lateral Displacements

Abstract Background: Closed reduction and locked intramedullary nailing has become a common surgical method in the treatment of femoral shaft fractures. Overlap and rotation displacements can usually be corrected through the use of an orthopaedic traction table. However, lateral displacement and angulation persist. Methods: In this paper, we describe a joystick that can be used in the closed reduction of a fracture. It can correct lateral displacement and angulation and has the advantage of multi-direction reduction. The device described in this paper includes two parallel horizontal joysticks, one vertical main joystick and four assistant rods. Moreover, there are many specific spacing holes in the two parallel horizontal joysticks and a groove structure in the vertical main joystick. When the main “H” joystick is pressed, it can adjust lateral displacements and angulation because of the lever principle. The distance between parallel horizontal joysticks and assistant rods can be adjusted to the fracture position and body mass index of different patients. Results: The study participants consisted of 11 males and 5 females with a mean age of 31.0 years. All participants had good closed reduction and achieved bony union without any complications such as infection, nerve injury, nonunion, malunion and limb length discrepancy. By using an “H” joystick, closed femoral shaft fracture reduction and locked intramedullary nailing becomes simpler and faster. Conclusion: Based on the use of this instrument, we can easily and conveniently obtain the correct reduction situation, which leads to better surgical results. This device can be applied in the reduction of clinical femoral fractures and gradually extended to the reduction of other fractures.

Download Full-text